Osteoporosis: Is There Any Way To Improve Bone Density?

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We thank Terry Endo Smith for sharing her story.

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Trying to Manage My Osteoporosis

By Terry Endo Smith

It is said that nearly 10 million people in America suffer from osteoporosis and 80 percent of those are women. I am one of them. Of course that means that approximately 2 million of those people are men. In fact a man over the age of 50 is more likely to break a bone due to osteoporosis than he is to get prostate cancer.

I have been investigating how to improve my bone density or at least halt the progression, but it is an ongoing process. So far I have not found a cure, but my reason for writing this article is to give some ideas that I have heard about or tried and start a dialog from others who may have tips to share.

It is hard to reconcile with the diagnosis of osteoporosis (porous bones) because you don’t feel your bones becoming less dense and certainly in the early stages and unless you break a bone, you don’t feel any pain. Also, there isn’t an immediate response to knowing if any treatment you are following is even helping. Usually, you have to wait two years between bone mineral density (BMD) tests.

BONES 101
Here are some basics about bones. The following information comes from the National Osteoporosis Foundation. The three major components that make bones flexible and strong are:
• Collagen which is a protein that gives bones their flexible framework
• Calcium-phosphate mineral complexes that make bones hard and strong
• Living bone cells which remove and replace weakened sections of bone

During your life, your skeleton loses old bone and forms new bone continuously. When you are younger you produce new bone faster than you lose old bone. Even after you stop growing, your bones become denser because you are producing new bone faster than losing your old bone. Somewhere between the ages of 18-25 you reach peak bone mass.

(Despite having Osteoporosis Terry Endo Smith remains active, as shown in photo right on a trip to Amsterdam)

After that bone loss happens faster than bone formation. This loss increases in midlife for both men and women, and for women, after menopause it even increases more. It has been noted that in the five to seven years after menopause, women can lose up to 20 percent or more of their bone density, so the more bone you have at peak bone mass the better.
RISK FACTORS

According to the National Osteoporosis Foundation, there are several risk factors, some uncontrollable and some controllable.

• Being female
• Over the age of 50
• History of broken bones
• Family history of osteoporosis or broken bones
• Low body weight/being small and thin
• Race/ethnicity such as Caucasian, Asian or Latino
• Menopause – estrogen levels drop sharply
• Not getting enough vitamin D and calcium
• Inactive lifestyle
• Smoking
• Drinking too much alcohol
• Certain medications such as steroid medications
• Certain diseases and conditions such as rheumatoid arthritis

DRUG TREATMENTS

Unfortunately, I have almost all of the uncontrollable risk factors. My gynecologist has been trying to get me on Fosamax or Actonel for a few years now. Fosamax/Actonel is supposed to alter the cycle of bone formation and breakdown: It is an antiresorptive bisphosphonate which slows the breakdown of bone while allowing you to make new bone at the same rate, which may prevent bone fractures. It is usually taken in pill form either daily, weekly or monthly.

Currently, I have declined to take Fosamax or Actonel and many other women I have talked to feel the same way. The list of possible side effects seems scarier than osteoporosis. My gynecologist did say that she would only put me on it for 3-5 years because of the potential of serious side effects but I am still not convinced there isn’t a more natural way.

Serious side effects from Fosamax can include permanent jaw bone damage and crippling bone fracture and it has also been linked to esophageal cancer and chronic irregular heartbeat, according to the website http://www.drugwatch.com (https://www.drugwatch.com/fosamax/)

The FDA first stepped in about a year after the drug hit the market (1995), sending its manufacturer, Merck a warning letter for “overstating the benefits of Fosamax while minimizing the risks associated with the drug.” Within several years, women started reporting thighbone breaks and jawbone death, although the FDA continually overlooked the problems. It wasn’t until 2004 that the FDA found that “long-term Fosamax use was conclusively linked to osteonecrosis of the jaw, which causes the jawbone to deteriorate.”

Estrogen therapy or hormone therapy have also been used to combat osteoporosis and used to be the main types of treatment. I am sure that my mother took hormone pills when she went through menopause. Now there are many studies showing that these therapies can increase the risk of stroke, blood clots, breast cancer, heart attacks and mental decline (Oh great!).

Anabolics are another class of drug. These medications speed up your rate of bone growth and increase your bone density. The contraindications state that people who have hyperparathyroidism, bone or bone marrow cancers, Paget’s disease of the bone, and increased calcium levels should not take this drug. It is prescribed for people that have very low bone density, have had a fracture or have a high risk for bone fracture. Also, a test on rats showed that when they were given a high dose for an extended period of time, it caused a rare bone cancer, so the drug can only be used for up to two years.

ALTERNATIVE TREATMENTS

The most popular non-drug treatment remedy for osteoporosis is weight bearing exercise, walking being one of the easiest. First they said 10,000 steps would help and recently they are saying it takes more, but walking certainly can’t hurt. Dr. Mehmet Oz says, “Walk 1/2 hour each day to stimulate bones to keep rebuilding.” (http://www.doctoroz.com/videos/warning-signs-osteoporosis)

According to WebMD.com: “One of the best ways to strengthen your bones and prevent osteoporosis is by getting regular exercise. Even if you already have osteoporosis, exercising can help maintain the bone mass you have.”

I have a girlfriend that has been walking with a weight vest, but she hasn’t had her BMD test done again since she started using the weight vest. I do believe that it could be especially helpful to those of us who have low body weight.

Dr. Loren M. Fishman, a physiatrist at Columbia University who specializes in rehabilitative medicine has been experimenting with yoga and bone health, hoping to see if yoga might be an effective therapy for osteoporosis. He performed a study where people have shown some success with certain poses in yoga and I even took a yoga class series to teach the 12 poses that are supposed to help strengthen your bones and to educate myself on what not to do in yoga. (http://www.familycircle.com/health/concerns/bone-health/yoga-poses-for-better-bone-health/)

The key is to hold the poses for at least 30 seconds, which doesn’t seem like a lot but if you’ve ever done a flow class, you only hold each pose for a few seconds.

One of the main things I learned in the class is the set of movements to avoid or modify when doing yoga. Poses that round or twist your spine should be avoided (i.e. Spine twist (vs. torso twist), forward folds, plough pose, shoulder stand, cat). The other good thing with yoga is that it helps with balance and it is well known that many elderly people experience their first broken bone due to a fall.

Although I feel this training has some merit, the cost is usually prohibitive for most people because to do it right you should be doing it with a trainer to make sure you are aligned properly for each exercise and don’t go out of alignment while doing the exercise. Also, they usually use specially designed Nautilus equipment that is constantly being calibrated so that transitioning between the positive and negative direction is smooth. Unfortunately, due to the cost I could only keep up the training for 6 months and after 3 months I had to go from twice a week to once a week. On my subsequent BMD test my numbers were still getting worse. I have read about women reversing their osteoporosis with this exercise regimen so I believe it can be successful.

I had heard that a doctor on the Dr. Oz show said jumping 10 times in the morning and 10 times at night could help osteoporosis so I started looking that up. According to Prevention.com: Jumping 10 times a day twice a day provides greater bone-building benefits than running or jogging, reports a study in the American Journal of Health Promotion.

Dr. Tucker, the doctor who did the research on that said: “Our study showed significant benefits over time. Women have to do the jumps daily to get the benefits. In addition, keep in mind, as women age it’s more and more difficult to improve bone density.” Then the article goes on to say the study did not include women with osteoporosis—and that “hopping may not be recommended in these cases.” This may be helpful for women before they are actually diagnosed with osteoporosis or with women that have osteopenia.

There must be something to that jumping because my chiropractor suggested I get an exercise trampoline and jump on that for several minutes every day as it seems to be less jarring on the body than jumping directly on the ground. I just got one a few weeks ago and am incorporating that into my routine. I got the trampoline (shown left) for about $30 on Amazon.com.

The other day I also decided to try skipping while I was walking my dogs. First, I had to see if I even remembered how to do it and then I checked around to make sure that nobody was watching. I probably looked kind of silly but it’s not quite as jarring on the body as running and probably good from a cardiovascular standpoint. As a kid I remember skipping up and down the street all the time. It’s a lot harder when you’re pushing sixty.

Diet can also affect osteoporosis. Dr. Michael Greger in his book “How Not to Die” talks about the benefits of phytates which is a natural compound found in many plant-based foods (beans, lentils, chickpeas, nuts and seeds). One study showed that there appears to be a protective affect against bone mass loss with phytate rich foods. (http://nutritionfacts.org/topics/osteoporosis/) Another article said phytates should be reduced and suggested soaking the beans in water for a while before cooking to lower the phytates, so that part remains unclear.

Foods to avoid are overly-salty snacks, high-in-sugar sodas, and other foods that can inhibit your body from absorbing calcium and reduce bone mineral density.

PREVENTING INJURY

Kathy M. Shipp, PT, MHS, an adjunct associate professor in the department of orthopedic surgery and senior fellow at the Center for the Study of Aging and Human Development at Duke University Medical Center in Durham, North Carolina stresses that once you have osteoporosis you need to change your ways of doing things.

She advocates that those with the disease should avoid sudden movements, especially those that twist the spine, and avoid lifting anything heavier than 10 pounds if possible. When bending down to lift something she says “keep your chest lifted, bend your knees, hinge forward from the hips and pull the object close to you. The load is less heavy when the object is held at the waist.”

The other important thing to note is that when bending at the knees to lift something up or put something down, your knees should never go in front of your ankles to avoid injuring your knees, which basically translates to “stick your butt out and use your glutes.” After going through physical therapy for my knee, I realized I had pretty weak glutes and my knees were always going in front of my ankles when I bent down. It requires some retraining but once you practice doing it the right way, it starts to become second nature.

As Dr. Shipp says, “Once people are used to moving in ways that are protective, they actually realize they have less discomfort in their back and have more energy.”

Those of us with osteoporosis will need to develop the habit of considering the position of our spine during exercises and everyday activities. We have to ask ourselves “Can I maintain a straight back with this exercise/activity, or does my spine curve forward?” According to SitAndBeFit.org “Forward curved spine increases the risk of fracture as osteoporosis worsens.”(https://www.sitandbefit.org/resources/osteoporosis/)

I’ve tried to change my life as far as doing things in a more healthy way. I would certainly be interested to hear of anyone who has actually improved their bone density numbers. Feel free to comment below. What are you doing and how is it working?

Terry Endo Smith
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We contacted Lisa Hale who owns a gym is in Fenton, Mo.She said she loved what Terry Endo said in the article and agrees with the jumping as a way to help. Here is what she had to say: