Overview: Osteoporosis

• Osteoporosis is defined as a generalized skeletal disorder characterized by compromised bone strength, which predisposes individuals to an increased risk of fracture.

• It is a significant cause of pain, disability, and death throughout the world. That treatment strategies are limited and imperfect heightens the importance of preventive strategies.

• Integrative medicine emphasizes the use of lifelong exercise habits and an anti-inflammatory diet to prevent the development of osteoporosis.

Important Points to Consider

• Large tablets may be difficult to swallow and may not fully disintegrate in the stomach. Some people tolerate calcium supplements better in the form of powders, capsules, and liquids. Calcium supplementation should not exceed 500mg at any one time, to maximize absorption. Avoid taking calcium supplements along with psyllium or with foods high in oxalic acid (eg.. spinachi or phytic acid le.g., wheat bran).

• Chewable calcium supplements are well tolerated by children Calcium carbonate is best taken with meals and is less expensive than calcium citrate. Calcium carbonate provides 40% elemental calcium. Calcium citrate is well absorbed with or without meals, and it is the best form for older adults with reduced stomach acid, Calcium citrate provides 21% elemental calcium. Calcium from dolomite, oyster shell, or coral is not recommended.

• Muhlbauer described 25 plant foods as bone resorption inhibitory food items (BRIFI). These include garlic, rosemary, Italian parsley, sage, thyme, parsley, dill, onion, arugula, prune, fennel, orange, leek, yellow boletus, wild garlic, field agaric, red cabbage, celeriac, red wine, and lettuce In addition to effects on acid-base balance, the benefits of plant foods also appear to be related to the pharmacologically active compounds they contain. Certain specific monoterpenes, flavonoids, and phenols may be responsible for the observed beneficial effects on bone.

Prevention Prescription

• An anti-inflammatory diet that includes an abundance of deeply colored fruits and vegetables, healthy fats, whole grains, and anti-inflammatory herbs, teas, and spices.

• Elemental calcium intake from diet in addition to supplements adding up to at least 800 mg per day.

• A serum 25-OH vitamin D concentration in the range of 40 ng/ml. (100 nmol/L) A balanced ratio of omega-6 to omega-3 fatty acids.

• Adequate but not excessive protein (0.8g/kg), including some vegetarian protein sources.

• One to two servings per day of whole soy foods.

• A good-quality multivitamin and mineral supplement

• Physical activity for 30 to 45 minutes most days of the week that includes weight-bearing, aerobic, and weight-lifting exercise.

• A daily mind-body practice

• Avoidance of smoking, excess alcohol intake, excess caffeine consumption. and vitamin A (retinol) in

  amounts greater than 2000 mcg/day.

• Reduction of the risk of falls and, if possible. avoidance of prescribing medications that harm

  bone or increase the risk of falls.

• Pharmaceutical therapies that are individualized, with risk and benefits explored with each patient

Integrative therapeutics review

• Osteoporosis is a costly and potentially disabling condition affecting millions of people. An integrative approach encompassing diet, exercise, supplements, and mind-body therapies, as well as pharmaceutical medications when indicated, is recommended to prevent and treat this disorder. The good news is that essentially the same strategies that help people build healthy bones will also protect them against heart disease, diabetes, depression, and a host of other chronic conditions.

Laboratory Evaluation

• 25-Hydroxy vitamin D level with a goal near 40ng/ml.

• Dual x-ray absorptiometry bone scan

• Consider highly sensitive C-reactive protein, thyroid-stimulating hormone, calcium, and alkaline phosphatase.

• Tis assess metabolic markers of bone turnover, consider urine levels of N-telopeptides or deoxypyridinium.

Lifestyle

• Avoid first-hand and second-hand smoke exposure.

Exercise

• 30 to 45 minutes/day of arrobic, weight-bearing and weight-lifting exercise (Patients with osteoporosis should consult with a health professional to plan an appropriate, safe exercise program)

Nutrition

• Limit

• Sodium

• Caffeine

• Phosphorus (including phosphoric acid in soda)

Encourage

• Anti-inflammatory diet

• Calcium-rich diet (see Table 37-2)

• Adequate protein intake from plant sources more than from animal sources; one to two servings a day of whole soy foods

• Vitamin K-rich foods. These include any green plant with chlorophyll such as green leafy vegetables such as lettuce, collards, spinach, kale, and broccoli. Other plant sources include vegetable oils, nuts, and fruits. Animal foods that include vitamin K, include chicken, soft cheeses, and butter. Natto, a fermented soybean food, is a very rich source of vitamin K

• Tea (Camellia sinensis), 2 cups a day

Supplements

• Vitamin D: 1000 to 2000 units/day

• Calcium citrate or carbonate as required so that total daily intake from diet, in addition to supplements, is at least 800 mg/day Multivitamin and multimineral: Minerals should include zinc, copper, magnesium, boron, and manganese.

Mind-Body Therapy

• Meditation, self-hypnosis, guided imagery. biofeedback, and breath work

Pharmaceuticals

• Consider a bisphosphonate in patients with a previous osteoporotic fracture, or a T-score between 2.0 and -2.5 and one or more additional risk factors.

• Consider a selective estrogen receptor blocker such as raloxifene, at 60 mg daily, in patients also at risk for breast cancer.

• Consider calcitonin in postmenopausal women. This can also reduce pain associated with vertebral compression fracture. The dose is one spray (200 units) in alternate nostrils daily.

Key Web Sources

• http://cals arizona.edu/cpan/

• http://riskcalculator.fore.org

• http://www.hot.org