Bone loss is probably one of the most feared and misunderstood aspects in health care. Most think calcium is the main focus when it comes to bone loss. Healthcare authorities recommend taking calcium (usually from a cheap, poorly absorbable source) and everything will be okay. In doing so, the cause of bone loss is overlooked and the effects accepted as part of the “normal” aging process. But there is actually much more to maintaining healthy bones than calcium, weight-training, or bone drugs. And one connection that is often overlooked is reducing inflammation.
It is important to understand that the way the body works does not change to suit a current philosophy of a diseases cause and effect. Neurology, physiology and anatomy in the human body do not change. They have meaning and cannot be ignored or changed to suit a particular philosophy. By understanding the cause, you will understand the effect. Each rationalizes into a procedure that we hope will eliminate the cause of disease and alters the effect back to normal health.
When it comes to bone health, a body suffering from chronic inflammation can send messages that disrupt the natural remodeling process that our bones undergo on a regular basis. And for many, the unfortunate result after years of this simmering fire is brittle, osteoporotic bone.
The Value of Continual Remodeling of Bone
The continual deposition and absorption of bone has a number of physiologically important functions.
Bone ordinarily adjusts its strength to the degree of bone stress. (Wolff’s Law) Bone thickens when subjected to heavy loads. (exercise)
The shape of the bone can be rearranged for proper support of mechanical forces by deposition and absorption of bone in accordance to stress places upon the bone. (exercise vs. no exercise/sedentary lifestyle) (spinal curvatures and breaks)
Old bone becomes relatively weak and brittle; new bone is needed as the old bone degenerates. Bone is alive and needs to be replaced just as other tissues of the body do. It takes about two years for bone to be 100% replaced.
Equilibrium between Bone Formation and Loss.
Osteoclasts and osteoblasts are instrumental in controlling the amount of bone tissue:
osteoblasts form bone.
osteoclasts reabsorb bone.
Osteoblasts are primarily responsible for turning osteoclast production and activity on and off. They do this via a system of signaling proteins called cytokines, i.e. c-Fos. The cytokine messengers in the inflammation–bone dynamic are essentially activators of osteoclasts, causing increased bone loss. When ongoing inflammation is present, more osteoclasts are generated and stay active longer than they should, disrupting the natural balance.
Think of osteoclasts as the building inspector / demolition crew. They constantly inspect the bone for signs of aging. When they find old bone, they tear it out so the remodeling crew (osteoblasts) can remodel the bone. Remodeling crews do not start remodeling until the demolition has been completed.
Bone is continually being formed by osteoblasts where osteoclasts have been active, and it is continually being absorbed where osteoclasts are finding old bone needing to be replaced. A small amount of osteoblastic activity occurs continually in all living bone (approximately 4 percent) so that at least some new bone is being formed constantly. Bone is being continually absorbed by osteoclasts (normally less than one percent in all living bone) at any given time.
Normally, except in growing bones (children), the rates of bone deposition and absorption are equal to each other, so the total mass of bone remains constant. Usually osteoclasts exist in small but concentrated masses; and once a mass of osteoclasts begins to develop, it usually eats away at the bone for about 3 weeks, eating out a tunnel. At the end of this time the osteoclasts disappear, and the tunnel is invaded by osteoblasts and new bone begins to develop. Bone deposition continues for several months. Bone loss medications such as “BONIVA are a nitrogen-containing bisphosphonate that inhibits osteoclast-mediated bone resorption” state this on their websites.
Now apply number three above to the statement and ask yourself what would happen if the osteoclasts bone inspector/demolition crew were made to stop their work? Well for one thing, calcium loss would stop. Hurrah!! Bone loss has stopped. WooHoo!! Does the bone stop aging? No, it continues to age and deteriorate. When the osteoblast remodeling crew finishes their current projects, they see no active tunnels so they stop working. Will this make the bone stronger, or with age, will the bone become weaker? Bone loss and aging still occurs even with these medications.
How does inflammation affect my bones?
When it comes to strong bones, our bodies rely on a dynamic coupling between the cells that break down old bone and those that build new bone. If the immune system is persistently activated, this process becomes uncoupled and the osteoclasts, the cells that break down bones, begin to run amok. Just as the inflammatory process is essential for healing the body, osteoclasts are essential for healthy bone turnover. But when there is imbalanced activity between osteoclasts and osteoblasts, the cells that build up bone, we begin to see more bone breakdown than building.
Cortisol – the stress hormone, is the leading contributor to bone loss. Elevated cortisol has a negative impact on bone metabolism. It lowers bone formation thus favoring development of osteoporosis in the long term. Know any one immune from stress? If you are constantly under stress, your cortisol level can remain elevated over long periods of time. Research now correlates chronically elevated levels of cortisol with blood sugar problems, fat accumulation, compromised immune function, exhaustion, bone loss, and even heart disease.
Cortisol also thins the lining of the stomach, decreasing the production of stomach acid. Did you know stomach acid is required to transport calcium into your body? This is why it is recommended to take a calcium supplement with some form of acid, i.e. calcium citrate. Apply a little common sense to this situation when your doctor tells you to take Tums antacids (calcium carbonate) for your calcium supplement, which further lowers stomach acid and makes less calcium available.
In a study appearing online in the February 2006 issue of the Journal of Clinical Investigation, Kyoji Ikeda and colleagues from the National Center for Geriatrics and Gerontology in Japan show that oral vitamin D treatment inhibits the production of the protein c-Fos. As c-Fos plays a key role in the development of osteoclasts, which are the specialized cells responsible for bone breakdown and resorption, the authors also show that the vitamin D–mediated inhibition of c-Fos prevented bone loss through a suppression of osteoclast development.
Vitamin D also reduces the production of proinflammatory cytokines. These findings clarify how vitamin D helps limit bone resorption in conditions such as osteoporosis, and suggest that high dose oral Vitamin D is more effective than calcium supplements. However, many in the healthcare community continue to say that Vitamin D only helps by supporting calcium absorption without looking at the impact elevated cortisol and inflammation have on calcium metabolism.
Many in the alternative healthcare community promote liver / gallbladder flushes and cleanses. They understand that poor liver function will impact your health. I find it ironic that at the same time recommend Vitamin D supplements that must pass through the liver to be emulsified prior to use. Taking a Vitamin D supplement may add more distress to the liver/gallbladder system by forcing it to work harder. I recommend using a pre-emulsified Vitamin D available at Wellness Alternatives to by-pass the sluggish liver/gallbladder.
Long term, which do you think would be more effective in preventing bone loss: calcium supplements and/or a Boniva-type medication that only ineffectively addresses one area of concern, or treating the underlying cause that predisposes many of us to bone loss? Do what you can to reduce your stress levels. How often to you exercise? We can assist you with your bone loss concerns.