Osteoporosis is a big word that means some people’s bones get weak and break easily as they get older.
If you’re interested in health, it’s essential to learn a bit about our bones. Strong bones help us run, play, and do all our favorite activities without getting hurt.
Trust me, I know a thing or two about bone strength. Here I am lifting over 1000 lbs. Such a feat would break the bones of some people, notably those with osteoporosis. However the lessons in building up to such an act shows that I know something about bone strength (plus muscles, sinews, etc.). We’ll get to that in a bit, but first let’s cover the basics.
While many people think of bones as static structures, typically because they’ve interacted with a skeleton at some point in their schooling, bones are very much living tissues. They are involved in more than just structure. For instance, the bone marrow inside the bones is a massively important part of blood building and our immune system.
Bone are always changing, breaking down old parts and making new ones with components like osteoclasts, osteoblasts and osteocytes at play. But with osteoporosis, the bones don’t make new parts as quickly as they break down the old ones.
As shown here, osteoporotic bone is fragile in comparison to normal bone.
Why Do Some People Get Osteoporosis?
Primary osteoporosis is the name given to the bones growing weaker from aging. Note that this is more common in women than in men, especially after menopause. The main reason for this is testosterone, not estrogen as is commonly thought, as will be discussed in more detail later.
Secondary osteoporosis is when the bones get weaker due to other health problems including the use of certain medications.
There is a third category called osteopenia. It’s like a warning sign. It means bones are starting to get weak but not as weak as osteoporosis. It’s like being in the middle – not super strong but not super weak either. (While it is good to know you may have a problem soon, like prediabetes or stage 1 hypertension, you must beware of the creeping medicalization this also indicates. This is whereby non-disease conditions come to be viewed and treated as medical problems. This will almost assuredly lead to an increase in unnecessary medication prescriptions.)
Risk factors include:
- Women: Women have a higher chance of getting osteoporosis, due to less testosterone.
- Age: As we age, the chances of having weak bones increase.
- Family history: If your grandma or grandpa had weak bones, you might have a higher chance too.
- Thinness: People with low body weight might have weaker bones.
- Drug use: Smoking or drinking too much can harm our bones.
- Thyroid Problems: When our thyroid gland is overactive, it can weaken bones. Problems in the para-thyroid gland can also cause issues.
- Digestive Disorders: Issues like celiac disease or Crohn’s disease make it hard for our stomach to absorb the micronutrients that our bones need.
- Rheumatoid Arthritis: This is a kind of arthritis where our own body attacks its joints, and it can also affect our bones.
- Eating Disorders: Conditions like anorexia or bulimia can harm our bones because our body doesn’t get the right amount of nutrients.
- Kidney or Liver Diseases: These organs help our body stay balanced, and if they aren’t working right, our bones might suffer.
There are several medications that rob from the bones and can lead to osteoporosis.
- Some Cancer Treatments
- Seizure Medications
- Blood Thinners
Diagnosis: How Doctors Check Your Bone Health
The best way to check your bone health is through a special x-ray called a “DXA scan”, sometimes called “DEXA” which stands for dual energy x-ray absorptiometry. This measures how much calcium and other minerals are in your bones.
Bone mineral density tests are usually done on bones such as the lumbar vertebrae, femur or forearm bones, that are most likely to break because of osteoporosis.
The DXA scan will result in a T-score. which tells how your bones compare to a healthy young adult. The closer the number is to zero, the better. Here’s what the numbers mean:
- -1 and above: Great news! Your bones are considered normal.
- -Between -1 and -2.5: Your bones are a bit weaker than normal. This condition is called osteopenia, which is like a yellow light warning that you might be on the road to osteoporosis.
- -2.5 and below: This means your bones are much weaker than normal, and you likely have osteoporosis.
There is also a Z-score which is a bit different. It compares your bones to others who are your age, weight, and from the same race or ethnic group. If your Z-score is a lot higher or lower than the usual, doctors might want to do some more tests.
There are other tools such as the FRAX tool which estimates how likely it is for someone to break a bone in the next 10 years.
Osteoporosis Symptoms, Signs, and Complications
In the beginning, you might not even know it’s there because you don’t feel anything different. But over time, signs start to show. People with osteoporosis can break bones easily, especially in the hip, spine, and wrist.
Have you seen someone who seems a bit bent over or has a hump on their back? That can be a sign of osteoporosis. This curved back is sometimes called a “Dowager’s hump.”
Back pain can be a sign too. If a bone in the spine breaks or squishes down (that’s called a fractured or collapsed vertebra), it can hurt a lot.
Because of the fear of falling or breaking a bone, some people might not do their favorite activities. This can make them more likely to fall, and it also makes daily tasks, like getting dressed or cooking, harder. The issue is that this is a vicious cycle because activity is needed for strong bones too. Staying still for a long time or not moving around much can lead to other issues, like weak muscles, heart problems, or even getting sick more often.
Conventional Prevention and Treatment:
Some of the standard advice for preventing or treating osteoporosis includes:
- Eat Right for Your Bones: Bones love calcium and Vitamin D. So eat foods rich in these, like milk, cheese, and some fish.
- Get Moving: Certain exercises, especially weight-bearing exercises, are great for bones.
- No Smoking and Easy on the Drinks: Remember, smoking is not good for our bones, and drinking too much alcohol can weaken them.
There are many medications that are used. These include:
- Bisphosphonates: These are medicines like Fosamax and Actonel. They help slow down bone loss.
- Boosters for Bone Growth: Medicines like Forteo help bones grow faster and stronger.
- Protectors: Prolia is a medicine that helps protect bones by blocking something called RANK ligand, which can hurt bones.
- Hormone Replacement particularly Estrogen: This may actually be the most useful treatment but is not very often recommended.
When bones break further surgical operations are done including vertebroplasty, kyphoplasty and spinal fusion.
But that’s all the standard medical advice. Let’s go a bit outside the bounds for a better plan of action.
Strong Bones in 3 Steps
I want to detail out a three step plan for anyone that wants stronger bones. This is not just for those with osteoporosis. These are actually the same steps for building strong bones as is useful in my strongman stuff.
Step 1 – Testosterone and Estrogen
The fact that testosterone is more helpful in bone strength can be seen in that women have far more osteoporosis than men. The higher levels of androgens is one of the reasons this is the case. This paper delivers a lot of information in just a few sentences:
“Androgens influence bone cell function via local and systemic growth factors and cytokines. By enhancing osteoblast differentiation, androgens regulate bone matrix production, organization, and mineralization. Androgens also regulate osteoclast recruitment and activity. Endogenous androgens increase bone mineral density (BMD) in both adolescent and adult premenopausal women. Women with excess endogenous androgen-for example, those with hirsutism and polycystic ovary syndrome (PCOS)-have increased BMD compared with normal young women. E and androgen therapy increases BMD to a greater degree than does E therapy alone.”
Androgens, that is testosterone as well as others, are used in bone production, organization and mineralization. Estrogens also play a role here, but androgens seems to be more so.
This is backed up by the fact that women with excess testosterone have higher bone mineral density than other women.
And most importantly, though estrogen does help with bones, estrogen and androgen therapy, beats it out when it comes to bone mass such as this study found.
One of the useful things about testosterone is that it is a precursor to estradiol via it’s conversion through the aromatase enzyme. Therefore, testosterone helps with estrogen but not vice versa.
Nor is it just bones. There are many other important benefits of androgens for women. See this article for more details: Ideal Testosterone for Women.
For any women diagnosed with or worried about osteoporosis, I would recommend getting your testosterone levels checked. While there is testosterone replacement therapy for women, you can go the more natural route and work with herbs such as:
- Pine Pollen (including low dose Pine Pollen Tincture)
- Tongkat Ali
- Horny Goat Weed (There was a 24-month trial of postmenopausal women taking phytoestrogens derived from Horny Goat Weed that showed significant increases in bone mineral density.)
Step 2 – Micronutrients
You can’t really have strong bones if you’re lacking the starting materials that are necessary to build them. Thus certain nutrients are critical to the formation of bone just like any other tissue. Here is a starter list of some of the most important:
- Vitamin D – Bone health was one of the first things that vitamin D was identified as helping. Since then we’ve learned it does so much more. If you can, get it from the sun as there are other benefits to sun-bathing. But most people will not get enough so supplementation is critical.
- Vitamin K2 – This lesser known vitamin is every bit as crucial for bone health. Taking it along with vitamin D may be the best bet.
- Calcium – Obviously, this is the primary mineral found in bones themselves
- Phosphorus – It works with calcium to build strong bones and teeth.
- Magnesium – Magnesium supports bone structure and is involved in hundreds of enzyme reactions in the body.
- Potassium – Potassium neutralizes acids that can remove calcium from the body.
- Boron – It aids in the metabolism of minerals such as calcium, magnesium, and vitamin D. It’s also important for sex hormone health.
- Vitamin C – It’s crucial for collagen formation, a vital protein for bones.
- Zinc – Zinc is essential for bone tissue renewal and mineralization.
- Omega-3 Fatty Acids – They may help decrease bone loss as one gets older.
Remember that it is not just about what you consume, but what you digest and assimilate. Micronutrients are best gotten from diet as much as possible, but targeted supplementation can be very useful.
Step 3 – Progressive Resistance Exercise
Recall that one of the risk factors for osteoporosis was “Thinness: People with low body weight might have weaker bones.” Why is this? The stress of gravity is less for thin people then larger people. Therefore the bones get the signal that they don’t need to be strong as there is not much weight to support.
The signals you send to your body are important. All exercise essentially is weight bearing exercise to a degree. Even just walking has gravity pulling down on your weight necessitating the bones to support against this. But this is insufficient. As one study put it, “Walking alone did not appear to improve bone mass; however it is able to limit its progressive loss.”
But with bodyweight exercises or lifting weights you can be working areas more so. You shouldn’t need studies saying this to understand its true.
Understand that this signal doesn’t just tell the bones to be stronger, but how it does so through multiple means is key. Progressive resistance exercise will impact hormones such as testosterone, and even clue your cells into saying we need to digest more calcium because we need it for strengthening the bones.
Short range lifts and partials, where 2x-6x your bodyweight can be handled provide the strongest signal.
The vicious circle of the frail elderly is they stop moving so that bones and muscles get the signal to waste away. Then the elderly are further limited in movement which provides the signal stronger. The good news is this can be reversed. You absolutely don’t need to lift 1000 lbs. You simply start with where you are at and build from there. That’s what progressive means.
If you’d like more information on exercise see my website LegendaryStrength.com.
I’m not a doctor, but I can virtually guarantee if someone has good to ideal levels of hormones, a solid supply of micronutrients, and does progressive resistance training they will have strong and healthy bones.