Can I Reverse Osteoporosis?

Apr 20

It’s a question we are asked almost daily. People want to know whether they can reverse the problem without using drugs. The answer? Well, it depends.

That is not to say osteoporosis cannot be reduced, but there is a line we can cross where the damage becomes irreversible without medical intervention. This article is intended to cover the treatable condition and help you reverse its course before it becomes a medical problem.

To be clear, osteoporosis is reversible with the right therapeutic and nutritional approach. However, certain lifestyle nuances may have to be curtailed to accommodate improvement. We also need to take into account the effect of certain medications, especially if you have lost a great deal of bone mass and your fracture risk is higher.

The first thing you might hear is that osteoporosis is not reversible. Not true. We have personally helped many clients improve their bone mineral density (BMD), and some have fully recovered. That said, it is easier to prevent osteoporosis than treat it.

Typically, osteoporosis is determined by an annual DEXA scan. However, most women are told not to get one until they are 65 years old. By then, it is too late, and the only recourse is drug therapy. You can get a DEXA earlier, but insurance might not pay for it unless there is a family history to consider.

What Osteoporosis Actually Means

It is prudent, therefore, to consider what osteoporosis is and what causes it. The World Health Organization (WHO) has defined osteoporosis as a statistical measurement of something called a T-score. This is the standard score of a measurement compared to the population of healthy 30-year-old adults. See the problem? If you guessed that we do not start measuring until 35 years later, then compare that 65-year-old score to that of a 30-year-old, you win the gold ribbon.

According to WHO, any T-score up to -1.0 is considered normal. If you measure between -1.0 and -2.5, you have the beginning of osteoporosis, called osteopenia. It means the risk of further bone loss exists. If you have a T-score of -2.5 or greater, you have osteoporosis.

That means osteoporosis is measured as being two and one-half standard deviations below the average 30-year-old. The further your score deviates from -2.5, the more difficult it is to change. Rest assured, it is not impossible. It just takes longer.

What Accelerates Bone Loss

Before I begin the conversation about reversing osteoporosis, let’s first talk about what accelerates it. The main cause of osteoporosis is a reduction in bone mineral density, which you know. But what causes that? The main trigger most often cited in women is an estrogen deficiency, but although logical, this is questionable. Osteoporosis may well be driven by hormonal imbalances, poor vitamin D absorption, and low strength, but it is accelerated by smoking, gut dysbiosis, high processed carbohydrate diets, and certain medications such as glucocorticoids.

With the average American diet about 71% processed carbohydrate, the majority of our food is broken down into sugar, which causes inflammation and insulin spikes. As the individual slowly increases resting blood sugar levels, the sugar begins to impair bone health by increasing urinary calcium, magnesium, and other mineral excretion. It also reduces calcium uptake from the intestines and, at the same time, lowers active vitamin D levels. This combination of inflammation and reduced mineral absorption, coupled with a diet that is more acidic than neutral, hinders bone repair and growth by increasing osteoclast activity, which breaks bone down, while reducing osteoblast activity, which builds bone up.

Chronic inflammation increases bone resorption, and increased insulin impairs the body’s ability to repair itself, including bone.

This can be exacerbated by certain medical conditions, such as overactive thyroid, chronic lung disease and cancer, endometriosis, vitamin D deficiency, and certain medications such as prednisone, often classified as corticosteroids.

Specifically, corticosteroids increase the rate at which the body breaks down bone while slowing its ability to build new replacement bone. Significant loss can occur within 3 to 6 months. In addition, acid reflux medications such as Prilosec, Nexium, and Prevacid, all of which are associated with increased risk for hip and spine fractures, contribute to the issue. Anticonvulsants such as phenytoin, phenobarbital, and carbamazepine have been found to accelerate vitamin D breakdown, which reduces calcium uptake. Antidepressants, or SSRIs, also interfere with bone-building cells, doubling the risk of fracture in adults over 50.

Other drugs associated with bone loss include loop diuretics, blood thinners, certain diabetes medications such as thiazolidinediones (TZDs), and of course GLP-1s, which are used for weight loss, but which cause 40% losses in lean tissue mass and will also contribute to bone loss in the long term.

What It Takes to Reverse the Trend

So that is the bad news. Now let’s talk about how to reverse all of these things. Before we start, yes, studies have found that people can reverse osteoporosis naturally when they performed four things:

Changed their diet to avoid inflammatory foods and sought out whole foods with supplements.
Followed an exercise program that increased their strength.
Kept regular with their strength program.
Exercised over many years.

See a trend there? Your type of exercise and your diet matter.

Like most things, this condition develops over a number of years. It will accelerate with a highly processed carbohydrate diet, too much sugar, and certain medications or radiation therapy. Because it took time to develop this condition, you must accept that it will take time to reverse it.

Bone remodeling is a slow process. Just be patient.

Since most of you want to know whether you can reverse it, let’s start here: in most cases, yes, it can be reversed without the use of drugs too. However, sometimes your amount of loss may mean that you need medications to allow the opportunity to rebuild your bones. Just keep in mind that while pharmaceutical intervention can improve your bone density, it does not improve bone quality and, in the long term, likely increases risk of fracture.

Why Strength Matters More Than Impact

Many times I have heard that the trick to increasing bone density is through impact. That is, use ground reaction forces to entice bone to grow. A study by Bassey and Ramsdale (1) did some research on that and found that no one reversed bone loss, but they were able to maintain bone density. It was not because people stepped harder against the ground. The fact is, when you push a limb into the ground, the muscles must contract, and it is the muscle that reverses bone loss. Stay with me here. I will explain.

Wolff’s Law is a physics law that, loosely interpreted, states that muscles which contract against a load, or resistance, cause the tendons of those muscles, which attach to bone, to stimulate that bone to become stronger. Essentially, the stronger a muscle gets, the stronger a bone gets.

Impacting a limb against a hard surface, such as the floor, does increase bone density in the heel. Not due to the impact of bone against something hard, but due to muscular contraction during ground contact. The only limitation is that there is no resistance, so there are no strength improvements. Thus, bone density is maintained, but not improved.

What improves bone density is exercise, and it does it for several reasons. Any exercise that requires both strength and ground contact activates something called mechanotransduction. It is a long word, but it means the same as Wolff’s Law. When your muscles are required to be stronger from a resistance training program, the bones they attach to must also be stronger. Resistance training causes specialized cells called osteocytes to sense the mechanical strain and send signals out to osteoblasts, which build bone. The interesting part of this phenomenon is that osteoclasts, which are cells that break down bone, become suppressed.

Exercise, especially Whole Body Vibration (WBV), has been shown to improve bone quality by altering bone geometry and morphology. There is an increase in mineralization in order to handle the added stress, which makes the bone become denser and thicker. There is also site-specific adaptation, where bone is laid down at the points where stress is applied. In that way, we can target areas of the body such as the hips or lumbar spine.

There are a number of factors that do impede results, however. We know, for instance, that as women hit menopause there is a decline in estrogen, and that affects bone mineral density. By 30 years of age, most people have reached their peak bone mass, and then they gradually begin to lose that mass over time. It is interesting to note that, about the same time, sarcopenia begins also. That is, there is a gradual loss of muscle strength and mass amounting to 5 to 7 pounds of lean mass loss every 10 years after the age of 30. That’s why exercise can slow down or prevent bone loss.

In one study, exercisers increased BMD 1 to 2% while the non-exercising control group lost 4%. Not just any exercise, though. Strength training is far better at increasing BMD, and WBV, if done correctly, is even better.

I should note that there are several poorly designed papers out there that find no significant results for increasing BMD. Most studies are too short in duration to note improvements, and the majority of WBV studies merely stand the subject passively on the WBV machine. Not only is this a useless waste of time, but it defeats the entire intent of WBV. The intent is to augment the exercise experience, not make the machine do the work.

What About Weighted Vests?

I’m often asked about weighted vests to help with osteoporosis. Let’s explore that for a second. The study in question used a weighted vest and had the subjects do squats, lunges, step-ups, and various modifications of the squat. Later, they had the subjects jump down from 4 inches, then 6 and 8 inches. That study lasted nine months, and the researchers found lots of positive change. But when we pull the study apart, they were doing strength training, and yes, we would expect to see changes as long as the diet was corrected also.

In another study with weighted vests, there were no changes in nine months. That was curious, but they only walked with weighted vests. This prompted a second version of the study using the same subjects. This time, the researchers increased the weight of the vests, and they ran the test for 4.5 years. At the conclusion of five years, the average woman in the exercise group added 2% bone to the hip, and the control group lost almost 4%.

While the focus was on weighted vests, it also points out that walking alone is not enough to reverse osteoporosis.

How Nutrition Fits In

How about nutrition? Studies find that there are nutrients that help improve your BMD. Keep in mind that these nutrients are supplemental to exercise, not a replacement for exercise. Nonetheless, these nutrients appear to have a beneficial effect on the bone-building cells of your body.

Notice that calcium is not on the list. While calcium is present in bone, we must also account for the more than 100 minerals that exist there too. Thus, your concentration should be on the other factors that build bone while getting any calcium you need from your diet.

Vitamin D3. D3 helps increase calcium absorption.

Vitamin K2. This vitamin directs calcium to the bone. You can get this from butter, curd cheese, edam cheese, egg yolks, and natto, a Japanese fermented dish, or supplement it with your D3. You need at least 180 mcg a day, but more is not harmful.

Arganine. This is a semi-essential amino acid. Essential means your body cannot produce it on its own. Non-essential means the body can produce it. Interestingly, when we are young, we can make a little, but we lose this as we get older. Since amino acids are the building blocks of proteins, we can get arginine from meat, chickpeas, lentils, and spirulina.

Strontium. This is a mineral found in seawater and soil. Seafood is rich in strontium, but you need more than you can eat, which is why supplementing it goes a long way. You can also find strontium in root vegetables, meat, whole milk, and wheat bran.

Retinoic acid. This is a compound derived from vitamin A. You can find it in all dark green, yellow, and red vegetables, as well as red or yellow non-citrus fruits. I believe it is also higher in sardines, cod, and fish oils.

A Different Lifestyle, Over Time

Reversing the effects of osteoporosis takes time. It also takes a different approach to lifestyle. Necessary steps include cutting down on sugar, soda, and processed foods, increasing protein and vegetables, and doing strength training exercise.

Getting your body out of osteoporosis also takes a team. I highly recommend sitting down with a lifestyle and nutritional professional and finding a place that offers Whole Body Vibration (WBV), such as ReVibe Fitness and Wellness in Minnesota. The missing piece to the puzzle lies in controlling your blood sugar, reducing inflammation, and building your strength.

You got this!