Building Healthy Bone
A better understanding of your bone health
A common condition women come to see me about is osteoporosis, which means “porous bones”, and its precursor osteopenia, or “deficient bones”. These bone diagnoses are made following a DXA Bone Mineral Density scan, which is most commonly recommended for women at the time of menopause. Once diagnosed, women come to see me with test results in hand to understand more about this diagnosis and to understand what natural approaches are available to rebuild their bone strength. Bones are absolutely fascinating, and there are multiple contributing factors to osteoporosis, so I wanted to share an overview of my approach with you.
There are 206 bones in the body making up our skeletal system providing support for movement, structure to soft tissue, protection to organs, storage for mineral reserves of calcium and phosphorous a well as fats for energy, and producing blood cells. Hematopoiesis, or the production of blood cells, occurs within the marrow of long bones.
Picture your bones. Do you imagine white brittle sticks with knobs on the end of them? Similar to a fossil bone discovered at a dig site? This dry and static image is not an accurate depiction. Our bones are dynamic! They are constantly actively remodeling themselves by breaking down and building themselves back up. This process is coordinated by osteoclasts and osteoblasts.
Osteoclasts break down bone and release calcium, minerals and collagen breakdown products into the bloodstream. Osteoblasts then lay down matrix to rebuild the bone, which is then remineralized and calcified to bone. This bone remodeling cycle replaces old and damaged bone to preserve bone integrity, and maintain the body’s mineral homeostasis.
Why does osteopenia and osteoporosis occur?
Quite simply: in osteoporosis, osteoclast activity, or bone breakdown, happens more quickly than bone build up.
Bone mineral density peaks at 20-30 years old and then gradually declines. During pre-menopause and menopause, women lose 1%-3% of bone density per year. At this time women are recommended to undergo a bone mineral density test known as a DXA (dual-energy x-ray absorptiometry). The first question women usually have is, what do these test results mean?
How to Interpret a DXA Bone Mineral Density Scan
T-score: Number of standard deviations above or below the average bone mineral density for a young adult at peak bone density. The image below shows the score ranges and bone health interpretations. A T-score between -1 and -2.5 indicates osteopenia. A T-score lower than -2.5 indicates osteoporosis and lower than -3 points to increased risk of fracture. A bone fracture is the risk posed by osteoporosis, which is most commonly seen at the femoral head attachment to the hip, vertebral spine or wrist.
Z-score: Comparison of the patient's bone mineral density to a cohort from their age group. A Z-score below -2 is considered below the expected range and indicates there could be coexisting problems such as glucocorticoid therapy or alcoholism.
Understanding a DXA Score
Functional Approach to Lab Testing
If your bone mineral density falls in the osteopenia or osteoporosis ranges, there are additional tests to look at to determine why your balance between osteoclast and osteoblast activity is unbalanced. A decline in bone mineral density is multi-factorial and the following labs should be looked at:
Parathyroid hormone (PTH) and calcium - PTH regulates calcium release from the bone, calcium absorption in the kidney and Vitamin D synthesis in the kidney. The largest reserve of calcium in the body is our bones. In cases of parathyroid disease, calcium imbalances will be detected on basic blood work.
Vitamin 25-OH D3 - Active Vitamin D3, known as calcitriol, is necessary to absorb calcium from the diet. Calcitriol is made from cholecalciferol in the kidney, and cholecalciferol is the 25-OH D3 version that is tested in the blood. To read more about Vitamin D3 formation and role in the body read here. If Vitamin D3 levels are not adequate, calcium absorption will be reduced. If Vitamin D3 levels are low, I will also look at the gut’s ability to absorb fats. Vitamin K is another necessary fat soluble vitamin that is essential for bone strength. Poor digestion or diseases such as celiac and IBD can result in nutrient deficiencies that contribute to osteoporosis.
Thyroid function - Thyroid hormones impact skeletal development. High levels of free T3, which can be associated with hyperthyroidism or improper levels of thyroid medication, increase bone turnover leading to osteoporosis. The research on hypothyroidism and bone strength is still unclear. I have seen the wrong dose of thyroid hormone replacement medication contribute to rapid bone mass loss.
Androgen sex hormones (DHEA-S and testosterone) and estrogen levels - Estrogen is a key regulator of bone metabolism in men and women. Estradiol level concentrations can predict fractures. Total estradiol levels, <5 pg/ml were associated with a 2.5-fold increase in hip and vertebral fractures in older women. Source: https://pubmed.ncbi.nlm.nih.gov/25555470/ Estrogen is a metabolite of testosterone, the precursor to which is DHEA. There is research linking DHEA supplementation to improvements in bone mineral density. This can be a more gentle approach to addressing hormones than starting with hormone replacement therapy (HRT).
Cortisol levels / Adrenal Stress Index - Glucocorticoids are known to reduce bone mineral density - this is one of the dire side effects of being on corticosteroid medication. I use a saliva test to check cortisol levels throughout the day to determine if excess cortisol could be a contributing factor to osteoporosis.
Inflammatory markers - Inflammation contributes to osteoporosis by turning new bone cells into fat and by up regulating RNKL which signals for increased osteoclast activity.
Other test options include Pyrilinks-D to test treatment efficacy between DXA scans. And I also offer genetic SNP testing for Vitamin D and collagen cross-linking.
Natural Treatments to Improve Bone Mineral Density
Now that we understand the results of the DXA scan and lab work, what do we do about it? The good news is there are alot of treatment options.
Naturopathic medicine is personalized to each individual. Treatments to improve bone mineral density are tailored to address the reason why high bone turnover is occurring. Is it a result of hormones, thyroid dysfunction, or poor absorption of nutrients?
I choose treatments based on the individual's lab results, genetics, health history, medications and lifestyle. My treatments are a combination of diet changes, exercises, botanical medicine, high-quality supplements and homeopathy.
Interested to understand your bone health better?
Set up a free 10 minute consultation with me to discuss.
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