• Kim Hood, MD

Osteoporosis: Who's Most Likely At Risk, Causes, & Best Way's to Prevent It

Being a gynecologist, I should know all there is to know about osteoporosis and osteopenia. These are common women’s health issues that effect many of us. However, also being an obstetrician, I focused mainly on pregnancy, and not as much on bone health. Now that I am moving past my “baby days,” I’m able to focus on other areas of gynecology that I love. Before, I talk about who’s at risk and what to do for osteoporosis, let me first define it.

Osteoporosis is a medical condition where the bones become brittle and fragile and break easily as a result of hormonal changes, age, and deficiency of calcium and/or vitamin D. Osteopenia is reduced bone mass but not as severe is osteoporosis. However, if left untreated, osteopenia can progress to osteoporosis. Both of these are usually diagnosed by a DEXA scan. This is a bone scan that looks at the hips and lower spine to calculate the bone mass of each. These scans are done in women usually 65 years old or more.

However, osteoporosis/penia is not just a disease “old people” need to worry about. Ladies, you need to think about this in your 20’s! As a matter of fact, studies have shown that babies born prior to 36 weeks gestation have an increased lifetime risk of developing osteoporosis or osteopenia. This is because 80% of that child’s calcium stores are obtained from mom during the last month of the pregnancy!

During your teens and 20’s, you begin to build the foundation for good lifelong bone mass. Therefore, making sure that you get foods that are rich in calcium AND magnesium are important. Some of these foods are spinach, swiss chard, kale, almonds, and quinoa. Broccoli is also a good source of calcium. You don’t just have to drink milk and eat cheese!

Vitamin D is important also! Foods don’t naturally have vitamin D. We obtain this from the sun. However, after being told that the sun is bad for our skin all these years, many of us have low vitamin D due to sun avoidance and sun screen. Most people need at least 2000-5000IU of vitamin D per day in the form of a capsule.

Due to the Standard American Diet (SAD), our gut health is not very good, in general. Our gut bacteria are not helping to process our food; our gut pH is altered which causes indigestion; our GI cells are not optimally functioning. This is affecting how much of our nutrients we are absorbing, if we’re even eating sources rich in calcium and magnesium. Also, due to the SAD, American’s are living chronically inflamed which also effects the absorption of our nutrients.

So, young folks, drop your sodas that are rich in phosphoric acid, which will dissolve your bone, and drop your chips and cakes. What you do today, will affect you tomorrow!

Why does it matter? 1 in 2 women over age 50 will have a bone fracture. Hip fractures result in death 30-40% of the time, and once you lose the bone, you can only build it back by as much as 40%! Plus, the medications to treat osteoporosis, once you finally achieve that level, aren’t very fun.

Who else is at risk? Well, women 65 years old or older (men 70 or older). You need to get a DEXA done every two years. Many times, insurance doesn’t want to pay for a DEXA if you are younger than 65. Reasons to do one if you are younger are as follows: breaking a bone from a minor accident, have rheumatoid arthritis, have a parent with a hip fracture, smoke, heavy drinker, low body weight, corticosteroid use for 3 months or longer, vitamin D deficiency, excess caffeine intake, menopause before age 45, sedentary lifestyle, hyperparathyroidism, and hyperthyroidism are a few reasons to obtain one between 50-65 years of age.

Some other risks of osteoporosis:

1. Stimulant use for 6 months or more! This would be excess caffeine use or patients on ADHD meds.

2. If you have IBD (irritable bowel disease), like ulcerative colitis or Crohn’s. These individuals can have bone loss equivalent to a woman 10 years past menopause. This is an extreme example of how poor GI health effects the absorption of essential nutrients.

3. Treatments or conditions that prevent ovulation, like the depo provera shot. This causes the patient to have very low estrogen levels and almost nonexistent progesterone levels. Provera is not a progesterone; it’s a progestin and does not act exactly the same, especially with respect to bone health.

4. Anorexia for obvious reasons.

5. Bariatric surgery will decrease the GI tract’s ability to absorb nutrients. These ladies need aggressive calcium, magnesium and vitamin D supplementation. Changes in bone can be seen as early as 1-2 years post surgery. The type of surgery you have matters also. You will have better absorption with the gastric band than with the gastric sleeve, but the roux-en-y causes the most problems with absorption.

6. Women who have gone through menopause earlier than 40 years old, like from a hysterectomy that removes the ovaries. Even with hormone replacement and supplements, these women are still at an increased risk for osteoporosis.

7. Patients with epilepsy. The medications can interfere with absorption of vitamin D and calcium.

8. Sleep! Too little sleep, you will not have enough growth hormone needed to create new bone. Too much sleep, you will be too sedentary to build appropriate bone. (too little is less than 6 hours and too much is more than 9 hours)

Now a word about smoking. Do you want to know why smoking causes an increased risk of osteoporosis? Cigarettes have cadmium in them. This is a heavy metal that disrupts function in several areas of the body. It increases the number and activity of osteoclasts. These are the cells that remove bone. However, it limits the ability of the osteoblasts, the cells that makes bone. So, more bone is being removed than is being created.

Cadmium is mainly stored in the kidney and the liver, and it does not even begin to break down and leave the body for 20-40 YEARS! While there, it disrupts other processes like production of progesterone from the ovary. Remember, progesterone helps to protect bone loss.

You may remember from a previous blog that I had my genetic health DNA done. I have a VDR receptor defect. This means that I have a harder time picking up vitamin D to use for bone production. I have some protection from osteoporosis like from the heaviness of being obese and having some Hispanic ancestry, but this receptor issue is still a risk factor for me, especially since I have a very low vitamin D level. My mother is heavy and has osteoporosis. She has to get Prolia injections every 6 months. So, I probably inherited the receptor defect from her.

For me and for her, we use magnesium glycinate @ 400mg 1-2 times daily. I do 1000mg calcium citrate daily; she does 2000mg calcium citrate daily. We both take 5000IU of vitamin D3 daily. This is a supplement regimen that I will continue due to my genetics. I have a diet rich in these nutrients but have not always absorbed them well. It will be interesting to see how my levels change as my GI health improves.

For women who don’t know their genetics or have osteoporosis, using magnesium glycinate 400mg once daily with 1000mg of calcium citrate and 2000IU of vitamin D3 would suffice. However, if you have any of the above risk factors, you may want to discuss with your doctor about whether or not you should use more.

It's not just your “little old ladies” that are at risk for low bones. Also, what you do today, effects what happens to you today. Do your best to optimize your diet to improve your GI health, which will optimize the absorptions of your nutrients, and remember, as a woman, it may not be a bad idea to take some lifelong additional supplements of calcium, vitamin D3 and magnesium.

Disclaimer: While I am a doctor, I am not your doctor. The information in this blog post is for information and entertainment and not intended as medical advice!

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