Osteoporosis

Osteoporosis is the loss of calcium and collagen from bones. This means that over the course of time bones become full of gaping holes, rather than the fine honeycomb like texture that they are when all is well. Unfortunately, with osteoporosis bones lose their ability to absorb shock and become liable to fracture with even a small knock or fall.

The skeleton reaches its peak mass at around age 35, and after the fourth decade bone content is lost at the rate of 1-2% a year. This process accelerates after menopause such that by 65, most women have lost 30-50% of their skeletal mass. Men are affected to a lesser degree. The level of calcium in the bloodstream has to be maintained by the body within a very narrow range. This level is influenced by intestinal absorption, excretion and hormones as well as growth, physical activity and disease. A slight drop in blood calcium stimulates the release of calcium from the bones, its absorption from the intestine and decreases its loss into the urine. When there is a slight rise in calcium blood levels the process is reversed and bone mineral content is replenished through the actions of vitamin D, calcitonin, oestrogen's and other hormones.

Probably one of the least publicised causes of calcium loss is through the body's neutralising the acid by products of a high protein diet. For every extra 10g of meat eaten the body loses 100mg of calcium in the urine. There is a known link between high protein diets and bone loss. Relying on dairy products for calcium intake can be tricky as many people are actually lactose intolerant and do not digest dairy products properly.

People’s tendency to bone loss is influenced by genetics, thyroid disease, oestrogen levels (because oestrogen enhances calcium absorption), age (calcium absorption declines with age) and level of exercise, especially weight bearing exercise. It should also be borne in mind that medications, drugs, smoking, caffeine and certain foods such as phytates in bran impede absorption of calcium, increase its excretion and decrease its utilization.

Prescription drugs known to interfere with calcium absorption include: corticosteroids, anticonvulsants, antacids that contain aluminium and conventional diuretics. Prolonged stress also depletes the immediate supply and stored levels of calcium. Lack of specific nutrients, especially Vitamins D, C and K and the minerals magnesium and phosphorus can affect calcium availability.

As with most health conditions diet and lifestyle are a huge factor. It would seem that women in the 18th century suffered less from bone loss that women today, and this must be largely due to changing patterns in nutrition and lifestyle. People assume that if you have enough calcium you will safeguard your bones, but in fact a study has shown that only 25% of people with bone loss show skeletal calcium deficiency. If you over supplement with calcium when it is not needed it can lead to kidney stones and soft tissue calcification such as arteriosclerosis.

So what can we do about reducing bone loss and, over longer periods of time, rebuilding lost bone? The first thing we must do is to pay attention to our diet, making sure we are not short of the nutrients which help absorption and maintenance of calcium in the body. It is especially important to get a healthy balance of magnesium and calcium. Dairy products are high in calcium but very low in magnesium. Leafy greens and nuts are good sources of magnesium to make up the deficit.

If you are one of the many people who is having to avoid dairy products then you will need to ensure that your diet is rich enough in non dairy calcium sources. Carrot juice is surprisingly high in calcium for example and soya products are good too.

Good herbal sources of calcium and magnesium are nettle, equisetum, oats, seaweeds such as kelp and arame, dandelion leaf, parsley and watercress. Women who are post or peri-menopausal will benefit from increasing the amount of phyto-oestrogens consumed in the diet. Soya products are good sources, and pulses like chickpeas and lentils are helpful too. Tofu is a good ingredient in a bone density action plan diet. It is interesting to note that Japanese women have half the hip fracture rate of western women. Medicago sativa (alfalfa) can be helpful, partly due to its oestrogenic properties too.

Since Vitamin D enhances absorption of calcium, it is a good idea to expose your face and arms to the sun for about 10 minutes per day without sunscreen, you could do this whilst exercising – killing two birds with one stone.

It is all very well putting measures in place to maintain healthy bones but when patients present with an existing diagnosis of severe osteoporosis it can be difficult for them to trust totally in herbal approaches, particularly as meaningful improvements in bone density will not show up on a scan for a period of 2 years and studies supporting the use of herbs in osteoporosis are sadly thin on the ground. In these cases it can be the best option to combine allopathic and herbal approaches. The use of herbs can help to mediate the side effects associated with allopathic approaches to osteoporosis.

One herb which shows promise in the rebuilding of lost bone is Rehmannia glutinosa. Rehmannia is an adaptogen from China with a host of beneficial actions on the liver and the adrenal glands. A study in 2003 has shown that treatment with this herb resulted in a significant increase in bone density in rats, so it may be worth supplementing with Rehmannia as part of an overall treatment strategy.

As ever with herbal medicine it is all about tailoring the approach to the individual. It is not a question of prescribing a set formula of herbs for patients with osteoporosis but a careful process of understanding the individual circumstances of each patient. The advice and prescription for each person will be different according to their unique situation.