Building Better Bones

(Originally posted on bcotoronto.com on Mar 14th, 2012)

I recently gave a talk at a local retirement home where I received many eager questions about osteoporosis and chiropractic, both if it is safe and what I would recommend. I would like to share this information with you this week. This is something that everyone should be aware of.

Many people fear that osteoporosis and chiropractic do not mix. The manipulation of joints scares people into thinking that their bones are going to break even when they are not weakened by osteoporosis. This is untrue. There is minimal risk of injury to a bone during an adjustment and letting your chiropractor know about your bone health beforehand can decrease that risk further. The only technique that has any real risk of bone fracture is an adjustment of the upper back (thoracic region) where the ribs undergo compression. Rib fractures can occur but this risk can be avoided with a minor alteration in the technique. Chiropractic is safe for patients with osteoporosis and can be quite beneficial. Healthy joints allow for healthy, pain-free movement and exercise which is what really helps build strong bones.

Bones are a latticework of struts that criss-cross and provide a solid structure to bear the weight of our bodies. In order to hold something up the strongest supports will be along the line of greatest stress, which in the case of the body is up and down with gravity. Throughout our lives our bones are constantly being dissolved and rebuilt to maintain their strength and quality. In fact, we have a completely new skeleton about every two years. When our bones are being rebuilt the strong new struts are oriented to the lines of greatest stress. In osteoporosis the dissolving activity of the rebuilding cycle overtakes the new bone production. Bone production can be stimulated by stress and this is what needs to happen to combat osteoporosis. Weight-bearing exercise is the best way to build strong bones. This does not mean you have to go out and bench press 250 pounds. Simple exercises like walking and squats will help build the bones of your legs and back. Many people get scared when they are diagnosed with osteoporosis and stop moving for fear of falling and breaking something. This only makes the situation worse.

When people do fall the biggest fear is breaking a hip and so people who know exercise is important will walk. But when you fall, it is natural to try to catch yourself by sticking out your hands. This means that your hands and wrists will hit the ground first. It is common to end up with a fractured wrist or shoulder. This is why it is important to give that same stress to your arms and upper back that walking does for your legs and low back. Using light weights or even large soup cans and lifting them above your head is enough to stimulate bone production and stress the bones to build strong struts again.

The other variable in the osteoporosis equation is that the new bone being produced is of lower quality. This is because calcium is not getting into the bones to harden it as well as it used to. Most people know that calcium builds strong bones. Fewer people know that you need good amounts of Vitamin D to absorb calcium. What even fewer people know is that you need a good balance of many other things in your blood stream to make sure the calcium gets into your bones.

Calcium and phosphorus are balanced in the blood stream, but when they are uneven our bodies will react to bring them back into balance by either pushing one out of the body or pulling one out of storage. When phosphorus is too high, calcium is leached out of the bones to balance it in the blood stream. So, diets high in phosphorus lead to calcium either being pulled out or being held back from the new bone in the first place. This makes for weaker bones and leads to osteoporosis. Phosphorus-containing foods are very prominent in the Standard American Diet as it is in high amounts in carbonated drinks, processed meats, and some cheeses. It is also found in milk, grains, and foods rich in protein. But let’s not throw the baby out with the bathwater just yet. Don’t get rid of all the phosphate containing foods from your diet. Phosphorus is very good for us but as with all things it needs to be balanced. So cut out the Coke and Pepsi, the beer, and the processed foods. A healthy, whole food diet will provide us with appropriate levels to keep us and our bones strong.

Magnesium is the next calcium balancer to discuss. Magnesium and calcium are absorbed into the body via the same route and so compete against one another. These chemicals are also balanced in the blood stream where high concentrations of magnesium will leach calcium from the bones. But as with phosphorus, we need magnesium in our bodies so don’t cut it out of your diet just yet. Having excessive concentrations of magnesium in the blood is not very common; it is more the competition for absorption that should be addressed. Try to separate calcium and magnesium foods into separate meals and snacks to maximize both minerals’ absorption rates. Magnesium containing foods include nuts, legumes, coffee, tea, and dark chocolate.

There is a lot of buzz around “Alkaline” diets right now and the research behind them suggests that this sort of diet can really benefit the bones. This is all based around the pH of the blood. For those of you who are not chemically minded, pH (potential hydrogen) is the system for measuring the acidity or alkalinity (base) of a substance. Neutral on this scale is a pH of 7, lower numbers are more acidic, and higher are more basic/alkaline. The pH of our blood stays within the range of 7.3-7.4, slightly alkaline and anything outside of this range creates big problems in our bodies. Our lungs, kidneys, and bones are involved in maintaining this delicate balance but right now we are only going to focus on the role the bones play. Calcium is used as a buffer against acid in the blood, so when our diets are “acid forming” we will leach the calcium out of our bones to maintain our health at the cost of our bone quality. Acid forming foods include coffee, tea, pop/soda, meat, milk products, and alcohol. So the Standard American Diet is incredibly acid forming. To keep our bodies balanced and allow our calcium to create strong bones we need to maintain a diet of mostly fruits and vegetables and limiting how many animal products we consume. For a more in depth discussion of this try these videos.

In terms of specific osteoporosis treatment, Strontium is an amazing mineral that has been shown to decrease the incidence of both spinal and non-spinal fractures in women with menopause-related osteoporosis (3, 5) and increase bone density (1, 2, 4, 5). Unlike most pharmaceuticals used to treat osteoporosis currently, Strontium not only promotes bone growth and mineralization but it inhibits the dissolving of your boney struts at the same time (4). Strontium gets into the bone the same way calcium does by being incorporated as a mineral to harden it and has been shown to be similar quality of bone as that mineralized by calcium (6). This is an exciting development in osteoporosis treatment. It is available over the counter but it is important for your primary healthcare doctor to know everything you take so ask your doctor about Strontium before giving it a try.

We can see that our boney health is a high-wire act requiring some attention to keep it on track. Yes, it is most prominent in women during or after menopause, but they are not the only victims of this condition. It is more prominent in that population because estrogen helps to regulate the activity of cells breaking down bone in the rebuilding cycle. But no one is immune to their own physiological processes. This is why it is important to maintain a good routine of exercise and a diet of fresh, whole foods throughout our lives to optimize our bone quality and strength.

Our bones are important. Don’t let them down and they’ll do the same for you.

Thanks for reading,
Dr. Ben

References
1. Pemmer B, Hofstaetter JG, Meirer F, Smolek S, Wobrauschek P, Simon R, Fuchs RK, Allen MR, Condon KW, Reinwald S, Phipps RJ, Burr DB, Paschalis EP, Klaushofer K, Streli C, Roschger P. Increased strontium uptake in trabecular bone of ovariectomized calcium-deficient rats treated with strontium ranelate or strontium chloride. Journal of Synchrotron Radiation. 2011 Nov;18(Pt 6):835-41.

2. Doublier A, Farlay D, Khebbab MT, Jaurand X, Meunier PJ, Boivin G. Distribution of strontium and mineralization in iliac bone biopsies from osteoporotic women treated long-term with strontium ranelate. European Journal of Endocrinology. 2011 Sep;165(3):469-76.

3. Cortet B. Use of strontium as a treatment method for osteoporosis. Current Osteoporosis Reports Rep. 2011 Mar;9(1):25-30.

4. Busse B, Jobke B, Hahn M, Priemel M, Niecke M, Seitz S, Zustin J, Semler J, Amling M. Effects of strontium ranelate administration on bisphosphonate-altered hydroxyapatite: Matrix incorporation of strontium is accompanied by changes in mineralization and microstructure. Acta Biomaterialia. 2010 Dec;6(12):4513-21.

5. Li C, Paris O, Siegel S, Roschger P, Paschalis EP, Klaushofer K, Fratzl P. Strontium is incorporated into mineral crystals only in newly formed bone during strontiumranelate treatment. Journal of Bone and Mineral Research. 2010 May;25(5):968-75.

6. Li Z, Lu WW, Deng L, Chiu PK, Fang D, Lam RW, Leong JC, Luk KD. The morphology and lattice structure of bone crystal after strontium treatment in goats. Journal of Bone and Mineral Metabolism. 2010;28(1):25-34. Epub 2009 Jul 15.

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