Osteoporosis, or thinning of the bones, is a huge concern for me and many of my patients. When bones get thin and brittle, they are more likely to break. That could result in pain, disability, surgeries like hip replacements, or could even lead to death. Right now, in the US, 10 million people have osteoporosis, and 52 million have osteopenia (the stage of lower bone density that precedes osteoporosis). By the age of 85, 1 in 2 women will suffer from an osteoporotic bone fracture. Osteoporosis is almost a universal problem.
Risk Factors
Classic risk factors for bone loss include age, being female, White or Asian race, lack of estrogen, too much caffeine, alcohol, smoking, small frame, and health problems like rheumatoid arthritis, diabetes, inflammatory bowel disease, celiac disease, the use of certain medications. I want to focus on one common thread that isn’t often emphasized but is so important- inflammation. Many of the above risk factors have inflammation in common. Women with an elevated level of CRP (a general marker of inflammation) have higher rates of low bone density even if they lack other risk factors for osteoporosis.
Bone Remodeling and Inflammation
The bone is a dynamic tissue that undergoes constant remodeling. Cells called osteoclasts break down bone that has imperfections. Cells called osteoblasts rebuild the bone in those weak spots. A number of pro-inflammatory markers like IL5, TNF alpha, and RANK-L promote bone loss. When we have elevated levels of inflammation, our bone remodeling process skews toward bone breakdown. Further, chronic inflammation inhibits Vitamin D, promotes free radicals, and drives the production of RANK-L. Additionally, inflammation causes stem cells deep in the bone to become fat cells instead of becoming beneficial osteoblasts. So, with excess inflammation, the inside of bones become full of fat instead of healthy bone tissue.
Estrogen and Inflammation driven bone loss
Where does estrogen come in? Estrogen has numerous effects on the bone remodeling process. One important action of estrogen is to prevent bone loss by blocking RANK-L. When women go through menopause and their estrogen levels fall, RANK-L driven inflammation increases breaking down bone very quickly. All women are vulnerable to increased bone loss at menopause, so experts assume that women who have higher levels of inflammation are more susceptible when menopause comes.
Prevention
Strategies for maintaining healthy bones include all the basics: eating a healthy diet with plenty of calcium, Vitamin D, magnesium, weight-bearing exercise, and the avoidance of tobacco and alcohol. Also, many women benefit from taking hormone replacement therapy. Beyond these steps, functional medicine recommends further lifestyle modifications to address the root cause of osteoporosis. Living an anti-inflammatory lifestyle is critical. Putting out the fire of inflammation is the whole foundation of what we do in functional medicine. Below are strategies that I recommend to my patients.
- Eat a diet rich in veggies, fruits, healthy fats and proteins, limit sugar and refined grains
- Identify and eliminate food sensitivities
- Avoid environmental toxins and pesticides
- Address chronic infections and gut microbial imbalances
- Manage stress, meditate, practice deep breathing
- Prioritize good quality sleep
- Exercise enough, but not too much
- Make time for social connections and healthy relationships
- Engage your spirituality
- Spend time in nature
- Make sure you laugh on a regular basis!
Clearly, some of these things you can tackle on your own, but for others, you’ll need the help of a functional medicine doctor. For my patients, we do a deep dive into nutritional status. This includes examining gut health since people who can’t absorb their nutrients don’t reap the benefit of the food they eat. We do stool studies to look at microbial imbalances like bacterial or yeast overgrowth. We look for food sensitivities. I focus on sleep optimization and stress reduction with all my patients to make sure their bodies are in top shape to handle the stress of everyday life.
Are you ready to stamp out inflammation and prevent, or even reverse, osteoporosis? Make an appointment with me and we’ll get started! Call 203-900-4914 for a free 15-minute discovery call.