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Low bone density

MagazineApril 2009 (Vol. 20 Issue 1)Low bone density

Q) I've recently been diag-nosed with osteopenia

Q) I've recently been diag-nosed with osteopenia. My doctor is keen to start me on raloxifene, but I'm worried about potential side-effects. Could you tell me more about this drug and whether there are any effective alternative waysto prevent osteoporosis?-T.J., via e-mail

A) Osteopenia refers to lower-than-normal bone mineral density (BMD), but not low enough to be osteoporosis. Although many doctors consider the condition to be a precursor to osteo-porosis, others claim it's an invented disorder and that the diagnosis itself is harmful. Indeed, one article in the British Medical Journal notes that potentially dangerous osteoporosis drugs are now being marketed to relatively healthy women-as much as half the world's postmenopausal women-who have been diagnosed as osteopenic (BMJ, 2008; 336: 126-9).

The drug your doctor wants to give you-raloxifene, a selective oestrogen-receptor modulator-is associated with hot flushes, leg cramps, and a high risk of thromboembolism and fatal stroke (Drugs, 2000; 60: 379-411; N Engl J Med, 2006; 355: 125-37). In fact, any protective effect of the drug for osteopenic women is likely to be minimal (BMJ, 2008; 336: 126-9).

The best way to reduce your risk of osteoporosis is to strengthen your bones naturally. Stopping smoking, drinking alcohol in moderation, if at all, following a careful diet and taking up exercise will probably do more to avoid brittle bones than any drugs.

Better bones naturally

- Vitamins and minerals. Much is made of the need for calcium, but this mineral is rarely enough on its own. Good bone health requires a variety of vital nutrients.

- Vitamin D is essential for healthy bones and calcium absorption, and not enough D has been linked to osteoporosis and osteopenia in women over 50 (Joint Bone Spine, 2008 Aug 21; Epub ahead of print). You can get D from certain foods (fish, liver, eggs), but the best source is the sun. Just 15 minutes of sunlight on your skin every day should produce all the vitamin D you need. In winter, you may need to take supplements. Studies show a 30-per-cent decrease in non-spinal fractures among seniors taking 800 IU/day of vitamin D (Ann Med, 2005; 37: 278-85).

- Vitamin K is not just important for blood-clotting, but also plays a major role in bone metabol-ism. In a three-year study of nearly 200 women aged 50-60, those taking vitamin K1 (phyllo-quinone; 1 mg/day) with a mineral+vitamin D supplement lost less bone than those taking a placebo or the mineral+ vitamin D alone (Calcif Tissue Int, 2003; 73: 21-6). Vitamin K2 (mena-tetrenone; 45 mg/day) boosted BMD and reduced spinal frac-tures in osteoporosis sufferers nearly as effectively as etidro-nate, but without the side-effects of the bisphosphonate (J Orthop Sci, 2001; 6: 487-92). Good sources of vitamin K include leafy green vegetables and fermented products such as natto.

- Strontium appears to have the dual effect of increasing bone formation while decreasing bone breakdown (Bone, 2008; 42: 129-38). In a three-year study of 1649 postmenopausal women with osteoporosis, 2 g/day of oral strontium ranelate increased BMD and reduced fracture risk by more than 40 per cent vs a placebo (N Engl J Med, 2004; 350: 459-68). Strontium is found in wholegrains, parsley, fish, Brazil nuts and lettuce.

- Magnesium, boron, silicon, zinc, manganese, copper and essential fatty acids can also help.

- Regular weight-bearing exercise, such as walking, running, aerobics and racquet sports, prevents bone loss (Curr Opin Rheumatol, 2008; 20: 213-7). Aim for at least 20-60 minutes three times a week. Exercises that improve balance and coordination, such as Tai Chi or step aerobics, can also help to prevent fractures and falls (BMC Geriatr, 2006; 6: 6).

- Whole-body vibration training (WBVT), which involves standing, sitting or lying on a vibrating platform to stimulate multiple muscle contractions, may help to prevent osteoporosis. Postmeno-pausal women who engaged in WBVT three times a week for six months saw significant increases in hip BMD, as well as more strength and balance (J Bone Miner Res, 2004; 19: 352-9). WBVT also prevented bone loss in the spine and femur (thigh bone) vs a placebo (J Bone Miner Res, 2004; 19: 343-51).

- Cut out coffee, as caffeine increases urinary loss of calcium; indeed, drinking four or more cups of coffee a day increases the risk of osteoporotic fractures (Osteoporos Int, 2006; 17: 1055-64). In contrast, tea appears to be bone-protective (Am J Clin Nutr, 2007; 86: 1243-7). Although tea contains caffeine, its calcium-leaching effect may be counter-acted by other constituents of tea, such as flavonoids.

- Limit chocolate, as women aged 70-85 who ate chocolate every day were found to have lower bone density and bone strength than those who ate it less often than once a week. As the study research-ers concluded, "Confirmation of these findings could have important implications for preven-tion of osteoporotic fracture" (Am J Clin Nutr, 2008; 87: 175-80).

For further information on osteo-porosis and particularly on how diet can help, see WDDTY vol 9 no 10.


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