Healthy bones: more than just calcium or drugs

This scenario plays itself out on a daily basis: women are administered a bone density test and found to have some degree of bone loss labeled osteopenia in milder cases or osteoporosis in more severe ones. They are then prescribed one of several drugs known as bisphosphonates that include Fosamax, Actonel, Boniva, and a few others. At the same time they are instructed to take large daily doses of calcium.

The drugs do work. When repeated, bone density tests show improvement. WebMD tells us how they work: they “slow or stop the natural process that dissolves bone tissue, resulting in maintained or increased bone density.”

Stopping the bones from dissolving might seem like just the right thing to do

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, except that these natural processes are essential for bone tissue to remain healthy. Bones need to be continuously broken down and rebuilt, and if you disrupt this process you generate bones that are denser but also unhealthy and brittle.

This is increasingly reflected in research showing that after years of taking these drugs women become vulnerable to a type of fracture known as “atypical fracture of long bones” as well as osteonecrosis, or bone death, seen mostly in the jaw. In fact the FDA is now requiring that a statement be included in the drugs’ labels warning of these possible risks.

The original mistake was to assume that calcium is all that is needed from the diet to maintain bone health. Even though bones do contain a large quantity of calcium they are made of at least a dozen minerals and it is becoming increasingly evident that all of these minerals are needed to keep the bones mineralized. It is even possible that taking too much calcium in the absence of other essential minerals could weaken bones instead of strengthening them.

In his interesting book “The Calcium Lie,” Robert Thompson, MD stresses this point and recommends that women drop the calcium and take raw unrefined salt instead to maintain healthy bones. Celtic sea salt is such a raw salt that is available from my office and many health food stores including Whole Foods. Celtic sea salt contains all the minerals from the earth’s crust that support bone health. Other options include an excellent product called IntraMin, in stock at my office, or Coral Calcium, which is rich in calcium, magnesium and all the trace minerals also found in sea salt.

Vitamins play into bone health as well. Most people have heard by now about the importance of vitamin D, but not enough is known about vitamin K. According to a recent review of existing research, both vitamin K1 and K2 when taken in high doses (up to 5 mg per day of K1 or 45 mg of K2) were found to reduce the rate of fractures in post-menopausal women.

Apparently vitamin K activates a protein in blood known as osteocalcin. Without enough vitamin K this protein remains inactive, but once activated by vitamin K it turns on the ability of bones to use minerals efficiently. Interestingly, vitamin K has only minimal effects on bone density but does make bones healthier and less prone to breaking. This shows that, when it comes to bone health, bone density is only part of the story: you can have dense bones that are brittle as well as bones that are not so dense but resistant to fractures. (Nutrition Research, Vol. 29, issue4, pages 221-8, May 2009).

One Response to “Healthy bones: more than just calcium or drugs”

  1. Hi dr.,

    My daughter and I both have osteogenesis imperfecta type I’ve. I am 34 year women that have never fractured. However, my daughter has fractured 5 times. She has flex rods on both of her legs. I k ow that we are not healthy eaters and wanted to start eating better and taking vitamins. I also have allergies most of the time and suffer from axiety or social phobia. I would really like to buy the vitamins and would follow a diet but need to know where to start. My daughter is not taking any medications or anything. The medications that kids with OI take have more side effects; therefore. They said she was better of not taking any. We live in Chicago and don’t know of any good doctor that can tell us what to take. My daughter is 12 years old and she was diagnosed when she was 8 years old. I was tested after because I wanted to how she got it and they told me that we have the same gene mutation. Please reply to me you are my only hope!!! Doctors don’t know too much about the condition. They have not suggested any vitamins or medications. However, I would hate to take medications that in the long run would give us more side effects.