The war against osteoporosis and the techniques you need to win now!

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Eli Curt Fuld                                                                                         Research Paper

Professor J. Seessel                                                                                   May 5, 2010

The war against osteoporosis and the techniques you need to win now!

Studies done by the US Department of Health and Human Services, as recently as in 2004, have shown that more than 10 million individuals were affected by osteoporosis at the time, and since then, the epidemic has only increased (Lancet 659). If ten million may, for whatever reason, not seem like an overwhelmingly large statistic, think of it this way – 10 million United States citizens is the equivalent of 30% of the population (Census Bureau).

The question, which I’m sure is on your mind as it is on mine, is how do we stay away from this extreme weakening of the bones? After all, osteoporosis is defined as, “a multifactoral progressive skeletal disorder characterized by compromised bone mass which predisposes to increased fracture risk” (Pigozzi 179). In case you didn’t understand that, osteoporosis is the weakening of the bones, which will lead to fractures and breaks in those bones, often by way of falls. At the onset of my research, I had one question in mind, with a follow-up: is there a singular best method for preventing osteoporosis, and if so, what is it? Conversely, if not, then what are the measures I should be taking to ensure I steer clear of this dreadful disease?

There have been many scholarly debates as to the best method of preventing osteoporosis. Through much research, I have found a general medical consensus exists that there is no singular method of prevention, which can singlehandedly trump the combination of several methods. Instead, experts suggest a combination of increasing one’s daily calcium intake, combined with upping one’s daily Vitamin D intake, to produce a greater effort in the deterrence of osteoporosis than simply upping one’s calcium intake alone.

Ever since I was simply a child, I’ve always been told to, “drink your milk so you can grow up big and strong.” As a youngster, I of course had no clue what milk would do to make me big or strong, but as the years progressed and my mind grew and matured, I came to associate milk with strong bones. When I thought about it for a long enough period of time, I would reach the conclusion that calcium led to strong bones – probably because it said it right there on the milk carton. And so in my household, as I’m sure is the same throughout households all around the world, it was understood, that milk, namely calcium, made bones big and strong.

Subconsciously, I’ve been living by that creed one way or another ever since my mother told me to drink my milk. When the choice given to me on a Sunday morning is eggs, waffles, or cereal and milk, even though the former two are scrumptious[1], I would nevertheless choose cereal and milk a good amount of the time. It was because I understood the importance of promoting strong bones – what my further developed brain now understands as a method of preventing osteoporosis. My presumption is that if I were to ask an average mother about the benefits of calcium, they would be spot on[2]. The scholarly source which best embodies the effects of calcium on bone health, “Vitamin D and Calcium In The Prevention of Corticosteroid Induced Osteoporosis: A 3 Year Followup”, states that, “calcium may help prevent the early loss of bone seen in the lumbar spine as measured by densitometry of the lumbar spine” (Adachi).

Adachi et al. published a three-year study for McMaster Hospital in Canada. In the study, their primary intentions were to discover the effects of calcium combined with vitamin D, in both the short run and the long run, on corticosteroid induced osteoporosis[3]. Corticosteroids have the potential to decrease testosterone, estrogen and the amount of calcium absorbed by the intestine (Eustice). Adachi et al. gave their patients 50,000 units of Vitamin D a week and 1,000 mg/day of calcium. Vitamin D does, in fact, aid in osteoporosis prevention, but not firsthand, in the sense that calcium does. Vitamin D enables the body to absorb more calcium, thus indirectly strengthening the bones (Adachi, Higdon 2). In order to prove these facts,  when Adachi et al. set out on their three-year journey to discover the strengths and weaknesses of calcium, they included Vitamin D in their subjects’ diets, which did allow their bodies to retain maximum calcium.

Through much researching and testing, Adachi’s clan of scientists concluded that calcium, when combined with Vitamin D, does not appear to be beneficial in the long run to patients who are suffering from corticosteroid induced osteoporosis. In fact, the benefits would be difficult to argue with in the short run, certainly worth including in one’s daily diet, but as time went on, those same benefits wouldn’t be as apparent. Now I understand that the study of preventing corticosteroid-induced osteoporosis is only one specific field of research, but the prevention of osteoporosis is the prevention of osteoporosis, regardless of how the sickness is obtained. I therefore conclude that calcium alone, or calcium in combination with Vitamin D is simply not enough to prevent the awesome power of this disease in the longer term.

In fact, many studies support the claim that calcium has a fantastic ability to deter osteoporosis, but very few claim that calcium alone, or when used in combination with Vitamin D, is enough to prevent the sickness singlehandedly. Another form of osteoporosis prevention I came across in my studies is exercising. That’s right, regular old gym rats may have stronger bones in addition to stronger muscles because muscle pulling on bone builds bone, so weight-bearing exercises builds denser, stronger bones (University of Arizona 1, Deenadayalan).

The University of Arizona College of Public Health makes the argument that exercising, and exercising alone, is enough to prevent osteoporosis. According to the University of Arizona, before a person reaches 30 years of age, their bodies are primed to exercise in excessive amounts, and the more they lift before they reach that age, the more bone mass they build, and the better off they are during the years afterwards – “the years of gradual bone loss” (University of Arizona 2).  The University’s claim is that any exercise which is working against gravity – weight lifting, hard running or jogging, hiking, dancing, yoga, or others of that nature – is best for building bone mass. Swimming and walking are good for cardiovascular endurance and fitness, but not for building bone strength.

The University concludes that by combining different types of weight-bearing exercises for 30 minutes daily, one can increase their bone strength, heart strength, and balance, which is key to preventing falls and eventual fractures. It seems as if the University of Arizona has it figured out: work out for two and a half hours a week, and you’ll keep your bones healthy and strong for as long as you shall live. The Joanna Briggs Institute sees eye to eye with the great University in the regard that exercising is enough to prevent osteoporosis.

Taken from their website, “the Joanna Briggs Institute is an International not-for-profit Research and Development Organisation specialising in Evidence-Based resources for healthcare professionals in … medicine…” Yamini Deenadayalan filed a report for the Institute which attempted to answer, “How effective is exercise therapy in preventing osteoporosis?” When she writes about exercise, she refers to exercising the upper limbs, the lower limbs and the trunk through calisthenics, stretching, strengthening muscles incrementally and walking exercises.

Aerobics, weight bearing exercises (as the University of Arizona stated earlier on), and resistance exercises all proved themselves worthy in the fight against osteoporosis. While walking was noted to have increased the bone mineral index of the test subjects’ hips and spine, it had no apparent effect on their fracture risks (Deenadayalan). But are physically exerting exercises the best method? If I were to combine exercise with drinking milk daily, would I be better off? Perhaps, but before we look at combinations of different preventative measures, I would like to analyze the affects of silicon on bone health – particularly, silicon found in beer.

When I first heard that beer was able to prevent osteoporosis, or even strengthen bones, I was flabbergasted as I thought it inconceivable for beer to have any positive effects on the body. I’m a college kid, and I have friends who drink beer. When they drink beer in excessive amounts, they often end up making reckless, immature, or just plain old rash decisions. But could it be that this alcoholic beverage, which can change a person’s outlook entirely, a drink which will make you incapable of operating a motor vehicle, of inebriating you to the point where you slur your speech, is also beneficial for your health further down the road?

The Journal of the Science of Food and Agriculture published an article called “Silicon in Beer and Brewing” where Charles Bamforth and Troy Casey, two well-respected scientists at the University of California, Davis,  evaluate the amount of silicon found in beer. Casey and Bamforth prove the undisputable fact, which is that beer contains a substantial amount of silicon, and silicon has been confirmed to promote the formation of collagen. Another researcher of silicon, Forrest H. Nielson, Ph.D., is a research Nutritionist employed by the United States Department Of Agriculture’s Agricultural Research Service. In his analysis of silicon, and its effects on bones, Nielson came across a startling breakthrough: Collagen is a type of protein that provides bones with strength and flexibility in addition to laying down new tracks for future bone growth. When silicon is abused however, and enough isn’t taken, certain diseases have been known to arise, including atherosclerosis[4], high blood pressure, osteoarthritis[5] and, most importantly, osteoporosis (Nielson). In a study conducted by Doctors Bamforth and Casey, they concluded that, “Silicon impacts bone mineral density in humans, and supplementing silicon in the diets of osteoporotic women increased bone mineral density” (Bamforth 3).

The doctors from University of California Davis’s studies have shown that, in fact, the best beers to drink are the ones with the most hops, as more hops yield more silicon, and more silicon yields increased bone mineral density, which means healthier, more resilient bones. But how can we measure which beers have more hops? Wheat-based beers, in general, have less silicon, partly because wheat malt has lower levels of silicon, and partly because the beer doesn’t have as many hops. The same can be said for light beers. The India Pale Ale (IPA) category is usually a category of stronger beer which is hoppier, and contains more silicon (Bamforth 9).

While a beer containing an abundance of hops can be used as a wooden shield in one’s arsenal for the fight against osteoporosis, nowhere in Casey and Bamforth’s article published in the Journal of the Science of Food and Agriculture does it say that silicon alone is a powerful enough preventative measure in the fight against osteoporosis. What we’re looking for is a shield made out of solid steel with a matching sword. Sure it may aid in keeping bones more durable in aging women and men, and it may even promote healthy bone growth, but silicon is not a strong enough measure to thwart the mighty osteoporosis unaccompanied.

And so with great pleasure, I would like to introduce the idea of fighting osteoporosis from multiple fronts – possibly combining some of the combative measures we’ve come across, and seeing if the amalgamation turns out to have indeed been more effective against the monstrous illness. The first source I would like to show you is The Journal of the American Osteoporotic Association (JAOA). JAOA has been creating medicinal breakthroughs in the field of osteoporosis since the beginning of September, in 1950.

As far as JAOA is concerned, preventing osteoporosis is one and the same as preventing bone fractures, especially in older men and women. To reduce osteopathic risk, that is to reduce fracture risk, The Journal suggests reducing fall risks (such as installing hand rails by staircases), smoke less cigarettes (“smokers are more likely than nonsmokers to be thinner and to consume more alcohol and coffee”), exercise regularly, see a nutrition counselor, and normalize joint motion through a rehabilitation program (Gronholz).

An additional way Gronholz suggests preventing the fractures which will inevitably lead to osteoporosis is through osteopathic manipulative treatment – that is normalizing joint motion in patients so that their bones, joints, and soft tissues are all more accustomed to the body’s movements. Some ways listed of doing this are through Craniosacral therapy[6], muscle energy therapy and the strain-counterstrain technique[7]. The strain-counterstrain is widely accepted as the safest for osteoporatic victims (Gronholz).

While Jill Gronholz and the JAOA have a very physical, hands-on approach to preventing what they interpret osteoporosis as[8], there are others who feel that while this type of approach is essential for the treatment and prevention of osteoporosis, it would be even furthered in its effectiveness when combined with other techniques. The Journal of American Medical Association is one such source.

In 2001, the Journal of the American Medical Association (JAMA) published a consensus on Osteoporosis, which is a wealth of knowledge in the field of preventative measures. Similar to Gronholz’s opinion, the journal has its own definition of osteoporosis prevention. “Fracture prevention is the primary treatment goal for patients with osteoporosis,” meaning in order to treat osteoporosis, all I have to do is prevent myself from fracturing my bones.

This train of thought is certainly a logical one, and JAMA offers several ways of preventing these falls, and osteoporosis. To clarify things, “risks for osteoporosis and for fractures overlap but are not identical” (JAMA). Once published in 2001, JAMA states that the recommended amalgamation of preventative measures are enough[9] calcium and Vitamin D intake[10], exercise – resistance and high-impact or weight-bearing exercises in particular, and any fractural preventative measure, such as those listed by Granholz above (JAMA).

Two other scholars who feel that there is a multiple-sided fight to be fought is Karen F. Mauck, MD, MSC and Bart L. Clarke, MD of the Mayo Clinic Proceedings. The Mayo Clinic Proceedings claim that, “osteoporosis is the most common bone disease in humans and affects both men and women, usually during or beyond the seventh decade of life” (Mauck). Doctors Karen and Clarke state that different patients need to take different actions, based on their doctors’ orders. Therefore, the doctors need to be on their toes, and they need to have both their metaphorical and their physical fingers on the pulse.

Basically, the doctors say that osteoporosis can be prevented by regular, pharmaceutical therapy, such as calcium and vitamin D supplementation, weight-bearing exercise, and fall prevention, and treatments via drugs, which are “antiresorptive[11] and anabolic agents.” Some of these therapies are bisphosphonates or selective estrogen receptor modulators. Bisphosphonates are drugs which are primarily used to prevent the loss of bone mass while estrogen (or hormonal) receptor modulators are pills that stimulate dormant estrogen in the bones.

In short, the Mayo Clinic Preceedings agrees with JAMA, agrees with Higdon, in fact, agrees with everyone – the best method of prevention is exercise, or the best method of prevention is calcium and Vitamin D – but they add on one thing: pills. They add all of the leading preventetive measures together, in combination with bone-intensifying medication, and believe that they’ve found the ultimate step in ridding our bodies of this terrible fiend for once and for all. But before we accept Mauck and Clarke as the definitive objectors to the disease, there is still one more source to analyze.

The National Osteoporosis Foundation (NOF) claims that, as we’ve already discovered, “No one step alone is enough to prevent osteoporosis but all five[12] may.” The NOF is a not for profit organization who’s primary interest is helping those with osteoporosis. However, in their section entitled NOF’s Five Steps to Bone Health and Osteoporosis Prevention, I learned that they agree with Higdon, they agree with Mauch, they agree with Clarke, they agree with Granholz, in saying that not one step was enough.

The NOF’s infamous[13] five steps were ensuring that a warrior in the battle against osteoporosis 1) secures their recommended daily amount (at least) of calcium and vitamin D, they leave out cardiovascular training, but include 2) weight-bearing exercises, 2) take bone health tests regularly, and, if so decided by those tests, take pills to strengthen your bones, 4) avoiding smoking and 5) excessive alcohol consumption (National Osteoporosis Foundation).

The information listed in this research is not cumulative or all encompassing, but it does offer the top preventetive measures for the terrible wicked sickness known as osteoporosis. To be able to suit up and go to war with these leading measures in my arsenal makes me more comfortable then relaxing with a beer on the yoga mat, while fighting the sickness at the same time.

Through my research, I have definitely concluded that calcium prevents osteoporosis. Vitamin D aids calcium in preventing osteoporosis. Exercising prevents osteoporosis, and so does preventing fractures in aging men and women. The right types of medication prevent osteoporosis – when taken in proper doses. When combined, however, all of these preventative measures make for a force osteoporosis does not want to meet in its worst nightmare. I am not scared of going to battle with osteoporosis, and with this information at your fingertips, neither should you be.

Works Cited

Adachi, J. D., W. G. Bensen, F. Bianchi, A. Cividino, S. Pillersdorf, R. J. Sebaldt, P. Tugwell, M. Gordon, M. Steele, C. Webber, and C. H. Goldsmith. “Vitamin D and Calcium In The Prevention of Corticosteroid Induced Osteoporosis: A 3 Year Followup.” J Rheumatol: Rheumatic Disease Unit, St. Joseph’s Hospital, McMaster University, Hamilton, Canada. 24 Feb. 2007. Web. 18 Mar. 2010. <http://www.ncbi.nlm.nih.gov/pubmed/8782129&gt;.

“Bone Builders – Exercise.” The University of Arizona – “Building Stong Bones For A Lifetime” The University of Arizona College of Public Health. Web. 15 Mar. 2010. <http://ag.arizona.edu/maricopa/fcs/bb/exercise.html&gt;.

Casey, Troy R., and Charles W. Bamforth. “Silicon in Beer and Brewing.” Journal of the Science of Food and Agriculture. 2009. Print.

Deenadayalan, Yamini. “The Joanna Briggs Institute: Osteoporosis: Exercise Therapy.” Evidence Summaries – Joanna Briggs Institute. Adelaide, 21 Sept. 2007. Web. 16 Mar. 2010. <https://yulib002.mc.yu.edu:8443/login?url=http://proquest.umi.com/pqdweb?did=1451754971&sid=5&Fmt=3&clientId=13170&RQT=309&VName=PQD&gt;.

Eustice, Carol, and Richard Eustice. “What You Need to Know About (Steroid Drug) Corticosteroid-Induced Osteoporosis.” About Arthritis – Rheumatoid Arthritis – Osteoarthritis – Related Conditions. 15 Apr. 2008. Web. 7 Apr. 2010. <http://arthritis.about.com/od/steroids/a/osteoporosis.htm&gt;.

Gronholz, Jill. “Prevention, Diagnosis, and Management of Osteoporosis-Related Fracture: A Multifactoral Osteopathic Approach.” Journal of the American Osteopathic Association. Oct. 2008. Web. 20 Apr. 2010. <http://www.jaoa.org/cgi/content/full/108/10/575&gt;.

Higdon, Jane. “Preventing Osteoporosis through Diet and Lifestyle.” Linus Pauling Institute at Oregon State University. July 2005. Web. 16 Mar. 2010. <http://lpi.oregonstate.edu/ss05/osteoporosis.html&gt;.

“JAMA — Osteoporosis Prevention, Diagnosis, and Therapy, February 14, 2001, NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy.” JAMA, the Journal of the American Medical Association, a Weekly Peer-reviewed Medical Journal Published by AMA. 14 Feb. 2001. Web. 10 Mar. 2010. <http://jama.ama-assn.org/cgi/content/abstract/285/6/785&gt;.

Mauck, Karen F., MD, MSC, and Bart L. Clarke, MD. “Diagnosis, Screening, Prevention, and Treatment of Osteoporosis – Mayo Clinic Proceedings.” Diagnosis, Screening, Prevention, and Treatment of Osteoporosis. May 2006. Web. 20 Apr. 2010. <http://www.mayoclinicproceedings.com/content/81/5/662.full&gt;.

Nielson, Forrest H. ” Silicon: An Essential Nutrient of Good Bone Health.” United States Department Of Agriculture: Agricultural Research Service. USDA, 23 Oct. 2003. Web. 18 Feb. 2010. <http://www.ars.usda.gov/News/docs.htm?docid=9264&gt;.

“NOF Osteoporosis Prevention – Five Steps to Prevention.” National Osteoporosis Foundation. Web. 22 Mar. 2010. <http://www.nof.org/prevention/&gt;.

Pigozzi, F., M. Rizzo, A. Giombini, A. Parisi, F. Fagnani, and P. Borrione. “Bone mineral density and sport: effect of physical activity.” Journal of Sports Medicine and Physical Fitness 49.2 (2009): 177-83. ProQuest Education Journals. June 2009. Web. 7 Feb. 2010. <http://proquest.umi.com/pqdweb?index=2&did=1876860641&SrchMode=2&sid=4&Fmt=6&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1265578414&clientId=13170>.

“Population Estimates.” Census Bureau Home Page. U.S. Census Bureau, Mar. 2010. Web. 06 Apr. 2010. <http://www.census.gov/popest/estimates.html&gt;.

“Use of Calcium or Calcium in Combination with Vitamin D Supplementation to Prevent Fractures and Bone Loss in People Aged 50 Years and Older: a Meta-analysis : The Lancet.” TheLancet.com – Home Page. Web. 23 Mar. 2010. <http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61342-7/fulltext.>


[1] Believe me, my mom knows how to cook! She makes these fantastic waffles from batter and sometimes she’ll put blueberries or strawberries into them,  with a little bit of maple syrup for a recipe which simply can’t be beat.

[2] In fact, in my research, I stumbled upon my own mother and asked her this very question. Her answer, “calcium makes your bones stronger, of course, Eli,” was frighteningly on target with what my scholarly sources have deduced.

[3] Here, osteoporosis is triggered by corticosteroids – steroids used as medicine.

[4] When artery walls thicken due to cholestorol (or other types of) buildups.

[5] When the joints in a body begin to erode

[6] When an osteopath massages their patients skull, spine, and overall craniosacral system – a term of the trade.

[7] When an osteopath stretches out a certain muscle, and then immediately snaps it back into its place while keeping pressure on it all the while to shorten the muscle and relieve any pain.

[8] In short, the result of one (or multiple) fracture(s).

[9] The term “adequate” is loosely defined in the article, simply leaving it at that. I assume that amounts are based on % of daily value.

[10] These two are listed as the main form of preventative measure, as we already established in the beginning of the paper, but still need help from other measures to reach their maximum level of prevention.

[11] These tend to slow down the remodeling of bones.

[12] And what, exactly, are those five? Read on!

[13] Infamous, to the osteoporotic army, that is.

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