Osteoporosis | Robert Lang, MD


Prevention is Paramount!

Osteoporosis – or literally "porous bones" – attacks the very structural base of our human body. Osteoporosis causes your bones to become weak and brittle — so brittle in fact that in severe osteoporosis, a simple fall or even inconsequential mild stresses like bending over or coughing can cause a fracture.

In many cases, low levels of calcium and other nutrients in your diet are what leads up to this debilitating condition (See below for a list of the major risk factors).

Osteoporosis fractures occur mostly in the spine, hips or wrist. When the bones in the spine compress due to osteoporosis, you can actually shrink in size, sometimes losing several inches in height. This loss can occur as a sudden painful compression fracture - or slowly with nothing more than intermittent backaches and gradual loss of height.

Surprisingly, 50-75% of the time the loss is slow, resulting in the gradual onset of kyphosis or what’s more commonly known as dowagers hump. Although it's often thought of as a women's disease, osteoporosis affects men too.

The onset in men is generally 10-20 years later than in women. This is for two distinct reasons:

  • Men start off with stronger bones to begin with

  • Men lose testosterone more slowly than women lose estrogen. (These respective male and female hormones are one of the factors responsible for maintaining healthy bone mass.)

Even if you don’t show signs of full scale osteoporosis, you may have low bone density, now commonly called osteopenia, putting you at risk of developing true osteoporosis if your bone loss isn’t stopped.

Osteopenia can be thought of as a sort of early warning sign between healthy bone mass and osteoporosis. In osteopenia, bone mineral density (BMD) (the level of minerals in the bones indicating how dense and strong they are) is lower than normal peak BMD, but not low enough to be classified as true osteoporosis.

If your BMD is low compared to normal peak BMD, you have osteopenia. Having osteopenia means there is a greater risk that, as time passes, you may continue losing bone minerals and develop osteoporosis.

The gold standard test for BMD is dual energy absorptiometry or DXA for short, which measures the density of the spine and hip, the two areas of most concern. Tests measuring the heel and finger should only be used for screening, and never for prescribing treatment. In fact, these finger and heel measurements became popular about 20 years ago because they were far less expensive than DXA.

Now that DXA is so widely available and less costly, I believe that every woman should have a baseline BMD measurement at menopause, and men tested at age 70, or earlier if at high risk. The earlier bone loss is detected the more time you have to do something to prevent further loss and complications.

Facts About Osteoporosis:

  • 1.5 million osteoporosis related vertebral fractures happen each year…

  • 1 in 2 woman age 50 and above will suffer vertebral fractures…

  • 1 in 4 men age 50 and above will suffer vertebral fractures…

  • 70 year olds are 7 times more likely to fracture a hip than 50 year olds

  • Women in their 80s have a 1 in 3 risk of a hip fracture

  • Men in their 80s have about a 1 in 4 risk of hip fracture

There is currently no cure for osteoporosis. However it can be significantly delayed with early detection and treatment – including diet, exercise and nutritional supplements.

Risk Factors for Osteoporosis & Osteopenia


  • Tobacco use

  • Excessive alcohol (3 drinks or more daily)

  • Inadequate intake of nutrients needed to make bone especially proteins, calcium, magnesium, manganese, copper, zinc, B vitamins

  • Sedentary life style – little or no exercise

Health Issues

  • Low estrogen levels in women

  • Low testosterone (men and women)

  • History of anorexia and/or bulimia

  • Early menopause or infrequent or absence of menstrual cycles

  • Family history of fractures (especially mother, father or sister)

  • Height loss of more then 1 1/2 inches

  • Loss of weight for any reason, especially after bypass surgery

  • Celiac disease, Crohn’s disease or other cause of poor nutrient absorption

  • Kidney disease

  • Vitamin D deficiency

  • Hyperthyroidism or excessive doses of thyroid hormone

  • Hyperparathyroidism

  • Prostate cancer treatment

  • A history of fractures with minimal or no trauma (stress fractures)

Age & Race Factors

  • Asian or Caucasian

  • Thin, small body frame

  • You're a woman age 65 or older

  • You're a postmenopausal woman under age 65 with one or more risk factors for osteoporosis

  • You're a man age 70 or older

  • You're a man between age 50 and 70 with one or more risk factors for osteoporosis

  • You're older than age 50 and you've experienced a broken bone

  • You're a postmenopausal woman and you've stopped taking estrogen therapy or hormone therapy


  • Steroids (cortisone, prednisone, or similar) including high doses of inhaled steroids for asthma

  • PPI’s or antacids for acid reflux

  • Actos for diabetes

  • Anticonvulsants for seizures

  • Some chemotherapy medications

  • Drugs to suppress the immune system for conditions such as organ transplant, lupus, arthritis, inflammatory bowel disease

  • Depo-Provera for contraception or other female conditions

  • Aromatase inhibitors such as anastrozole for treatment of breast cancer

  • Thyroid hormone (but only at excessive doses)

  • SSRI antidepressants such as Prozac, Paxil, and similar medications

While the above chart seems rather expansive, there are a number of things you can do right now for reducing these risk factors.

Risk Factors You Can Change

  • Low Calcium Intake. A lifelong lack of calcium plays a major role in the development of osteoporosis. Low calcium intake contributes to diminished bone density, early bone loss and an increased risk of fractures.

  • Tobacco Use. The exact role tobacco plays in osteoporosis isn't clearly understood, but researchers do know that smoking contributes to weak bones.

  • Eating Disorders. Women and men with anorexia nervosa or bulimia are at higher risk of lower bone density.

  • Sedentary Lifestyle. People who spend a lot of time sitting have a higher risk of osteoporosis than their more active counterparts.

  • Excessive Alcohol Consumption. Regular consumption of 3 or more alcoholic drinks a day increases your risk of osteoporosis.

  • Corticosteroid Medications. Long-term use of corticosteroid medications, such as prednisone and its active metabolite prednisolone, cortisone, and dexamethasone are damaging to your bones.

    These medications are common treatments for chronic conditions, such as asthma, rheumatoid arthritis and lupus, and you may not be able to stop taking them. If you need to take a steroid medication for long periods, your doctor should monitor your bone density and recommend other drugs to help prevent bone loss.

  • Other Medications. Long-term use of aromatase inhibitors to treat breast cancer, antidepressant medications called selective serotonin reuptake inhibitors (SSRIs), the cancer treatment drug methotrexate, some anti-seizure medications, the acid-blocking drugs called proton pump inhibitors and aluminum-containing antacids are all associated with an increased risk of bone loss.

Tai Chi, Yoga & Osteoporosis

Loss of height as we get older can be due to fractures of the spine in people with severe osteoporosis. But the most common cause is due to shrinkage or compression of the discs between the spine bones. The curvature of the spine as we get older is mainly because the muscles in front of our spine are much stronger than those in the back.

Animals that are hunters (think cat and dog), instinctively stretch when they awaken from a nap. This keeps their spine supple and strong. If you don’t stretch the muscles in front of the spine and strengthen the ones in the back, you’ll end up with kyphosis, the medical term for a dowager’s hump. That’s why Yoga and Tai Chi have been around for so many hundreds of years; they help keep our spine straight by not only stretching the front and back spinal muscles, but also by releasing tension both physically and mentally.

Prevention is Key!

Three factors essential for keeping your bones healthy throughout life are:

  • Adequate amounts of calcium as part of a balanced diet,

  • Adequate amounts of Vitamin D (minimum 2000 IU per day, 5000 IU or more if you have an autoimmune disease)

  • Regular exercise.

Dietary Calcium

The amount of calcium you need to stay healthy changes over your lifetime. The Institute of Medicine (IOM) recommends the following amounts of daily calcium from food and supplements:

  • Up to 1 year old — 210 to 270 milligrams (mg)

  • 1 to 3 years — 500 mg

  • 4 to 8 years — 800 mg

  • 9 to 18 years — 1,300 mg

  • 19 to 50 years — 1,000 mg

  • 51 and older — 1,200 mg

Dairy products are one, but by no means the only source of calcium. Be aware that there are actually no good studies showing that dairy products actually help prevent bone loss, this according to Walter Willet, M.D. PhD, the nutritional guru from Harvard.

It’s not known why, since dairy products have so much calcium. One speculation is that the pasteurization process subtly changes the health benefits of milk and milk products by inactivating and destroying certain enzymes. Unfortunately most of the research into calcium absorption from dairy products is sponsored by the Dairy Council and therefore is subject to bias.

I personally am not against using dairy products, but want people to know that trying to get all of your bone-promoting nutrients strictly from dairy food may not be the best course of action. There are a host of other healthy and tasty foods that are rich in calcium and other essential bone-building nutrients. For instance, almonds, broccoli, spinach, cooked kale, organic eggs, canned salmon, and canned sardines (with the bones!) are all rich sources of calcium.

But please remember, there’s such a thing as taking too much calcium! The Institute of Medicine (IOM) recommends taking no more than 2,500 mg of calcium daily. Moderation is important because too much calcium can interfere with the absorption of other minerals.

Osteo Nutrients II
Calcium, Magnesium & More

If you’re finding it difficult to get enough calcium from your diet, taking a calcium supplement such as Osteo-Nutrients is an excellent choice for preventing bone loss. If you’re trying to lose weight, this also has the added benefit of not adding excess calories to your diet.

OSTEO-NUTRIENTS II is a comprehensive bone support formula containing optimal amounts of readily absorbable elemental calcium and magnesium, as well as other essential nutrients for healthy teeth and bones.

Don’t be fooled into paying a lot more for expensive “food based” or “natural” calcium products which claim to be “proven better.” The tests used to back up these statements are inadequate and not scientifically valid. Plus, some of these preparations may be contaminated with heavy metals such as lead and mercury, especially those derived from shellfish organisms.

The calcium in Osteo-Nutrients II is essential to many physiological functions, such as helping to maintain and build bone mass and strength before and during menopause.

Magnesium is included as another necessary mineral for building and maintaining healthy bone mass. Plus, magnesium plays a crucial role for optimal health of the nervous system, muscles, bowels and virtually every organ in your body.

Boron, vitamin D and silica which play a vital roles in optimum bone health, are also added to this formula.

Recommended Dosage: 1-2 capsules twice daily (depending on your intake of calcium from other sources) taken with food, or as directed by a healthcare practitioner. I recommend taking 1 capsule with breakfast and 1 with dinner, ensuring your body has a steady, constant supply of calcium.

If the calcium intake isn’t spread out over the day, your body will take it from your bones if your calcium levels fall too low. One Osteo-Nutrient II is approximately equivalent to one serving of dairy.

Osteo-Nutrients II

Order Your Osteo-Nutrient II Bone Support Formula Here

Vitamin D

Getting enough vitamin D is just as important to your bone health as getting adequate amounts of calcium. Unfortunately, few people get adequate amounts of vitamin D from sunlight. It seems the paranoia spread about the “dangers of sunlight” has been quite effective in making people think getting a tan is tantamount to inviting skin cancer into your life.

Here’s the truth of the matter: Other types of cancer such as breast, colon and prostate are more prevalent in those who shun the sun! If you're housebound, or if you regularly use sunscreen or avoid the sun entirely, you’re putting yourself at risk for vitamin D deficiency.

More importantly, much higher doses of Vitamin D are needed to prevent many other common conditions such as: Diabetes, heart disease, Alzheimer’s, osteoarthritis, obesity, cancer (including breast, prostate, colon and at least 10 other cancer types), autoimmune disorders (such as rheumatoid arthritis, lupus, and Crohn’s Disease) and high blood pressure.

We currently recommend taking a minimum of 2000 IU of vitamin D daily. We monitor the Vitamin D level in our patients and recommend higher supplementation if levels are low. The test we order are the most accurate is the 25-OH (hydroxy) Vitamin D.

“Normal” values are between 20 and100. However, since up to 90% of “normal” people at northern latitudes are Vitamin D deficient, the “normal” range is biased to a low “normal.” In fact, people with levels below 50-60 are at higher risk for all the conditions listed above. That’s why we recommend our patients be at a minimum level of 60. It’s important to know that current government recommendations are based only on one factor - bone loss prevention, which is a paltry 800 IU of Vitamin D daily.

I personally and professionally recommend taking higher doses of vitamin D for the prevention of many common chronic health conditions as listed above.

Vitamin D3

Order Your Vital Nutrients Vitamin D3 Here


Along with eating the right foods and taking the proper supplements, I can’t stress enough the importance of regular, sensible exercise.

For creating and maintaining healthy bones, any weight-bearing exercise is beneficial, but walking, running, jumping, dancing, and weightlifting seem particularly helpful. Swimming and bicycle riding although great for aerobic exercise, unfortunately isn’t beneficial for bones. (Water makes you essentially near weightless and bicycling is not weight bearing!)

Don’t Let Osteoporosis Gain An Upper Hand!

Not having enough calcium in our diet is one of the most common factors associated with an increased risk of osteoporosis, with all its associated problems: Weak and fragile bones, loss of height, curved spines, and bone fractures.

For those of us who are lactose intolerant or are watching our calories, it’s especially important to take calcium & mineral supplements – ensuring our bones have all the building blocks necessary for staying strong and healthy, no matter what stage in life we’re in.

Be well…

Robert Lang, M.D.



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