By: Dr. Michael Klaper, M.D.
Everyone has an image of her in his or
her mind - the little, old woman, bent over
with a C-shaped spine. She is the
embodiment of a process that does to the
skeleton what Alzheimer’s disease does
to the brain.
In osteoporosis, for which she has become the
symbol, the bones become so weakened and crumbly they have the tensile
strength of styrofoam.
Daily body movements and the relentless force of gravity have compressed
the vertebral bones of her spine, collapsing them, and bending her
Most of her skeleton is equally as fragile. A cough, a hug, or a minor fall, can
snap a rib, an arm, a thigh - and a fractured hip in one’s seventies or eighties
can be a death sentence.
The specter of the elderly woman with the collapsing spine described above is
a common one, but far from complete picture.
The young, lean, female long-distance runner or a 60-year old apparently
healthy male would not seem to be candidates for osteoporosis – yet they too
can be victims.
In industrialized nations, osteoporosis is a devastating, but silent, epidemic.
One out of four Americans will suffer an osteoporosis-related fracture during
their lifetime - at least 1.2 million fractures in the U.S. resulting in medical and
social costs of at least 6.1 billion dollars every year.
If you believe the many advertisements, osteoporosis results from not
swallowing enough calcium in our daily diets. Yet, medical studies show that
merely consuming more dairy products or calcium tablets is not sufficient to
prevent nor reverse this devastating disease.
So, let’s consider some of the underlying causes of osteoporosis, as well as
strategies for preserving and even strengthening our bones.
To understand osteoporosis, we must first realize that our bones are alive.
Rather than dead, chalky rods that support us as we walk, sit, and stand, our
bones are living tissue, with a rich blood supply and a high level of metabolic
Bones are constantly being built up by busy cells called “osteoblasts,” as well
as being dismantled and re-shaped by the bone-dissolving cells called
The balance of bone build-up versus bone breakdown determines
the strength of our skeletons. When bone dissolution and breakdown
exceeds the rate of bone construction, our skeleton becomes weakened and
susceptible to fracture - the disease of osteoporosis.
The loss of calcium from the bones is painless. Osteoporosis gives no
warning symptoms until it is detected on a test or, worse, announces
itself with a painful fracture.
If a person has the risk factors for osteoporosis - Caucasian race, sedentary
lifestyle, cigarette smoking, etc. - she or he should consider having her bone
Contrary to popular belief, an x-ray is not effective in diagnosing early
osteoporosis. By the time decreased bone density can be diagnosed on an x-
ray film, the osteoporotic process is already far advanced.
Long before reaching this point, anyone suspected of developing
osteoporosis should have their skeletal density assessed with a non-invasive
test called bone densitometry.
This painless examination uses a light ray to measure the density of
the bones, usually at the wrist and lower spine. Any family doctor can order
Osteoporosis is not an inevitable part of growing older. Nature would not
supply us with a heart and blood vessel system made to function for over 100
years, while giving us bones destined to fall apart at age 60!
Bones are supposed to last as long as all the rest of our organs, at least to the
hundred-year mark - and beyond.
Rather than being a normal part of aging, osteoporosis is a disease state –
characterized by excessive loss of calcium from the bones with eventual
dissolution of the bone structure.
This is an important concept. Osteoporosis is not so much a disease of
deficient calcium intake, but rather excessive calcium loss from the bones.
Where is the calcium going? It's going out through the kidneys into the urine -
and down the toilet!
Why does this happen? In our daily lives, we encounter a number of "calcium
thieves" that can rob our bones of this vital mineral.
Interestingly, with one exception, all the “calcium thieves” have something in
common - they are things that we put in our mouths.
We will examine them in a moment, but first we must consider the one "thief"
that we do not ingest - in fact, the one that we do not have to do anything to
invite to weaken our skeleton.
Actually, this rascal is the number one cause of calcium flowing from the
bones of modern women and men - simply the lack of physically using our
bones, especially against the force of gravity.
Like muscle, nerve, and all the other tissues of the body, the more we use our
bones, the stronger they become and the better they function.
Every step you take sends pulses of electrical energy up and down
the lengths of your leg bones. These pulsating currents of bioelectricity help
to keep the calcium atoms firmly anchored in the substance of the skeleton.
Thus, every movement of our body - especially movements against resistance
such as gravity, elastic exercise bands, etc. - helps to keep the bones calcified,
healthy, and fracture-resistant.
Unfortunately, today most of us do very little manual labor - machines
carry our loads, and even carry most of us everywhere - so we are free to sit
for most of our day.
This is a very effective way to let the calcium drain out of our bones. As we
look around the globe, we see that in countries where people spend their
entire long lives physically active, their bones stay strong. In these nations,
the disease of osteoporosis is rare.
A dramatic demonstration of the opposite situation is seen in the astronauts,
who spend relatively few days in gravity-free environments, and yet
who suffer severe loss of calcium from their bones.
Fortunately, the calcium is restored to the skeleton in a relatively short time
when the astronaut is back in a normal-gravity environment.
This is an important, and hopeful, clue for the rest of us - evidence that the
osteoporotic process can be reversed.
To keep your bones healthy and to prevent osteoporosis, the most important
thing you can do is to stay as physically active as you can throughout
Since calcium is always being laid down in the skeleton, it is never too late to
begin to strengthen the bones.
Medical studies by Dr. Aloia and others have shown that, even in elderly
people, osteoporotic bones can be made stronger by gentle but steady
exercise, like walking up stairs or squeezing rubber balls.
Such is the power of using our muscles - it actually helps pull calcium into the
bones and keep it there, keeping our skeleton strong.
Any exercise that places a mild, repeated stress on the bones causes the
bones to become thicker, stronger, and more calcified.
Never miss a chance to walk up stairs or to carry packages. Never stop
walking - try to take a brisk, 30 to 60-minute walk at least every other day - and
more frequently is even better.
Although exercises against gravity are especially potent in helping bones stay
strong, muscle contraction of any kind will help generate electrical currents
that help pull calcium into the bones.
Elastic, stretchable bands that can be used in resistance training, even while a
person is sitting, are also excellent tools to provide muscular exercise that will
help keep bones strong.
Now that we understand that our ever-more-sedentary desk jobs and lifestyles
are the chief cause of the osteoporosis epidemic that is ravaging virtually all
industrialized societies, we’ll look at the other major calcium thieves
that attack our bones - namely, those hiding in things that we ingest.
Let’s see how a moment of pleasure to entertain the tongue can rob precious
calcium from the bones and weaken our very skeleton.
The “calcium thieves” that gain “oral entrance” into our bodies commonly
A. Concentrated animal protein. Chicken, fish, and other meat-based products
(burgers, hot dogs, fish fillets, etc.) all contain concentrated protein whose
acidic nature dissolves calcium out of the bones.
The dissolved calcium is washed through the bloodstream and is excreted by
the kidneys into the urine. This phenomenon is well known to nutritional
scientists and is called “protein-induced hypercalciuria”.
This means that diets high in meats and other animal products produce a
sustained loss of calcium from the body.
It has been known for years that the ethnic group with some of the
most severe osteoporosis on the planet are the Native American Inuit living in
This is due in significant part to their ingestion of large quantities of high-
protein fish and seal meat. This high-protein diet apparently results in high
losses of calcium from their bones and leads to advanced osteoporosis
among their women.
What this effect means to your bones is that most every time you have a meal
based upon a large piece of chicken, fish, or red meat, for the following several
hours, precious calcium is leached from your skeleton into your urine -
destined for the sewer system.
Therefore, it is wise to minimize the portions of animal protein on your plate
and look for more skeleton-friendly foods in the plant kingdom.
Fortunately, most proteins of plant origin, especially those in whole grains,
potatoes, fruits, seeds, and green and yellow vegetables, are significantly less
acidic than animal-based proteins - and thus they have far less tendency to
steal calcium from the bones.
It's been observed for many years that osteoporosis is less of a problem
among vegetarians than among omnivores.
So, to reduce your loss of bone calcium from your food choices, stop seeing
chicken, fish, and lean beef as "health foods."
Begin to base more of your meals on whole, plant-based foods, like Oriental
vegetable stir-fries over rice, bean burritos, whole grain casseroles, potato-
based entrees, as well as other high-fiber meals.
If you are trying to decrease the amount of carbohydrates in your
diet, increase your proportion of vegetable-based entrees on your plate
(stews, soups, salads, stir-fries, etc.) and reduce the proportion of pastas or
other high-carbohydrate foods.
Although animal proteins are among the most pervasive of “calcium thieves”
in the Western diet, there are other common culprits that we ingest that cause
our bones to age and weaken prematurely.
B. Sugar (as in cakes and candies), which makes the kidneys urinate out
C. Phosphoric acid, a common ingredient in cola drinks that gives the cola its
“bite,” is a potent calcium thief.
D. Caffeine in coffee, tea, or cola drinks.
E. Cigarette smoke.
F. Alcohol and Tobacco both leach calcium out of the bones, (alcoholics and
cigarette smokers both suffer high rates of osteoporosis).
G. Finally, excessive amounts of salt (actually, the element sodium) in some
people can cause excessive urinary calcium loss.
People at risk for osteoporosis should avoid pickled foods, preserved meats,
chips, and other high-salt foods.
Well, there you have the recipe for osteoporosis: Be a woman (women start
with less calcium in their bones than men), work at a sedentary desk job, eat
your tuna fish or chicken breast for lunch, sip all day on your diet cola, smoke
your cigarettes, have a glass of wine or beer after work, and do as little
physical exercise as you possibly can.
This is a sure way to waste away the very element needed to keep your bones
strong, and to hasten your trip to a fractured hip - a predictable, but fortunately
For people who dutifully drink milk and swallow cheese, ice cream and yogurt,
believing that the magic of cow’s milk will ward off fractures in old age, be
advised that there is very little evidence that dairy products prevent
osteoporosis - in fact, just the opposite may be true.
Surprisingly, the nations who consume the most dairy products - the United
States, Israel, the Netherlands and Scandinavian countries - suffer the highest
incidences of osteoporosis.
If dairy products actually prevented osteoporosis, it would be rare in America
and these other countries - yet, it is actually more rampant in these nations
than in less developed countries.
Conversely, most humans on our planet, in Asia, South America, and Africa,
virtually never consume cow's milk products - the milk, transportation, and
refrigeration simply are not available.
Yet, osteoporosis is not a common condition in these countries. Most of these
people (barring starvation or parasitic diseases) enjoy strong bones
throughout their physically active lives, deriving essentially all their calcium
from green vegetables, seeds, grains, and from their drinking water.
Incidentally, seeing cow's milk and dairy products as far from essential for
bone health can be advantageous for the rest of your body.
Cow's milk contains proteins and other substances that are thought to play a
major role in many serious diseases, like asthma, rheumatoid arthritis,
recurring ear infections, eczema, colitis, and various autoimmune diseases.
Don't be surprised if, after a few weeks without dairy products, your
body feels and functions better in many ways - less swallowed phlegm,
intestinal gas, runny nasal secretions, and other common, milk-related
Fortunately, these days, going dairy free is no great hardship. It is easy to find
non-dairy replacements for milk, yogurt, ice cream, cheese, and other cow's
milk-based products - just check in the refrigerator and freezer cases of your
local natural food store or supermarket.
Supplements and Other Strategies
Although calcium intake alone is not to be relied upon as the total
osteoporosis prevention or reversal program, an abundant calcium intake
should be part of everyone’s diet.
Aiming for a calcium intake of 1000 mg. to 1200 mg. a day is a good idea. Until
the last fifty years, our diets contained far more whole fruits and vegetables -
and thus significantly more calcium - than we consume today.
Unless you eat several helpings of dark green leafy vegetables and a cup of
nuts or seeds daily – not impossible, just uncommon - one would be wise to
consider including in the daily diet calcium-fortified orange juice from the
supermarket, or beverages such as calcium-fortified soy milk and rice milk
from the natural food store.
You can also take a calcium supplement, as a tablet, liquid or powder - 500 to
1000 milligrams per day.
(This amount of supplemental calcium should be sufficient, since the calcium
found in other foods and drinking water predictably provides at least 500 mg. -
700 mg. of calcium per day.)
Preferably, supplemental calcium is always balanced with approximately equal
amounts of magnesium, as magnesium is essential for retaining calcium in the
Remember, however, that you cannot prevent or reverse osteoporosis just by
swallowing large amounts of calcium supplements.
Excessive amounts of calcium can lead to precipitation of calcium-containing
kidney stones as well as calcium deposits in muscles, tendons, and other vital
Osteoporosis is a disease of the active dissolution of bone structure - calcium
first, and then the structural collagen protein – and the entire process must be
As important as it is for us to avoid “calcium thieves,” there are several
additional nutritional components to bone health that must be consumed in
order to prevent or reverse osteoporosis.
These nutrients include: Vitamin K, Vitamin B6, and the earth elements,
manganese, copper, zinc, boron, and silicon.
These nutrients are all present in whole, plant-based foods, such as
dark green leafy vegetables, root vegetables, nuts, seeds, grains, sea
vegetables (nori, arame, wakame, etc.), and fruits.
Vitamin D is essential for us to absorb calcium from our food into our
bloodstream. Vitamin D is made naturally in our skin as sunlight falls upon it
(15 minutes per day of gentle sunlight on the skin of the arms is all that is
required. If such sun exposure unavailable, an oral Vitamin D supplement
should be taken).
In view of the foregoing, if you are taking a multivitamin/mineral
supplement, be sure it contains the following nutrients in approximately the
To gain the most benefit, try to consume the supplements twice daily, with or
shortly after meals:
Calcium 250-500 mg., Magnesium 250-500 mg., Zinc 15 mg., Copper 1-2 mg. 5-
10 mg. Boron 1-3 mg. Silicon 1-2 mg. Vitamin B-6 5-25 mg. Folic Acid .08 - 5 mg.
Vitamin C 100-1000 mg. Vitamin D 100-200 I.U. Vitamin K 100-500 mcg.
A person who is being medicated with the anticoagulant drug,
warfarin, should not take supplements with Vitamin K, as that vitamin can
counteract the effects of their “blood thinner.”
The above nutrient recommendations, along with a full discussion of the
diagnosis and management of osteoporosis, are presented in the excellent
book, Preventing and Reversing Osteoporosis, by physician and educator,
Alan Gaby, M.D.
Hormone Replacement Therapy
It is true that the hormones estrogen and progesterone play a significant
role in keeping bones well calcified.
After a woman reaches menopause, and her ovaries produce less of these
essential hormones, bone strength may suffer. Hormone replacement has
been seen as a major answer to the osteoporosis problem; however, it has
now become evident that swallowing oral estrogen tablets alone is not the
Although possibly offering benefits for the skin and other tissues in the body,
in the skeleton estrogen replacement therapy inhibits the action
Thus, estrogens act by retarding normal bone breakdown. In this way,
estrogens stop the breakdown of bone, but they do not increase the rate of
bone formation by the osteoblasts.
This is important because inhibiting the action of osteoclasts does not make
for stronger bones.
Osteoclasts have an important function, namely removing old bone spicules
that have been micro-fractured through the shocks of daily living.
It is essential that the osteoclasts remove these weakened bone struts
to make way for new bone construction by the osteoblasts. In this light, it can
be seen that the action of estrogens may ultimately not decrease the rate of
In other words, estrogen-like drugs may slow down the removal of old bone -
and thus create denser-appearing bones on x-rays and scans - but it is
far from proven that estrogens actually make the bones stronger and (the
ultimate test) reduce the incidence of osteoporosis-related fractures.
On the negative side, estrogen therapy can produce adverse effects, such as
enlarging breast lumps and making menstrual bleeding heavier and more
They may even put a woman at higher risk for several types of cancers,
including of the breast and uterus.
Should a woman and her doctor decide upon estrogen therapy, some of these
problems may be avoided through the use of a “balanced estrogen”
containing appropriate amounts of the three most abundant estrogens in the
body, estrone, estradiol, and estriol.
Balanced estrogen patches, tablets, and vaginal creams/suppositories are
available through compounding pharmacies.
A woman may also want to talk to her doctor about a new class of drugs, the
so-called “selective estrogen receptor modifiers” like raloxifene.
These drugs may slow down bone loss– although they are not free of side
effects and are certainly not the entire solution to the osteoporosis puzzle.
Again, the woman and the physician are the best people to make the decision
as to the appropriateness of this therapy.
Incidentally, just because a woman is past the age of menopause and
does not produce large amounts of estrogen from her ovaries, it does not
mean her body is completely incapable of producing estrogen.
Her adrenal glands, as well as the subcutaneous fat stores under her skin, are
two tissues still capable of producing estrogen - if the woman consumes the
appropriate essential fats in her diet.
Adequate essential fat intake can be assured through ingesting a teaspoon or
two of flaxseed oil or hempseed oil daily (along with 200-400 I.U. of Vitamin
E to prevent oxidation in the body).
A handful (one-half cup) of green, organic pumpkin seeds or raw walnuts will
also help provide these essential omega-3 fats, as will the soybean oil in one-
half cup tofu.
The judicious use of these omega-3-containing oils will not only help maintain
normal hormone balance and stronger bones, but also help create a more
moisturized, youthful-looking skin.
If estrogen replacement therapy is decided upon, it is also wise to consider
including natural progesterone as part of the hormone replacement program.
Natural progesterone is also produced by the ovaries and is capable of
stimulating new bone growth, thus actually helping bones grow stronger.
There are advantages to specifying the form of progesterone to be “natural
“Progestins” like the commonly prescribed medroxyprogesterone (sold under
the name, “Provera” and other brands) are chemically modified and can cause
headaches, mood swings, and other adverse side effects.
Natural progesterone is available, currently without prescription, at natural
food stores and pharmacies.
With medical guidance, natural progesterone can be used with good effect in
conjunction with or in place of estrogen-based therapy.
When using powerful hormones like progesterone, more than “just enough” is
not better. Usually, just one-half teaspoon of progesterone cream rubbed into
the skin of the forearm will produce the desired effect.
If the woman is still having menstrual periods, the progesterone cream should
be used during the last two weeks of her monthly cycle. If she is past the age
of menopause, the small amount of progesterone cream can be applied daily.
It is important to work with the physician to check the progesterone levels in
the saliva to determine the best dose of cream.
Both the woman and her doctor can learn the fundamentals of using natural
progesterone in the prevention or treatment of osteoporosis in the excellent
monograph, Natural Progesterone, by John R. Lee, M.D.
Research is also beginning to accumulate that men with low bone density can
benefit from small doses of progesterone cream, as well.
Men do make progesterone naturally and it is an important hormone in
maintaining healthy bones and tissues in both sexes.
A philosophy similar to that for estrogen replacement therapy in
the prevention of osteoporosis can be applied to the “biphosphonate” drugs
such as alendronate and etidronate.
In other words, “biphosphonate” drugs may slow down the removal of old
bone, and thus create denser-appearing bones on x-rays and scans, but
whether they actually create stronger bones that will resist fracture for many
years is far from clear.
The studies done to date on the action of biphosphonates on bones have only
been carried out to a total of five years of treatment.
We may well see an increase in bone fractures in biphosphonate drug users
after five or more years of use. At this time, these drugs should be viewed as a
“stop gap” measure that may “plug the leak” of calcium from the body.
However, they should not be viewed as the long-term “cure” of the problem –
that goal has been presented in the previous pages and is
Reversing Bone Loss
If a diagnosis of osteoporosis has already been made on a bone
density study, then increasing your bone density should become priority
Yes, osteoporosis can be reversed. Even into old age, the osteoblasts still
retain the ability to deposit calcium in the bone structure - and indeed they do
so on a daily basis.
Because bone building is constantly in progress, bones – even osteoporotic
ones - can be helped to make themselves stronger.
A basic bone-building plan should utilize all of the modalities below:
1. Eliminate all “calcium thieves” – especially excess animal protein,
sugar, salt, cigarette smoke, alcohol, and phosphoric acid-containing cola
2. Be sure your intake of calcium and magnesium exceed 1000 mg. of each
3. Assure an adequate intake of other trace minerals, especially boron,
manganese, chromium, copper, zinc and silicon in the dosages previously
4. Assure adequate vitamin intake, especially B-6, folic acid, vitamin C, and
vitamin K at the dosages given previously.
5. Consult with your physician about the role of hormone replacement,
especially natural progesterone for women and testosterone for men.
For the lean, athletic woman whose menstrual periods have stopped, she is at
risk for osteoporosis due to excessively low hormone levels.
In her pursuit of a low-fat diet, she may be ingesting so little fat that she cannot
make adequate levels of progesterone in other bone-protecting hormones.
(For that reason, she would be wise to increase the amount of fat in her
diet via ingesting two to three teaspoons daily of an omega 3-rich oil such as
flax seed oil or hemp seed oil, available in the refrigerator case of natural food
Such a small amount of fat will not result in weight gain, but can be
instrumental in maintaining healthy bones and other hormone-dependent
6. Institute a regular program of weight-bearing activity, possibly including
exercise with elastic-resistance bands.
If this common sense approach to building and maintaining bone strength is
diligently practiced, you can look forward to enjoying strong bones that will
serve you well throughout a long, active, and healthy life.
By: Dr. Michael Klaper, M.D. www.doctorklaper.com