Article first appeared in NUTRITION PIE: July , 2006 Revised Feb 2010
Mechanics of Healthy Bone Building
1.5 million fractures every year. Countries with the highest consumption of dairy foods and thus highest calcium intake levels also have the highest bone disease rates. Evidently this implies that osteoporosis is not a disease of low calcium intake, it is a condition of increased bone loss and poor bone structure. Nutrition experts just keep increasing calcium recommendations. While this has shown increased densities in short term studies, longer research is now revealing little or no benefit in lowering fracture risks. It’s time to stop and evaluate what is happening. Bones are designed to last a lifetime. Here are some facts you need to know.
BONE MECHANICS Bones have two unique parts. A collagen protein matrix and a mineral complex. Think of a high rise office building with the steel framework and floors as the matrix and the walls and windows forming the rooms and building shell as the minerals. Bones are about 1/3 protein matrix and about 2/3 mineral complex.
There are two different types of bones. Cortical bones are long hollow tube-shape structures such as in legs and arms. They are very dense bones and take great force to break. This type of bone cells also form the coverings for all bones. They are less involved in osteoporosis except that it appears upright walking wears thin the cortical bone at the neck of the leg femur causing hip fractures in some women. These fractures are almost all mechanical stress shape related and not under influence by dietary considerations as they are by certain forms of exercise. This helps explain why the results from studies occasionally only show benefit in bones other than hips.
The other bone type, Trabecular, forms the vertebrae of the spine, the round tips of the cortical long bones, the wrists, and the hips. Trabecular bone is shaped a lot like the honeycomb of beehives. These bones are most subject to thinning and fractures from osteoporosis.
Reference for the most complete reference on bone mechanics and osteoporosis information up to 2004. This website is about the rest of the story since 2004. New research has uncovered concepts that need to be included in the bone health discussion but are not yet getting deserved attention.
BONE GROWTH FACTORS The building of strong bones is a complex process controlled by hereditary, dietary, and lifestyle factors. These are the materials your body needs for the job:
PROTEIN ..major structure of bone collagen matrix
Vitamin C ..helps make collagen
Silicon ………directs forming of collagen matrix
Calcium ..major mineral in complex
Magnesium ..part of minerals and helps thyroid and parathyroid glands function
Phosphorus…… ..combines with calcium
Potassium…… ..prevents calcium excretion
Vitamin D** ..aids calcium & phosphorus intake and osteocalcin, protein for matrix
Vitamin K… ..production and activation of osteocalcin, a matrix protein
Essential Fatty Acids ..aids uptake of fat soluble vitamins D and K.
Zinc*, Copper, Iron, Manganese, Fluorine, Boron, Strontium ref, Vitamin B6, B12, and Folic acid …… ...all have smaller but vital roles as well.
*Zinc levels are reduced by high calcium supplementation. Take at least 5 to 10 mg with high calcium amounts. ref
**Naturally produced sunshine vitamin D may be less toxic than supplemental vitamin D at high levels. The question is how does vitamin D influence calcium uptake. The level of vitamin D may not reach toxic levels but could have undesired actions just in aiding calcium utilization in the body. This makes proper supplement levels all the more critical.
THE PROBLEM Research is now pointing to almost the opposite of what experts have been saying for the last fifty years. DAIRY or HIGH CALCIUM by itself doesn't PREVENT very many FRACTURES, and might actually contribute to the problem in the long term. ref Yes, it does add some density. Thus, density may not be the only important factor in fracture prevention. SIDEBAR: Studies reveal more fractures in people with low vitamin K compared to people with high vitamin K even though both groups had the same bone densities. The reality is that the 1/3 bone collagen protein matrix is also responsible for part of bone strength and fracture prevention. Minerals do help, of course. ref A new test is being used in Europe that measures this matrix quality. Rather than measure mineral density in bone, this new lazar test, the Selectis Bone Quality Test, measures the bone collagen matrix, or “the bone architecture based on bonding levels in the micro- architecture” that are perhaps more representative of the tinsel strength of bone. It is proving more reliable in predicting future fractures than the DEXA density test now used. This helps explain why vegetarians who consume less calcium and have lower bone density might also exhibit less fractures than animal protein eaters. So, if calcium is not the answer by itself, what is? Holding calcium in bones may be more important than how much you consume. ref 1 A level of intake over the amount that is excreted every day is desirable of course, but it is the balance with other nutrients and overall dietary factors that needs to be maintained. This has been calculated at a positive 300 mg about the estimated 450 mg that is lost daily by the average American, or 750 mg TOTAL. This is the amount many other Countries recommend. While this is only 50% of U.S.A. recommendations, this amount may be more optimal for total healthy body functions including bone, nerve, muscle, cardiovascular, and brain health. But, the standard American diet and lifestyle have many pitfalls to holding calcium in bones and some people will need slightly more. Calcium is constantly being called upon to perform other jobs that lowers its bone-building and/or maintaining of density availabilities:
*High acid-producing foods (protein, sugars and refined grains**) can rob bones of calcium and magnesium as buffering agents needed to neutralize blood acid conditions.***
*Animal proteins are higher acid producers than plant source proteins. This is one possible reason dairy does not promote bone health in the long run. High animal protein could increase calcium elimination.
*Lack of exercise needed to put stress on bones which sets in motion a strength building process.
*High phosphorus in diet from sodas, grains, and proteins pulls calcium out of bones to again neutralize acids formed.
*Lack of sunshine vitamin D production. High calcium uses up available vitamin D. This could increase prostate and breast cancer risk. Look for the recommended allowance for vitamin D to go up soon.
*Consumption of overly refined foods robbed of their nutritional values, especially white flour with lower magnesium, B vitamins, and strontium.
*These also negatively affect calcium retention: high sodium, low potassium, low magnesium, high caffeine, high sugar, low thyroid and parathyroid gland functioning.
*And vitamin K levels might be too low to protect against calcium ending up in soft tissues such as artery walls instead of helping to build bone density.
**Special NOTE: Whole grains and legumes contain mineral binders that prevent absorption of some of the minerals from these foods. If only whole foods are eaten, a mineral supplement may be needed.
***Fortunately, the body has another preferred acid alkaline balancer, the bicarbonate system. Bicarbonate is made in the body from carbon dioxide gas and water, both usually amply supplied instead of the body having to draw on minerals which are often in short supply. Bicarbonate often combines with sodium to travel the body, but it is when bicarbonate combines with potassium that the most calcium is saved. ref
THE SOLUTION The only factors research has consistently shown of value to build or maintain bone are INCREASED INTAKE OF VEGETABLES AND FRUITS to lower net acid load by increasing potassium intake, plus a variety of WEIGHT-BEARING EXERCISES. A study of women from age 12 to 20 revealed only a modest 1% gain in density from dietary and supplement calcium intake of 1400 mg, while the exercise group at a dietary calcium intake of just 750 mg from food increased density 16%. At 1400 mg or higher, the risk of CVD increases as indicated by increasing artery calcifications.
HEALTHY BONE RECOMMENDATIONS Current nutritional guidelines have increased recommended servings of vegetables and fruits from 5 to 9 per day, and calcium intake up at 1200 to even 1500 mg to try and combat the dietetic high acid load and lack of exercise resulting in high rate of bone loss. The problem is at this level of calcium without proper balance of other nutrients, especially magnesium, vitamin D, and vitamin K, cardiovascular disease may increase as the CHD Death Rate chart depicts. Other conditions may develop as well such as kidney stones, soft tissue calcification, and there may even be associations with prostate and breast cancers. Studies looking at just increasing magnesium, vitamin K, and silicon are showing benefit by themselves or when combined with calcium and vitamin D.
The bottom line reality is that you want to naturally slow down bone turnover and conserve the remodeling process to last your entire lifespan. A lifetime of high calcium intake may in fact wear out the bone building mechanisms. How? The body must maintain blood levels of calcium at just 1%. This is very critical to muscle contraction and nerve flow. Excess calcium in the diet has to be either not absorbed or quickly taken out of the blood. The bones act as a storage place for this excess calcium until it is needed to increase blood calcium levels or it is eliminated. Putting this extra calcium in bones requires bone cells to work overtime. Bone cells have a "replicative capacity" which means they can divide and form new cells only so many times. People with osteoporosis exhibit more bone building cells nearing their replicative capacity end. The cells age faster than bone cells in same age people without osteoporosis. An interesting study in young people found that during increased calcium intake, bone density increases by slowing bone turnover and packing in more calcium. But as soon as the research ended and the calcium intake went back to prestudy levels, the bone began loosing density and returned to nearly the same initial level as the beginning of the study.
Osteoporosis is really a state of higher activity of bone tearing down cells than bone building cells. Bone saving drugs are designed to "de-activate" some of the bone tearing down cells. Actually, the drugs destroy these cells. This is to hopefully balance the two actions and prevent further bone loss. It's a very delicate balance to get the right amount of the drug. This may be your only option at an advanced stage of osteoporosis. If you are on a bone saving drug, YOU STILL HAVE TO BE CONCERNED WITH BUILDING BONE FACTORS. In fact, most if not all of the drug studies also include calcium and vitamin D (but all the bone building nutrients are needed). What is often left out of the discussion is that the process of tearing down and building up replaces old worn out brittle bone with new stronger fresh bone. Thus, while bone drugs increase density, it is often at the expense of new younger and stronger bones, a situation that may not always be best for long term fracture prevention. So, if you are able, all avenues should be explored before turning to drugs, or in addition to them. In the long run, a natural approach utilizing the factors listed in this article might even eliminate the need for these drugs. Begin actions today to keep your bones healthy for your entire lifespan.
SIDEBAR: This article has attempted to simplify a process of great complexity. There are many related synergistic actions that have to be considered. The level of thyroid and parathyroid functioning is of chief importance. It is the bigger picture that needs correcting first. You can only finish the puzzle when you have all the pieces. Having extra calcium and vitamin D is not of much value without enough vitamin K to activate the vitamin D produced osteocalcin directing calcium to go into bones. The combinations exhibited of vitamin D Binding Protein polymorphisms (Gc1F, Gc1S and Gc2) plays a critical role in bone building. Ample protein and vitamin C can build enough collagen matrix but without active silica directing its placement.... Harmony and balance are Nature's hallmarks.
SIDEBAR 2: Here is a paragraph from a government sponsored study of military recruits and stress fractures. "Bone measurements should not be used routinely for screening recruits. Problems with the accuracy of bone mineral content measurements (both specificity and sensitivity) make it difficult to predict stress fractures in military women. Moreover, mean bone mineral density measurements among athletes with stress fracture lie within the normal range." The implication here backs up the bone matrix structure factor over just testing the mineral density.
SIDEBAR 3 (Feb 2010): While Astronauts are in weightless space, calcium pours out of their bones. A new technique was developed to stop this loss. Standing on a vibrating platform has been found to stimulate bone holding calcium abilities. Watch for this device to become available soon to help Seniors that are too fragile to exercise.
UPDATE (August 2007) A United States Dept of Agriculture study found a surprising result. Testing vegetarian women verses animal protein diet women for bone tearing down and building up factors. The researchers found both groups lost the same amount of bone, which was counter to the assumptions before the study, but the vegetarian women BUILT more bone. ref
Caution: Women taking birth control pills appear to lose more bone density than normal. Increasing calcium consumption with protective nutrients and lifestyle activities may be necessary to safeguard bone health.
Caution: Men who have high normal serum calcium levels are at a greater risk for prostate diesase. Here is the rub; serum blood levels of calcium may be inversely as well as directly related to calcium intake. Lower calcium intake may cause the body to rob calcium from bones. Bone calcium is the wrong pH. It takes some time to turn into the pH necessary to perform blood functions, thus the blood would show higher levels when tested until this pH adjustment occurs. Doctors give calcium channel blockers to heart attack patients. This prevents constriction of blood vessels and helps normalize heart rate. What effect does this have serum calcium levels?
Wrap Up: When faced with the weak bone issue, scientists have two options. One is to recommend increasing dietary calcium since short term studies show denser bones. The theory being that denser bones would promote long term fracture prevention. Long term Studies have now revealed very little support for this theory. There is some benefit, but not at the degree the theory assumed. Experts have continued to increase calcium recommendations even in the face of these contraindication results. The calcium recommendations for the USA are now 50% higher than the rest of the world.
Can increased calcium compensate for lack of exercise and a faulty diet? Evidently it can't! Does extra calcium (and D) help? Yes, but only up to a certain point. What is that point? It appears to be near 800 mg total calcium from diet and supplements per day. Does high calcium have any potential negative consequences? Absolutely, even though the body uses many elaporate compensatory methods.
There is another way to accomplish the desired bone health that is safer, prevents the undesirable consequences of too much calcium, and actually achieves greater bone fracture prevention. The better way is to protect the calcium already in the bones by stopping the PROCESSES that result in the loss of so much calcium out of the body. And the other benefitof this option is to also build a stronger matrix structure. This would maintain tissue protection levels of activated vitamin D, and create up and down swings in PTH levels which research finds the most beneficial. A chronic high PTH robs bone calcium, while a chronic low PTH from continual high calcium limits vitamin D activation.
With chronic everyday high calcium intake, the body shuts down calcium absorption percentages and prevents the activation of vitamin D. Low vitamin D levels are now being associated with many diseases. Almost 75% of the US popluation is measuring deficient in vitamin D.
These 2 articles have explained many of the reasons for this view. Nutritional professionals are not really ignorant of all these facts, although their recommendations sure make them appear as such, it is often just that they know people are not going to change their behaviors that much, so they recommend the easy approach of extra calcium. Plus there are vested economic interests that benefit from these recommendations. Enough study research results give credibility to either side, depending upon the criteria used to pick supporting research. But the sad truth is that extra calcium is not working becasue of the imbalances this creates and the many undersupplied bone building nutrients and the oversupplied calcium robbing nutrients. The concept of bones acting as calcium storage units is understated as an explanation for fracture prevention over the long term.
Comparative cultural studies reveal that many countries, where people consume less calcium and exercise more, develop far less fractures. Osteoporosis is not a condition of low calcium, unless you live in the United States. And then it is also low from overconsumption turning off absorption channels plus bone building cells burnout. Other dietary factors play a significant role in how the body deals with calcium as well.
Your genetic influence, your stage of bone health, how you respond to treatment protocols, and your ability to perform lifestyle changes are factors that your doctor analyzes to find the best treatment program for you. You need to be monitored to find this out. The information on this website should be discussed with your health care provider to find out how it can best serve your bone health needs.
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