What is Osteopenia vs Osteoporosis?
As we age our bodies inevitably change. Tissues and organs that were once robust may start to lose integrity and strength. The loss of bone mineral density (BMD) as we age can be characterized as either osteopenia or osteoporosis depending on the severity; with osteopenia being considered less severe than osteoporosis.(1) Both osteopenia and osteoporosis can increase risk of fractures. Symptoms of these conditions may include poor stooped over posture, bone pain (particularly in the back), increased fractures, loss of height, and poor oral health. (2) However, patients may have no symptoms at all and may be diagnosed during routine screening; which is recommended in woman over the age of 65. (3)
How is Osteopenia and Osteoporosis Diagnosed?
Osteopenia and osteoporosis are diagnosed by measuring BMD through an imaging process called the dual-energy x-ray absorptiometry (DXA) scan. A DXA can determine between normal density, osteopenia, or osteoporosis based on the BMD. BMD is classified by t-score, with the value of 0 being average BMD. T-score values greater than 0 are considered denser than average whereas t-scores less than 0 are thinner than average. According to the World Health Organization (WHO), a t-score between -1 to -2.5 is defined as osteopenia, whereas t scores less than -2.5 are diagnostic for osteoporosis. (1)
Standard of Care Treatments for Osteopenia and Osteoporosis
One of the most fundamental standard of care treatments for Osteopenia / Osteoporosis is weight bearing exercise. Multiple studies have shown that weight bearing exercises and resistance training can significantly improve BMD. Therefore, it is important for those with BMD issues to engage in regular weight bearing exercises to promote strong and healthy bone. (4,5,6) Supplementation with both calcium and vitamin D is also important as both administered together has shown to reduce risk of fracture in those with osteoporosis by 15% in one meta-analysis. (7)
Another standard of care treatment that is used when less invasive options are not feasible (particularly with osteoporosis more than osteopenia), is called bisphosphonate therapy. Bisphosphonates are a class of medication that inhibit bone resorption by inhibiting an enzyme called farnesyl pyrophosphate synthase which causes downstream effects that inhibit osteoclast activity, the cells whose role it is to break down bone. By inhibiting osteoclast activity, bone resorption is reduced which increases BMD, thus reducing fractures in those with osteopenia and osteoporosis. Other medication classes that may be used include Selective Estrogen Receptor Modulators (Raloxifene), biologics / monoclonal antibodies (Denosumab), and hormonal therapies (estrogen, testosterone, calcitonin) among others. (8) Although adverse effects may be a risk with some of these medications, for many patients they are helpful and well tolerated. However, even with the use of medications and lifestyle changes, there may still be those who would like to further optimize BMD. Luckily, naturopathic medicine can support patients in this manner. Below are a few naturopathic options which may help to improve BMD.
Alternative Treatments for Osteopenia and Osteoporosis
Epimedium/Icariin
Icariin (the active ingredient in Horny Goat Weed) has been shown to increase a signaling factor in the body called osteoprotegerin, which has been shown to increase bone remineralization by increasing osteoblast activity (cells that mineralize bone) while also inhibiting RANKL (a signaling factor that increases osteoclast activity). (9,10) Thus, using either Epimedium or the active ingredient Icariin may be a valuable addition to a treatment plan addressing osteopenia or osteoporosis.
Theobromine
Theobromine the active ingredient in cocoa which has also shown to increase BMD by increasing osteoprotegerin. (11,12,13) In fact, theobromine is so effective at increasing BMD that it is now included as an active ingredient in alternatives to fluoride toothpaste. Thus, using Theobromine may be another consideration in an alternative treatment plan for osteopenia or osteoporosis. However, chocolate consumption may or may not decrease BMD. This is because chocolate contain anti-nutrients like oxalates and methylxanthines which may decrease BMD. (14,15) Thus if you are considering using theobromine, it is probably best to use it as a concentrated supplement rather than getting it from chocolate.
Dietary Silicone
Dietary silicone has been shown to increase BMD in men, premenopausal woman, and woman on estrogen therapy. The results suggest that dietary silicone can increase BMD through estrogen dependent mechanisms. Thus, it seems having sufficient estrogen improves the efficacy of silicone supplementation. (16,17) Silicone promotes bone mineral density by promoting the synthesis of collagen, which is an important often overlooked component of bone. Silicone supplementation has been shown to increase bone matrix synthesis (both non-collagenous matrix polysaccharides and collagen). (18) It is thought to do this by acting as a cofactor for the prolyl hydroxylase enzyme, an enzyme used in the synthesis of collagen. It has been proposed that Silicone my also act as a inducer of gene transcription for the type 1 collagen gene, further implicating it’s use in many conditions including osteopenia and osteoporosis. (19) In fact, some studies suggest that silicone supplementation may be more effective than etidronate (a bisphosphonate medication). (20)
Sigma Anti-bonded Calcium Carbonate (SAC)
SAC is a newly designed form of calcium carbonate. Normally, a calcium carbonate molecule has a calcium atom sigma bonded to two carbonate molecules whereas with SAC, the calcium molecule is anti-bonded to two carbonate molecules. (21) Antibonding is a phenomenon in which electron orbital wave functions cause destructive rather than constructive interference patterns. This creates a nodal plane between the anti-bonded atoms that has an electron density of 0, which does not occur in normally bonded atoms. (22) This is a high energy state of calcium carbonate, and given the instability of the molecule, the calcium atom readily dissociates from the carbonate atoms, thus increasing the release of the bioactive ionic form of calcium Ca2+. This bypasses the need for strong stomach acid, digestive enzymes, and vitamin D3 to absorb calcium. Rather, SAC releases ionic calcium which can be immediately utilized for metabolic function. (21,23)
Animal studies on SAC have yielded interesting results, demonstrating that SAC increases estradiol, osteocalcin, type I collagen C-terminal telopeptides, femoral breaking force, BMD, calcium, and phosphorus in ovariectomized rats. (24) Research conducted by Moffitt Cancer Center and the Calcium and Bone Health Institute (CBHI) have also shown promising results in human trials, demonstrating statistically significant increases in BMD for those with osteopenia and osteoporosis. (25) The CBHI is also working on a combination product of SAC with vitamin D3, potentially increasing the efficacy of SAC further. (23)
Why I’m Passionate About Bone Health
Osteopenia and osteoporosis are very common diseases that have long reaching health impacts. Increased fracture rates can have devastating impacts on a patient’s ability to ambulate and perform activities of daily living; sometimes proving fatal. My own grandmother had osteopenia, ultimately dying from a pulmonary embolism after suffering from a pelvic fracture; igniting a passion within me to pursue bone health. Despite the risks you may face, research shows us that the skeleton is an incredibly adaptive organ and can be strengthened and supported with the right treatment approach.
Fortify Your Health
If you’re ready to explore how naturopathic medicine can fortify your health and strengthen your skeleton, we’re here to support you. Schedule a visit with a Heart Spring Health provider to take the first step.
To schedule an appointment, call 503-956-9396 or contact us now to schedule an appointment today.
