Osteoporosis, osteopenia and low bone density affects over 3 million people in the US alone.  Some view it as a fact of life and part of getting older, but there is much we can do naturally to build stronger bones

Bone is not a static structure and is constantly being remodeled. Mature bone tissue is regularly removed from the skeleton by cells called osteoclasts (a process called resorption), and new bone tissue is formed by cells called osteoblasts (a process called ossification).

Remodeling helps to reshape bone following fractures and also responds to mechanical loads like exercise. An imbalance in bone resorption and formation can result in bone diseases like osteoporosis and arthritis.

Osteoporosis occurs when the bone mass decreases more quickly than the body can replace it, leading to a net loss of bone strength. As a result, the skeleton becomes fragile so that even a slight bump or fall can lead to a broken bone (referred to as a fragility fracture).

Osteoporosis has no signs or symptoms until a fracture occurs – this is why it is often called a ‘silent disease’. Osteoporosis affects all bones in the body, however, fractures occur most frequently in the vertebrae (spine), wrist and hip.

Osteoporotic fractures of the pelvis, upper arm, and lower leg are also common.

Osteoporosis itself is not painful, but the broken bones can result in severe pain, significant disability, and even mortality. Both hip and spine fractures are also associated with a higher risk of death – 20% of those who suffer a hip fracture die within 6 months after the fracture.

Osteopenia is when your bones are weaker than normal but not so far gone that they break easily, which is the hallmark of osteoporosis. This condition happens when your body gets rid of more bone than it is creating.

Some people are genetically prone to it, with a family history of the condition. You’re also more likely to get it if you’re a woman.

Your bones are usually at their densest when you’re about 30. Osteopenia, if it happens at all, usually occurs after age 50.

The exact age depends on how strong your bones are when you’re young. If they’re hardy, you may never get osteopenia. If your bones aren’t naturally dense, you may get it earlier.

Osteopenia — or seeing it turn into osteoporosis for that matter — is not inevitable. Diet, exercise, and sometimes medication can help keep your bones dense and strong for decades.

Medical Causes for Poor Bone Health

  • Eating disorders, like anorexia and bulimia, can strip the body of vital nutrients.
  • Untreated celiac disease. People with this condition can damage their small intestine by eating foods with gluten in them.
  • An overactive thyroid. Too much thyroid medication can also play a role.
  • Chemotherapy. Exposure to radiation can have an effect.
  • Certain medications. These include steroids such as hydrocortisone or prednisone and anti-seizure drugs.

Lifestyle Causes for Poor Bone Health

Problems in your diet, lack of exercise, and unhealthy habits can contribute to this condition. Watch out for:

  • A lack of calcium or vitamin D
  • Not enough exercise, especially strength training
  • Smoking
  • Too much alcohol
  • Carbonated beverages

There are numerous measures of bone health. In humans, researchers often use a DEXA scan to determine bone mineral density.

In general, higher bone mineral density is associated with a reduced risk of fracture and bone disease. However, increased bone mineral density, bone mass, and bone length do not always suggest better bone health.

In adult humans, bone mineral density is 50 to 80 percent heritable. For quite some time, heritable traits were thought to be only passed on from parent to offspring through DNA.

We now know that vertical transmission of microbes occurs at birth—as a baby passes through the mother’s birth canal, he or she acquires crucial microbes that shape the composition of their gut microbiota.

It’s possible that in addition to the heritable traits encoded by our own genetics, additional determinants of our bone health are acquired based on our microbial inheritance.

Bone Density & Gut Health

Bone complications are often seen in individuals with GI disorders.

Patients with inflammatory bowel disease (IBD) have an increased risk of osteopenia, osteoporosis, and bone fracture. This has been attributed to malabsorption of calcium, reduced blood levels of vitamin D and K, or bone loss after glucocorticoid treatment.

Gut and systemic inflammation are also associated with increased production of cytokines that are key contributors to bone loss.

Healthy bones require a multitude of nutrients, including calcium, phosphorus, vitamin D, vitamin K2, vitamin A, and magnesium. Recent research has also suggested the role of several B vitamins and even vitamins C and E in bone health.

Disruption of the microbiota can significantly alter nutrient absorption.

Gut dysbiosis has been shown to increase the number of calories absorbed from food. Yet it can also result in inflammation of the gut epithelium, the location of nutrient transporters that allow for the absorption of vitamins and minerals.

In addition to influencing absorption and metabolism, microbes themselves also synthesize some of our vitamins. These include thiamin (B1), niacin (B3), pantothenic acid (B5), biotin (B7), folate, tetrahydrofolate, pyridoxal phosphate, and vitamin K2.

While there are certainly many factors that influence bone health, including genetics, diet, mechanical loading, and other environmental factors, gut health seems to play a crucial role.

Below I have compiled a list of ways to support healthy gut flora and how each might improve bone health.

  • Eat your fermented foods! Adult male mice treated with Lactobacilli for four weeks showed increased femoral bone volume, increased bone formation, and a reduction in circulating pro-inflammatory cytokine expression. Lactobacilli were also shown to prevent bone loss in a model of type 1 diabetes. You can find Lactobacilli in sauerkraut, kimchi, and other fermented vegetables.
  • Prebiotic fibers in dandelion greens, plantains, and other foods promote the growth of beneficial bacteria. Prebiotics has been shown to have a beneficial role in mineral metabolism, enhancing calcium absorption in both rodents and humans. This enhanced absorption translates to increased bone density. While different fibers have different effects, a study testing eight different prebiotic fibers in young rats showed that most prebiotic fibers had significant effects on bone density measures.
  • Bone broth. Bone broth supports a healthy gut lining and a healthy microbial community. Homemade broth also provides all of the necessary vitamins and minerals for building bone, as well as the proteins collagen and glucosamine for healthy joints and cartilage.

Additional Lifestyle and Nutrition Tips for Better Bone Density

  • Get plenty of Vitamin D. Ideally, 10-15 minutes in the sun with as much skin exposed (without sunscreen) is best. This helps your body to naturally produce Vitamin D, which is a major factor for strong bone health. Sometimes, time in the sun isn’t enough, and supplementing with Vitamin D may be necessary, but eating foods rich in Vitamin D is idea. Eggs and fatty, oily fish like salmon are great choices. Be sure to choose a D3 supplement with K1 and K2, which are needed for Vitamin D to be absorbed and used in the body.
  • Get plenty of calcium. For many, the first thought is to eat a lot of dairies. For those sensitive to dairy (and many of us are without even realizing it), it can cause gut health issues and inflammation, which keeps us from absorbing the nutrients we need. Dark, leafy greens and green veggies are loaded with calcium and are a much better alternative. Eating small fish like mackerel and sardines that have bones you eat are also excellent for adding more calcium to your diet. Additionally, calcium supplementation may be needed.
  • Clean protein. Protein is a building block for strong bones and muscles. Similar to calcium and vitamin D, insufficient protein intake is detrimental to bone development and bone mass maintenance later in life. Aim to eat around 60-75 grams of clean protein each day.
  • Weightlifting or weight-bearing exercise is important. Use small hand-held weights or resistance bands for an easy at-home routine in building stronger bones.
  • Beyond weight exercises, just moving your body is important. Take a walk, do yoga or pilates, go for a jog, play with your kids or pets, have a dance party. Just make sure you’re moving your body for at least 10 minutes every hour during the day. Moving your body helps to support your bones, joints, and muscles, while also boosting those endorphins – making you feel good all over!
  • Say goodbye to carbonated drinks. Carbonated drinks, whether sweetened or flavored or not, can be acidic to the body – especially sodas. In order for your body’s cells to do their jobs and help process the soda you drink, vital minerals are leached directly from your bones – ultimately making them weaker over time. It’s best to avoid sodas and to limit carbonated waters.
  • Stop smoking, avoid alcohol. Both of these habits directly affect your overall health, but add to weaker bones.

Does low bone density run in your family?

Researchers have been looking into genetic components of low bone density and have isolated 126 target genes that can influence how well we build and break done bones as well as heritable causes of low bone density.  Although it may sound overwhelming, scientists have isolated a few key genes that have the highest effect on bone density along with actionable steps to help those with these genetic tendencies be more proactive about building better bones.  Remember, your genes are not your destiny and can shed light on the best diet and lifestyle choices for your unique genetic makeup. Click here to learn more about personalizing your healthy lifestyle using genetics.

While standard American diets and lack of exercise, or just sitting at a desk all day, can lead to osteoporosis, you can see that there are many things we can do to help strengthen our bones. Which of these will you incorporate into your routine this week?

Showing 4 comments
  • harvey garn
    Reply

    Thanks Dr. M
    What about bunions? I have custom arch supports, eat mostly organic vegetarian, detox occasionally, eat fermented foods a bit each day,… Can I shrink my bunions? Or is surgery the only answer?

  • Ellen
    Reply

    How can I promote bone health and not add to or aggrevate calcification of the cervical spine?

  • Skidgel Toni
    Reply

    This was an interesting read. My daughter has celiac, as does my sister. The doctor, upon hearing that, said to my mother:”That explains why you have osteoporosis and anemia!” Up until then, I had never connected the two.
    My grandson, a very picky eater, and one who tends to drink several carbonated waters every day, just broke his leg and is immobilized for 6-8 weeks. I plan to send this article to my daughter to read.

  • sirglio frei
    Reply

    Thanks for helping out, fantastic information.

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