Marcelle Pick Site

by Marcelle Pick, OB/GYN NP

Osteoporosis is a progressive condition where more bone is lost than is formed, resulting in decreased bone mass, or a bone mineral density (BMD) that deviates two or more points from the norm. Over time whatever bone is left is thin and porous and fractures easily doing everyday things—like walking and coughing.

Women with osteopinea experience a weakening of the bone matrix and a loss of flexibility, but bone mineral density deviates only 1-1.5 points from the norm. It is considered a precursor condition to osteoporosis.

Osteoporosis occurs earlier and more severely in white women from Northern European descent who are small-boned and thin. Asian women also have a slightly higher risk. Other risk factors include:

• Post-menopause, either natural or surgical
• Delayed puberty, persistent amenorrhea, low hormone levels
• Poor diet, including vitamin D, calcium, and/or magnesium deficiency
• Advanced age
• Heavy alcohol consumption
• Smoking
• Under or overexercising
• Less than 15% body fat
• Elevated blood acid levels
• Use of corticosteroids or other medical drugs
• Thyroid or kidney disorders
• Bone cancers or other malignancies
• GI conditions that interfere with natural mineral absorption

When diagnosing osteopinea and osteoporosis, most doctors rely on a bone density scan, usually dual-energy X-ray absorptiometry, or DEXA. There are other tests, including CT scans, dual photon asroptiometry (DPA) and ultrasound, but DEXA is by far the most prevalent.

In this test an X-ray is focused on a body site (usually the wrist, hip or lumbar spine). Particles that don’t hit a mineral will pass through tissue and can be measured—the more roadblocks along the path the greater the loss of energy in the beam of light. In this way, bone mineral density can be measured. But no two women are the same, even though the test holds them to the same norm. A larger boned woman may have more bone tissue, thus more minerals and may score a higher density then a smaller boned woman.

A bone scan that deviates 2 or more points from the baseline indicates osteoporosis by traditional standards. A score above 1.5 indicates osteopenia, although I have seen women put on Fosamax who deviated only 1.3 points. Different machines will give different readings, so look at your bone scan results with a healthy dose of skepticism.

And realize that while it is one of the best tools we have right now, measuring BMD is more important as a point of comparison over time than your number. Despite what you may have been told, low-density bone is not necessarily weak.

by Marcelle Pick, OB/GYN NP

Bones are complicated living tissue, not ossified shells around marrow like soup bones you bring home from the butcher. Bones are 35% latticed protein—an infrastructure known as the collagen matrix—and 65% mineralized collagen, which gives the bone its strength.

Bone health depends on a give-and-take process, called remodeling. During this process, bone cells called osteoclasts travel through bone tissue retrieving old bone and leaving small, jagged spaces behind. This triggers their counterparts, called osteoblasts, to come in and fill these spaces and deposit new bone. About 5-10% of all our bone tissue is replaced—or turned over— in a year in this way. Osteoblasts cannot work properly without sufficient osteoclast activity, and new bone is stronger and—this is key—more flexible than old bone.

Healthy bones store about 99% of the body’s calcium; the rest is used throughout the body for other vital functions. Bones also house about 85% of the body’s phosphorous, and about 50% of the body’s total sodium and magnesium.

Women with healthy bones still experience bone loss as they age. The bell curve looks something like this: During puberty, when our body and skeleton are growing, bone formation outpaces bone loss. By our early 30’s, most women (and men) have reached peak bone mass. By the late 30’s, bone resorption is slightly higher than formation (about .5-1%). After menopause this rate accelerates to 1-5% , on average, depending on a woman’s diet, exercise, body frame, drug intake, and overall health. Within five years after menopause, bone loss evens out again to a gradual and healthy decline of 1-1.5% per year. If you have osteoporosis, however, this rate of bone loss goes into hyper drive. Some women can lose up to 25% of their bone density in the ten years following menopause.

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by Marcelle Pick, OB/GYN NP

The battle cry around osteoporosis and women has only been raised in the past twenty years, coinciding with incomplete research put forth by the pharmaceutical industries in support of HRT. While accelerated bone loss and fractures have always been a concern for people over 65, younger women got dragged into the fray when research indicated that the natural, gradual decline in bone loss accelerated in the 3-5 year period after menopause.

I want you to understand first and foremost that losing bone is a natural—in fact vital process. Only bone loss (also called resorption) can trigger healthy new bone formation (also called deposition or formation). As with all things in nature, good bone health relies on a balance between this action and counter-action, like breathing out and breathing in.

New bone is strong, flexible with the ability to forbear both compression (running, jumping) and tensile (flexing) pressure. In some women, the balance between bone growth and loss gets severely thrown off —when this begins happening is highly individual, but estimates suggest as much as 20 years before menopause.

What about the idea that menopause triggers bone loss? Most women aren’t given a bone mineral density test (BMD) until mid-life unless they experience an unusual fracture (like a hip fracture) at an early age. Who’s to say what’s normal for you if you don’t have a baseline to compare to?

What’s more, advancements in technology allow us to diagnose bone density more efficiently—a factor that must be taken into account when you look at the statistics on osteoporosis risks. It may seem as if the condition is on the rise, but we only recently developed appropriate tools for measurement!

I think it is no coincidence that much of the fuss about osteoporosis coincides with the marketing of HRT to the public. Since bone loss accelerates briefly during menopause, osteoporosis has come to be viewed as a treatable “symptom” of the “disease” of menopause—yet another indictment of natural aging that women can feel bad about and “cure” through potentially hazardous (and expensive!) drugs.

What’s given less press is the fact that bone strength depends on several factors—not just density— and focusing so much on one side of the equation (inhibiting resorption) to the exclusion of the other (supporting new bone growth) comes at its own price.

The fact is bone strength requires a balance of both and this is influenced by many factors:  genetics, body frame size, diet, calcium intake, vitamin D levels, hormonal balance, stress, and lifestyle. And because bones are constantly regenerating, every positive step you take to support their function will make a big difference.

by Marcelle Pick, OB/GYN NP

Over the past twenty years, women have been hearing more and more about the grave dangers of osteoporosis, and its precursors, osteopenia and osteomalacia. Simultaneously, prescriptions for drugs that build bone density, like Fosamax and Actonel, have risen quickly, with no research to support their safety and efficacy for long-term use.

Admittedly, osteoporosis is a serious condition that sharply raises the risk of a debilitating fracture in older women—but it is treatable and easily preventable. What troubles me is the growing number of younger women who are being labeled “at risk” for osteoporosis and given prescriptions. By mainstream medicine standards, almost half of white baby-boomer women in this country are considered at risk—no wonder the makers of Fosamax boast that they’ll have 40% of American women on their product in the near future. It’s a case of the tail wagging the dog.

What doesn’t get said is that a certain annual rate of bone loss is a natural part of aging,  (between 1-1.5% per year, with a few years of acceleration after menopause) and that bone loss is a necessary stimulant to bone formation. What’s more, studies just don’t support the connection between maintaining bone density and a decrease in fractures later in life.

Read our articles on Osteoporosis to learn more!

by Marcelle Pick, OB/GYN NP

There is no hard evidence that bone density correlates with bone strength or flexibility—the two factors that prevent fractures. In fact, bones can be dense (rich in calcium and hard), yet brittle—what matters more is the health of the collagen matrix, which keeps the mineralized bone supple and resilient.

The collagen matrix is a bedrock of nutrients and minerals that allows the bone to expand, contract, and mend without breaking. Think of the difference between a living, breathing sand dollar or sea urchin and its ossified shell. Or the difference between a slab of dried wood and a thinner piece that has been saturated in protective oils. While this is not an exact correlation, it may help you understand why a dense, hard covering can actually be more breakable than a thin but well-integrated whole—and why drugs like Fosamax and Actonel that focus only on bone density are not the answer.

In fact, BMD is not a reliable predictor of fractures. A study published in the 1995 New England Journal of Medicine reported that in 65-year-old women with no previous history of hip fracture, several other factors were more significant than bone density, such as tranquilizer and sleeping pill use, coordination, poor vision and depth perception; past history of hyperthyroidism, being tall, low blood pressure and rapid pulse, and lack of muscle strength.

In another study, published in JAMA in 1989, use of anti-anxiety medication like benzodiazapenes and other tranquilizers increased the risk of hip fracture by 70%. More recently, a large percentage of falls (and ensuing fractures) reported in a nursing home study were attributed to women rushing to the bathroom in the dark. For more on this and bladder control issues, please see our articles.

If this is the case, why has there been so much focus on density? One answer is that we actually have a test for it. Other factors influence bone health (and general health) are harder to quantify.

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by Marcelle Pick, OB/GYN NP

Your bones, including your hair, teeth and nails, are mirrors of what you put into your body. At Women to Women, we encourage our patients to try a combination approach to preventing and treating osteoporosis that begins with optimal nutrition.

In short, this means:

• Take a daily medical-grade nutritional supplement rich in the minerals and nutrients that support bone function. Your vitamin should contain calcium and magnesium as well as vitamins A, D, K and B6, B12, and folate. Calcium is only as good as its rate of absorption, so buy the best quality you can afford.
• Eat a balanced diet rich in whole grains, leafy green vegetables, fruit, and seaweed products. These are much richer sources of calcium and vitamins then dairy products. If you consume dairy, try to buy organic.
• Limit protein and avoid refined carbohydrates and simple sugars. Avoid sodas and limit caffeine—both are bone weakeners.
• Add a portion of healthy fats to each meal. Essential fatty acids are closely involved with calcium absorption. Bone building vitamins A, D and K are fat-soluble and a certain amount of fat is needed for proper hormone and immune function.
• Support hormonal balance during perimenopause. Talk to your practitioner about using progesterone cream to help maintain a healthy rate of bone formation during this time and throughout menopause.
• Exercise daily, include weight-bearing exercises. Bones are kept healthy with use! The more you ask of them, the stronger they’ll become with the right support.
• Maintain a healthy ratio of body fat. This is one area where thin is not better. Some practitioners think that women naturally gain weight after menopause to warehouse estrogen to combat bone loss. 20-25% body fat is normal.
• Get some daily sun exposure to trigger natural production of vitamin D, at least 15 minutes of unprotected sun in the early morning and evening.
• Examine your feelings about aging and weakness. Strength comes in many forms.. Don’t let other people’s definitions define you and your experience.
• Listen to your body and respect its desire to heal itself—in many ways it often knows best and may need just a little more support.
• After 50, continue to get bone scans every couple of years to check your own individual progress.

Solid bones, healthy body

In the end, osteoporosis is only as frightening as the power we give it. With some attention to your diet, a good supplement, and a few healthy lifestyle changes, most women can prevent, treat, even reverse bone loss without drugs and painful side effects.

For many millennia women and men have been gradually losing bone as they age – today your bones may need some extra help with so many burdens to contend with. If you give them what they need, you’ll find that healthy bones will help you do in life what they do best in your body – adapt, regenerate, and support.