Some wisdom about osteoporosis

* Why some bone loss is essential and what to expect throughout perimenopause and menopause
* What exactly is osteoporosis and who is really at risk?
* The important difference between bone density and bone strength
* False claims of medications claiming to prevent osteoporosis
* Osteoporosis and hormones — the effects of irregular periods, menopause, and hysterectomy
* Why calcium supplements aren’t enough — and how to make calcium work for you
* Risks of Fosamax and other bisphosphonates — are they safe?
* What to do if you are already taking Fosamax
* How to maintain healthy bones naturally, without drugs or their side effects


In a mere 20 years, the perception of osteoporosis has morphed from a rare but serious disease that affected only older women to a frightening condition of epidemic proportions that threatens almost half of post-menopausal women in the US.

What’s changed?

Frankly, not much except the hype. I rarely criticize the drug companies, but in this case I have to say the publicity about osteoporosis is mostly about profits, not about women’s health.

I want every woman to understand that there’s so much you can do to support bone health — naturally and without drugs. I’ve seen so many patients actually reverse osteoporosis by fixing their nutrition and digestion and adrenal function.

So let’s cut through the hype and understand the reality behind your risk of osteoporosis — and what you should be doing to promote bone health no matter your age.
Osteoporosis: countering the fears

Bone loss and fractures have always been a concern for women over 65, and rightly so. But a couple of decades ago research indicated that bone loss speeds up in the years immediately after menopause, raising concerns about osteoporosis among much younger women. Next, conventional medicine created a new condition, osteopenia, which soon was construed to be a precursor to real disease. Suddenly any woman over 40 felt she was at risk for osteoporosis.

Compounding these fears is women’s confusion over bone mineral density tests. The BMD compares your bones to those of much younger women. But who’s to say whether your bone density is abnormal if you can’t compare it to your own baseline? Moreover, bone density itself is not a very good measure of bone strength or the risk of fracture. But women aren’t told to take their BMD results with a grain of salt. On the contrary.

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Warm up, cool down. Be sure to give yourself at least 5 minutes on either end of your workout to get your muscles loosened up. This helps prevent injuries, feels great, and helps your muscles elongate and restore balance.

I think it is no coincidence that much of the fuss about osteoporosis coincides with the shameless marketing of HRT to women. For almost 60 years, based on very little research, HRT was given to women to keep them “forever young,”as though menopause was unhealthy or at least to be avoided. By expanding their target market (HRT was supposedly good for all women) and their usage (HRT was prescribed as a preventative) these drugs became the most-prescribed drugs in America. A similar campaign is underway today for Fosamax.

Let me say one more thing about using fear to market drugs. The pharmaceutical companies want you to think something’s wrong with your body that only their drugs can fix. The truth is your body is quite miraculous, with healing powers far greater than any drug, and a little bone loss is perfectly normal.
Healthy bone function and peak bone mass

Bone loss is a natural, in fact vital process. Only bone loss (called resorption) can initiate healthy new bone formation (called deposition or formation). As with all things in nature, good bone health relies on a balance between this action and counter-action, like breathing out and breathing in.

New bone is strong, flexible with the ability to bear both compression (running, jumping) and tensile (flexing) pressure. Bones strengthen with use, just like muscle, all through your life. But at some point, bone loss gradually begins to outpace bone growth — when this begins happening is highly individual, but it can be as much as 20 years or more before menopause.

Bone health is influenced by many factors: family history, body frame size, diet, calcium intake, vitamin D levels, physical exercise, hormonal balance, stress, and lifestyle. And because bones are constantly regenerating, before and after menopause, every positive step you take to support their function will make a big difference — whenever you take them.

To get a better idea of how this works, let’s take a closer look at our bones.

Bones are complicated living tissue, not hard shells around soft marrow like soup bones. Bones are 35% latticed protein — an infrastructure known as the collagen matrix — and 65% mineralized collagen, which gives the bone its strength.

Bone health depends on the give-and-take process I described above, also called remodeling. During this process, bone cells called osteoclasts travel through bone tissue retrieving old bone and leaving small, jagged spaces behind. This triggers their counterparts, called osteoblasts, to come into these spaces and deposit new bone. About 5–10% of all our bone tissue is replaced — or turned over — in a year in this way. Osteoblasts cannot work properly without sufficient osteoclast activity, and new bone is stronger and — this is key — more flexible than old bone.

Exercise and physical stress naturally build new bone and speed the remodeling process, even when you’re older. That’s why you can lift progressively heavier weights in an exercise program — it’s not just muscle you’re building.

But no matter how much bone you make, you’ll still experience bone loss with age. The bell curve looks something like this: during puberty, when our body and skeleton are growing, bone formation outpaces bone loss. Between ages 20 and 30 most women have reached peak bone mass, but the age varies depending on race and lifestyle.

The concept of peak bone mass has been oversimplified. The accepted idea is that it’s like a retirement account — the more healthy bone you’ve accumulated by your mid-20’s, the more you’ll have to draw down as you get older. But peak bone mass can vary as much as 100% in women of the same age from different cultures. And peak bone mass seems to have minimal affect on fracture risk: for instance, Asian women have a lower bone mass than Western women but a lower fracture rate.

Differences in ethnicity, diet, exercise, onset of puberty, and lifestyle make peak bone mass a very individual characteristic, hard to quantify — and not a good measure of bone health.

At some point in your mid to late 30’s, bone resorption begins to outpace formation (by about 0.5–1.0% per year). After menopause this rate may accelerate to 1.0–5.0% with the dip in reproductive hormones. Within five years after menopause, when hormonal fluctuations settle down, bone loss evens out again to a gradual and perfectly normal decline of 1.0–1.5% per year.

So what differentiates normal and abnormal bone loss — and who’s really at risk for osteoporosis?
What is osteoporosis anyway?

If you have established osteoporosis (not just the risk of getting it), bone loss may accelerate over time to absorb up to one-third of your total bone mass. Over time whatever bone is left is thin and porous — it looks like ruined honeycomb — and fractures easily doing everyday things like walking and coughing.

Before 1994, to officially have osteoporosis, you actually had to break a bone as the result of minor impact or trauma. Since then, new bone-scanning technology has cast a wider net and allowed medicine to quantify the diagnosis. Osteoporosis is now defined as having a bone mineral density (BMD) that deviates more than 2.5 points below a standard. That standard is the average for a large sample of 20 to 29-year-olds. In short, you’re being compared to young women with supposedly peak bone density.
What is osteopenia?

As recently as the 1970’s, the diagnosis of osteopenia didn’t exist (my colleague, Dixie Mills, checked her textbooks from medical school just to be sure). Experts chose this term in the 1980’s to fit the women who didn’t quite have osteoporosis to motivate them to pay attention to bone health.

However, there was no medical basis for choosing this number and no studies to support everyone’s immediate assumption that a diagnosis of osteopenia meant you were headed for osteoporosis. No one seemed to notice — except of course the drug companies — that by this definition almost half of all post-menopausal women now had the new medical condition called osteopenia.

Because osteoporosis is progressive, the diagnosis of osteopenia can be very frightening — many women stop lifting heavy objects or engaging in physical exercise for fear of fractures. But in reality almost all women with osteopenia should be getting more exercise, not less!
Risk factors and causes of osteoporosis

A small percentage of women will get true osteoporosis. Osteoporosis occurs earlier and more severely in white women of Northern European descent who are small-boned and thin. And despite the claims made by the calcium supplement makers, the highest rate of osteoporosis is seen in cultures that eat the most dairy.

Other risk factors for osteoporosis include:

* post-menopause, either natural or surgical
* maternal history of osteoporosis
* delayed puberty, persistent amenorrhea, low hormone levels or other endocrine disorders
* poor diet, including vitamin D, calcium, and/or magnesium deficiency
* gastrointestinal disorders that interfere with natural mineral absorption
* eating disorders
* advanced age
* heavy alcohol consumption
* smoking
* under or over-exercising
* less than 15% body fat
* elevated blood acid levels
* use of corticosteroids or other medical drugs
* thyroid or kidney disorders
* bone cancers or other malignancies

I would add that adrenal exhaustion is a major factor in my patients with osteoporosis. I often see women with several problems or comorbid conditions: inadequate nutrition, weak digestion, low metabolic rate (often as a result of chronic dieting), and adrenal fatigue. For these women, osteoporosis is a result, not an underlying cause, of other health conditions. Giving them a drug like Fosamax does nothing to fix the real problems.

Click here to learn more about how to prevent weak bones and what substances you should avoid.
Bone density, bone strength and the risk of fracture

When most women hear the word “osteoporosis”they think with a shudder of hip fractures, broken wrists, and the loss of height and spinal deformity characterized as the “dowager’s hump.”We automatically assume, because we’ve been told, that low bone density is the first step to bone fractures.

But there is no hard evidence that bone density correlates with bone strength or flexibility — the two factors that prevent bone from fracturing under stress. In fact, bones can be dense (rich in calcium and hard) yet brittle — what matters more is the health of the collagen matrix, which keeps the mineralized bone supple and resilient.

The collagen matrix is a foundation of nutrients and minerals that allows the bone to expand, contract, and mend without breaking. Think of the difference between a living, breathing sand dollar and its ossified shell, or a slab of dried wood and a thinner piece that has been saturated in protective oils. While this is not an exact comparison, it may help you understand why a dense, hard covering can actually be more fragile than a thin but well-integrated whole — and why drugs like Fosamax and Actonel that treat only bone density do not necessarily prevent fractures.
Bone density test and osteoporosis screening

Unfortunately we can’t test bone health directly — we mostly look only at bone density. But it’s better than nothing, as long as you remember the limitations of the test.

When diagnosing osteopenia or osteoporosis, most doctors rely on a bone density test, usually dual-energy X-ray absorptiometry, or DEXA. There are other tests, including CT scans, dual photon asorptiometry (DPA) and ultrasound, but DEXA is by far the most prevalent. Click here for more information on bone density testing and its use in osteoporosis diagnosis.

Be sure when discussing your BMD results with your healthcare practitioner, remember to ask what standard you were evaluated against. Often simply normalizing for your age, race, or region will give you very different results. And be sure to get a copy of the results. This is your test and you should keep your own medical file.
Bone health and fractures

While fractures are frightening and can be incapacitating, the common perception that low bone density causes fractures is misleading. The simple reality is that falls cause fractures. The average age of a hip fracture for a woman is 79, and over 90% of hip fractures occur after a fall (not vice versa). Most falls are due to complicating factors, and low bone density is pretty far down on the list of risks. Click here for more information about osteoporosis and the risk of bone fractures.

Why has there been so much focus on bone density as a cause of fractures if the relationship is so weak? One answer is that we actually have a test for bone density. The other is that there is a product to sell — biphosphonates (such as Fosamax and Actonel) and HRT.
Drugs for osteopenia and osteoporosis

Research on HRT in the 1970’s showed that estrogen therapy (and later the combined estrogen plus progesterone therapy) helped inhibit bone loss for about seven years after menopause.

This news meant that prescriptions for HRT were written increasingly for the prevention of diseases like osteoporosis — not for relief — and as a result, women were put on hormone therapy whether or not they were experiencing symptoms of menopause. And the truth is that HRT does help bone density — at least in some women.

No wonder HRT was the most frequently prescribed drug in this country by 2001! A year later, when the WHI released its data on the real risks of HRT, this became a dubious practice.

Another fact women weren’t told is that once hormone therapy is discontinued, bone loss accelerates to reach its age-appropriate rate — the nominal gains are “wiped out.” Most HRT studies are rarely carried out for longer than a few years, at which point bone loss may have stabilized itself anyway. And there’s no indication that HRT therapy has any long-term effect on fracture risk in women over 75 — when most fractures occur. And there are no studies of the long-term effects on bone health of HRT therapy.

Fosamax charged into the osteoporosis market as HRT receded. Fosamax works by inhibiting bone resorption. Unfortunately that’s not as good as it may sound. Remember that bone function is a two-way street: if resorption is delayed, then so is formation — so no bone is lost, but no new bone is made.

Evista (raloxifene) is a selective estrogen receptor modulator similar to tamoxifen. It is increasingly prescribed to women with or at risk for osteoporosis. Developers claim it reduces fractures without the risks of HRT. Side effects include increased hot flashes, leg cramps, flu-like symptoms, blood clots and peripheral edema. These symptoms of inflammation are obviously not good for you. Studies are currently underway looking at this drug’s potential to prevent breast cancer.
Osteoporosis prevention and hormones

Before menopause, it’s important to promote your body’s natural hormonal balance so bone growth stays consistent. After menopause, your body has many natural mechanisms to boost estrogen levels and maintain bone health.

One is to store a little extra weight (that’s one of the reasons that recent weight gain is so stubborn). Estrogen is made and stored in fat cells, so keeping a few more around is actually good for your bones. This is one case where thin is not better!

Testosterone, a potent steroid hormone, increases muscle mass, which in turn helps build bone density. After menopause, testosterone can be one of the substances your body converts into estrogen. (Click here for a diagram of how hormones are made in your body.) When you exercise, your body releases testosterone — just one of the reasons physical activity is a natural antidote to bone loss.

But what about women who don’t make enough hormones naturally?
Osteoporosis, irregular periods, and hysterectomy

Much of the information on estrogen and bone loss comes from women who’ve undergone a full hysterectomy and received HRT therapy in their 20’s and early 30’s — the stage at which they are supposed to be maximizing bone density.

Teenagers and young women who’ve experienced hormonal deficiencies characterized by frequent amenorrhea due to malnutrition, eating disorders, over-exercising, or other factors are at a greater risk for osteoporosis for the same reason.

These women just haven’t had the steady supply of sex hormones to store up a good base of bone to age with. If any of these factors sound familiar, talk to your practitioner about your risk of osteoporosis and the usefulness of a pursuing a course of bioidentical hormone therapy that includes the proper balance of estrogen, progesterone, and testosterone.

And keep in mind that a risk is just that — a risk — not your destiny. Instead of worrying so much about bone loss, most women would benefit by focusing more on natural steps to improving bone health.
Calcium and bone health

Healthy bones store about 99% of the body’s calcium; the rest is used throughout the body for other vital functions. Bones also house about 85% of the body’s phosphorous and 50% of the body’s total sodium and magnesium.

Calcium is one of the most important minerals in the body, not only for bone health but for other physiological functions, including nerve transmission, blood clotting, muscle growth and contraction, heart function, hormone function, and metabolism.

But calcium makes you work for it. It requires a lot of digestive teamwork, including the presence of stomach acid, a whole alphabet of vitamins, magnesium, other essential minerals, and a well-functioning GI tract to deliver calcium’s many benefits. If you have deficiencies anywhere along the line, it won’t matter how much calcium you eat, your body will take it (and whatever other minerals it needs) from your bones. This usually shows up first in non-vital areas like your teeth, hair, and nails.

To test how easily your calcium supplement breaks down in a healthy stomach, put it in a glass of vinegar and stir occasionally. It should dissolve completely in twelve hours.

Bones release calcium by upping the rate of resorption. Whatever doesn’t get used gets excreted through the kidneys — this is why doctors test your urine for calcium as one marker of bone loss. In Chinese medicine the bones are said to be ruled by the kidneys, so interlocked are their functions.

But increasing calcium is not the answer: too much is as problematic as too little, causing other difficulties, like kidney stones, gallstones and hypercalcemia. Our American diets have plenty of available calcium and we still have osteoporosis — what many of us lack is the ability to successfully use the calcium we get.

If you have GI issues, including IBS or celiac disease, you can’t absorb the calcium you need from your food. Older women often lack the digestive acids necessary to break down calcium. Ironically, women are told that antacids like TUMS are good calcium supplements — but antacids oppose the very stomach acid (hydrochloric acid) needed for calcium absorption. Protonics, like Nexium, have the same problem.
Nutrition and calcium absorption

Vitamin D is crucial to moving calcium from the small intestine into the bloodstream, in conjunction with stomach acids and other vitamins. In one study up to 30–40% of older patients with hip fractures had a vitamin D deficiency or insufficiency. Maybe the real health risk for bone fractures is vitamin D deficiency, not low bone density! (For more information on the importance of vitamin D, see our article.)

Magnesium increases calcium absorption from the blood into the bone. Dairy products contain little magnesium and alcohol depletes it. Ironically, too much calcium blocks the absorption of magnesium, leading to a deficiency characterized by hair loss, muscle cramps, irritability, trembling, and disorientation.

A good balance between calcium and phosphorous (about 5:1) is crucial to bone strength, but too much phosphorous depletes calcium. Soda and red meat — two staples of the American diet — are full of this mineral, so much so that now some sodas have extra calcium to counteract the deleterious effect of drinking so much phosphorous.

Trace minerals like boron, selenium, copper, silicon, manganese, and zinc are also important in supporting the healthy balance that makes bone. For an in-depth explanation of all this and more, I encourage you to read Annemarie Colbin’s wonderful book, Food and Our Bones.

Good calcium digestion is dependent on a lot of other factors too, but I’ll cover only two other substances here because of their prescription use in osteoporosis treatment: calcitonin and parathyroid hormone. The former is secreted by the thyroid gland, the latter by the parathyroid gland.

Calcitonin stabilizes high levels of calcium by inhibiting osteoclast activity (the agents in bone resorption). It’s now available as a prescription nasal spray but is most effective in women who have osteoporosis as a result of corticosteroid use. It causes nasal irritation, headache and joint pain.

Parathyroid hormone (PTH) is normally triggered by high levels of phosphorous in the blood with corresponding low levels of calcium. Daily injections seem to stimulate bone formation and are being used to treat women with severe osteoporosis. High doses of the medication caused bone cancer in rats so treatment is not recommended for more than two years.
Osteoporosis and inflammation

An emerging area of study is the relationship between bone loss and blood acidity. It has been known for a while that vegetarians and women eating a low-protein diet have a lower rate of bone loss. What hasn’t been understood is why.

New studies are showing that high levels of the pro-inflammatory blood acid called homocysteine double the risk of osteoporosis-related fractures. It has also been linked to other inflammatory conditions like heart attack, stroke, and Alzheimer’s disease.

A recent report published recently in the New England Journal of Medicine asserted that elevated homocysteine levels inhibit new bone formation by interrupting the cross-linking of collagen fibers in bone tissue. It’s also possible that the body tries to neutralize acidic blood serum (i.e., low pH) by releasing more bone calcium. Homocysteine levels can also be stabilized by taking a vitamin supplement with folic acid, B12, and B6.

Be aware that a minority of the population can’t convert folic acid due to a genetic factor. If your homocysteine levels remain high even after a few weeks of B supplementation, you may want to ask your practitioner about adding a more bioavailable form of folate called 5-methyl-tetrahydrofolate to your diet.

Other foods that cause blood acidity are refined carbohydrates and simple sugars — yet another reason to minimize these unhealthy foods in your diet.

So, if we know that all this and more go into the proper balance of bone formation and resorption — and one function can’t thrive without the other — why is mainstream medicine so skewed to the side of drugs for osteoporosis?
The benefits and risks of Fosamax and other bisphosphonates

The original use of bisphosophonates — the class of drugs that includes Fosamax (alendronate), and Actonel (risedronate), was industrial: corrosion prevention, laundry soaps, and fertilizer. They were used primarily in the textile and oil industries.

Scientists only discovered that bisphosphonates inhibit bone resorption in the late 1960’s. Bone density tests proved that the drugs increased bone density as long as they were taken regularly. The FDA approved Fosamax for use in the treatment and prevention of osteoporosis in 1995 — the year after osteopenia was created as a medical condition. Sales are now in the billions of dollars a year.

There have been no studies on how these drugs affect bone health and overall health in long-term use. The longest study spanned ten years, during which time half of the test population dropped out citing difficulty in following the protocol and negative side effects. And now that we know that inhibiting bone loss also inhibits new bone growth — it’s possible that we are creating a generation of women with dense but old and brittle bone. And the alendronate in Fosamax actually remains in your bones. Who knows what the long-term effects are of that?

Since almost half of women over 50 are alleged by conventional medicine to be at risk for osteoporosis, it seems we are in the midst of yet another grand public experiment, the scale of which rivals the early days of HRT. The FDA is now considering approval of Fosamax for pediatric use. If most of our bone growth happens as children and teenagers, I can’t imagine what the long-term effects might be of inhibiting that process at an early age.

Merck, the parent company of Fosamax (as well as Vioxx) claims that its drug is safe if taken as directed (upon rising, with a full glass of water at least 30–60 minutes before breakfast, during which time you must stay upright to minimize the unpleasant side effects). Inflammation of the esophagus and stomach lining can occur if you lie down too soon after taking the pill. Merck asserts that long-term use of Fosamax has no ill affect.

While this may be true for some women, the side effects of Fosamax for others appear to worsen quickly — some women complain of debilitating indigestion and stomach pain in as little as three days. Other women taking Fosamax for longer periods report serious bone and joint pain and decreased mobility (perhaps a side effect of increased bone mineralization with no new bone growth?).

This all supports our argument that each person reacts to drugs in an individual way. (For a fascinating look at side effects and ratings of Fosamax from women who are on it, visit this discussion group on Fosamax.)

But the inflammatory effect of Fosamax is surfacing. A 1993 report discovered that a small percentage of bisphosphonate users experienced serious eye problems that could lead to vision loss; 33% of the study group complained of blurred vision. More troubling is the small group of people in a recent study who were on corticosteroids and then Fosamax-like drugs: 1 in 12 experienced bone death (osteonecronosis) in their jaws.

I see the troubling risks of Fosamax use borne out in my practice all the time. I’m beginning to think there is a subset of the population which has a very difficult time with heavy metals; their bodies don’t cleanse, or chelate the metals from their systems and so these toxins accumulate in their muscle, fat, and bone tissue. It is my theory that in some women, bone fragility may stem from a burden of heavy metals like aluminum and mercury that actually bind to the bone tissue, usurping calcium in the bone’s core structure, and severely weakening it.

When these women are put on Fosamax, without addressing their other systemic issues, they face a steady downward spiral that begins with worsening GI issues and culminates in debilitating joint and bone pain and general metabolic/physical degeneration. In a mainstream medical practice, this domino effect will lead to more prescriptions — NSAID’s for pain, protonics like Nexium and Prilosec for digestive issues, and Lipitor for high cholesterol. While these medications may control symptoms in the short-term, they do nothing to treat the underlying issues.

More to the point, there is practically no long-term research being done on the safety of combining these drugs with Fosamax. According to one limited study of Fosamax and naproxen (a popular NSAID prescribed for arthritis pain), 38% of users developed stomach ulcers and 69% experienced serious side effects, leading the authors to conclude that the drugs had a synergistic effect that promoted gastric ulcers. If you understand that bone health depends on your stomach’s ability to digest protein, calcium and minerals, you can see how very detrimental this is.

The inflammatory nature of bisphosphonates makes sense when you think that this is a class of drug in the same family as cleansing powders! What’s more, most of these women are paying a hefty monthly price for this treatment. The average cost of a month’s prescription of Fosamax is $65. Multiply that by the millions of post-menopausal women who are expected to be on the medication for anywhere from 20–30 years, and you see why the drug companies are so anxious to maintain the current atmosphere of paranoia about osteoporosis.

If reading the news about Vioxx and other drug recalls is not enough to convince you that pharmaceutical companies have their bottom line at heart, not the public’s interest, consider this quote from FDA employee and whistleblower Dr. David Graham:

But, when there are unsafe drugs, the FDA is very likely to err on the side of industry. Rarely will they keep a drug from being marketed or pull a drug off the market… There’s no incentive for the companies to do things right. The clinical trials that are done are too small, and as a result it’s very unusual to find a serious safety problem in these clinical trials. Safety flaws are discovered after the drug gets on the market.

He ends with the simple fact that in order for a drug to get FDA approval, it only needs to be more effective than a sugar pill.

The truth is that the two most important things you can do for your bones — eating well and daily exercise — can’t be marketed by big companies for profit: walking is free and you have to eat anyway. Even the highest medical-grade vitamin supplement costs less per month than a prescription for Fosamax and you get a lot more bang for your buck without the risks; quality supplements work from the inside out to support a host of body functions in addition to bone health.

I think it’s high time we stop being guinea pigs for the sake of drug-based medicine. We need to accept responsibility for our health and make the lifestyle changes necessary to nurture it.
What if you are already taking Fosamax?

If you’ve been taking Fosamax, don’t stop suddenly. Talk to your doctor about your concerns and discuss other forms of osteoporosis prevention. You can begin to educate yourself about your options and, most importantly, change your diet and exercise regularly.

As your bones begin to benefit from your new changes, you may find you can stop your prescription in confidence. If you have already received a diagnosis of osteoporosis, consider it a wake-up call to take action. Osteoporosis is a preventable and reversible condition, it just takes a little work. Here’s where to begin.

The Women to Women approach

Your bones, including your hair, teeth and nails, are mirrors of what you put into your body and the balance in your life. At Women to Women, we encourage our patients to try a combination approach to preventing and treating osteoporosis that begins with optimal nutrition. In short, this means:

* Take a daily medical-grade nutritional supplement rich in the minerals and nutrients that support bone health. Your vitamin should contain calcium and magnesium, vitamins A, D, K, B6, and B12, folic acid, and essential fatty acids. A calcium supplement is only as good as its rate of absorption, so buy the best quality you can afford.
* Exercise daily; include weight-training exercises at least twice a week. Bones are kept healthy with use! The more you ask of them, the stronger they’ll become, especially if you feed them well.
* Eat a balanced diet rich in leafy green vegetables, fruit, whole grains, and seaweed products. These are much richer sources of calcium and vitamins than dairy products. If you consume dairy, try to buy organic.
* Have protein as part of every meal and snack, but don’t overdo it.
* Avoid refined carbohydrates and simple sugars. Minimize sodas and limit caffeine too — both are bone weakeners.
* Include healthy fats in every meal. Bone building vitamins A, D and K are fat-soluble and a certain amount of fat is needed for proper hormone and immune function.
* Maintain hormonal balance during perimenopause. This is critical to healthy bone formation. Healthy adrenal balance is especially important. And if you get a low bone density reading, have your hormones checked, including your free and total testosterone levels.
* Support your body’s detoxification functions, especially for your liver.
* Maintain a healthy ratio of body fat: 20–25% body fat is normal.
* Get some daily sun exposure to trigger natural production of vitamin D, at least 15 minutes of unprotected sun in the early morning and late afternoon.
* Get a baseline bone density scan in your 40’s if you have any of the risk factors for osteoporosis. That way you’ll have something to compare yourself to later on. After 65, continue to get bone scans every couple of years to check your own individual progress.
* Examine your feelings about aging and weakness. Strength comes in many forms. Don’t let other people’s definitions limit you and your experience.
* Listen to your body and respect its desire to heal itself — in many ways it often knows best and may need just a little more support.

I recently saw a patient in her 50’s who had first come to me two years ago with a diagnosis of osteoporosis — she was 2.7 standard deviations below the norm. But her real problem was the “superwoman syndrome”: adrenal exhaustion from over-work, neglected nutrition, and putting herself last. I told her she could overcome her osteoporosis if she worked at it. And she has — her latest BMD shows her above the norm.
Solid bones need support

In the end, osteoporosis is only as frightening as the power we give it. With some attention to your diet, a medical-grade supplement, and a few healthy lifestyle changes, most women can prevent, treat, even reverse bone loss without drugs and their side effects.

In Chinese medicine, osteoporosis is considered a physical manifestation of not feeling supported in life. Ask yourself if there is a relationship there to how you feel in your life.

Our youth-obsessed culture tends to undermine our self-esteem as we age rather than celebrate what we have learned and accomplished. As we continue on the amazing journey of life, maybe we can begin to see that time will actually make us stronger if we let it. And with the right support, our bones will help carry the load.