How to manage our bone density as we age

A 65-year-old retired woman came to the clinic with a bone density problem. She had not been having any bone pain, but after a check-up with her GP a DEXA (dual energy X-ray absorptiometry, which measures bone mineral density) showed that her bone density levels were below normal levels. She was on the borderline between osteopenia, or bone mineral deficiency, and osteoporosis. Bone mineral density is a measure of bone strength. The main areas of potential concern are the spine, particularly the lower spine, and the hip joint and upper femur (the thigh bone), as these are the areas under the greatest pressure during daily life and therefore at the greatest risk of fracture when weakened.

Her GP had recommended a common calcium supplement, but she wanted to see which one was appropriate from a naturopath’s perspective.

She was on no other medication, exercise was irregular and digestive symptoms were a recurring issue, with indigestion, bloating and wind most days. Diet was toast and jam for breakfast, a ham, cheese and tomato sandwich for lunch and meat and three veg for dinner. She had a sweet tooth and snacked on lollies and drank four cups of coffee a day with two sugars. A non-smoker, she had a glass or two of wine with her night meal.

She also suffered frequent cramps in the legs at night, had difficulty getting to sleep, was lacking energy, suffered mild anxiety and when stressed had minor palpitations of the heart. This was checked by her GP and she was sent to a cardiologist for an assessment, the results of which were good for her age. She also suffered from mild osteoarthritis, mainly in her right thumb and lower back, causing pain at times.

The treatment

To support bone strength — if you don’t use it you lose it — weight-bearing exercise and a healthy diet are critically important. For exercise she liked walking, so I recommended this for half an hour four or five days a week, preferably early in the day and in a park or bush so that it was enjoyable. I also recommended following this a regime with weights three times a week to strengthen her upper body. She joined a local older persons’ gym class for this and enjoyed it. She also mobilised her friends to join her in the exercises, and they became a positive social experience.

Aligned with the exercise there were significant dietary changes to make, the first one being removing the sugar as this was impacting adversely on many areas of her health, including her bones. She reduced her coffee consumption to one cup per day with oat or almond milk and a little honey. I recommended a more balanced higher vegetable diet with varied sources of protein, including fish. The daily vegetable consumption for health is a minimum of five serves of vegetables daily and a couple of pieces of fruit. One serve is about a handful. I specifically recommended two serves of green leafy vegetables per day as part of this quota. I also suggested nuts and seeds or unsweetened yoghurt or kefir as much better snack options than lollies.

Treating osteoporosis purely as a calcium deficiency condition is oversimplifying the problem. It is more a condition of abnormalities in calcium metabolism — a complex issue and managed differently. For example, it is very common for older people to have both osteoarthritis and osteoporosis, where there are calcium deposits in the joints but lowered calcium in the bones, an indication that a calcium deficiency is not the real issue. When measuring calcium in the blood it is usually within normal range, as it was in this case, so it is logical that supplying just a calcium supplement may not be the ideal solution.

Interestingly, there is research evidence to suggest that osteoporosis may be more of a magnesium deficiency, and she was certainly showing symptoms of low magnesium: cramps, insomnia, palpitations and anxiety. Humans have mechanisms to support the critical balance of calcium and magnesium in the blood and tend to use bone as a storehouse to maintain this balance. Therefore, to maintain calcium in the bones and reduce its leaching into the blood, critical nutrients include magnesium in particular, along with zinc, silica, boron and phosphorus.

As she wanted a calcium supplement, I recommended one based on calcium hydroxyapatite. Calcium hydroxyapatite is the ground-up internal part of bone (usually from another animal), and it contains all the nutrients needed for bone health, in approximately the correct proportions, so is a healthier option than the more common calcium carbonate.

As she was already supplementing with vitamin D3, vitamin K2 was added to support the action of D3 and reduce any risk of over-calcification. I also added a magnesium supplement to reduce her symptoms of deficiency, and it proved very effective.

I gave her a herb mix including pau d’arco to improve digestion, to relieve the arthritis and to reduce a possible overgrowth of candida as evidenced by the sugar cravings. I also recommended a sugar metabolism supplement to reduce her cravings. Regular exercise also helps with this.

Improving bone density is a long, slow process, and as I have been seeing this lady for several years we have been monitoring her progress with an annual DEXA, and her bone density is slowly improving by about 1 or 2 per cent per year. With this regime her digestion and her arthritis symptoms have improved. Her overall health and energy have also improved, so she is very happy to continue with the program, with occasional minor adjustments, indefinitely.