Osteoporosis (Osteopenia) Causes, Treatment & Can It Be Reversed or Prevented (Recent Research)

This article is a transcribed edited summary of a video Bob and Brad recorded in September of 2020.  For the original video go to https://www.youtube.com/watch?v=P130CIaRjpc&t=756s

Brad: Hi Folks, Brad Heineck, physical therapist,


Chris: Hi, I’m Chris, the pharmacist.


Brad: Bob, unfortunately is not here today, he’s enjoying life somewhere else. He’ll be back. We're happy to have Chris here today. He's got plenty of expertise for this title: Osteoporosis, Osteopenia Causes, Treatment & Can It Be Reversed or Prevented. This is highly researched. You spent many hours on recent research for this. We have a lot of good information. Let's clarify Osteoporosis and Osteopenia first Chris. What is it and who does it affect?


Chris: Well, I guess, they’re both brittle bones, weakening of bones. Osteopenia generally would come before osteoporosis. It’s kind of that gradual stage in between: normal bones you go to osteopenia and then you go to osteoporosis. Kind of step wise motion there.


Brad: So, if you have osteopenia, it’s not that bad. Your bones are stronger than they are if you have osteoporosis. That’s measure by what they call a T-score. If you go into the doctor’s, they’ll give you some numbers. I believe if I have this right, -1.0 to a -2.5 is considered osteopenia.


Chris: Correct.


Brad: If it goes worse, a -2.5 or lower, then you’re in the osteoporosis range. I think some people hear the name and they really don’t fully understand. It happens, pretty much to everyone as you age, it’s like getting gray hair. The big thing is, you can treat it, self-treat it to a certain degree. You can do that successfully. So, my question is, as the title, can it be reversed, or prevented, yes or no?


Chris: The answer is yes, so that’s good news.


Brad: All the time?


Chris: I think, most of the time. You have to kind of adhere to some rules. Basically, the big thing with osteoporosis and osteopenia really is to make sure that we’re exercising. You need to have weight-bearing exercise. That’s going to be one of the key elements to trying to reverse or slow it down, depending on where you are in the spectrum.

Brad: Obviously, as a therapist, you’re talking about my wheelhouse. So, it’s like, yes, I can get into this. What else is there?


Chris: Besides the weight bearing exercise, we can look at eating our daily diet. We have to eat a healthy, balanced diet. That’s critical folks. The biggest thing is if you can get your calcium through foods. Dairy products, that’s kind of the primary one for most. Some of us are lactose intolerant. So, then we go to nuts, we go to green leafy vegetables.


Brad: Hold on, Chris. Before we go any farther, I think we need to talk about, what is the big deal with osteoporosis? What happens if you get it? What are the dangers?


Chris: It’s brittle bones, Brad. It means that bones have a higher risk of fracturing. They are most commonly found in your hip, your spine and your wrist. Those are the three most common, but they can be anywhere.

Brad: In therapy, you’ve heard of compression fractures. That happens in the vertebra and these can be very painful. It’s going to change your life for a number of months before it heals. A compression fracture in the spine is not like your bone that completely fractures. A vertebra actually crushes, it changes shape. Your body has to heal and readapt to that, which is very uncomfortable. It’s not an enjoyable thing at all. The hip, you said, is another thing, obviously, I’ve had people that are pretty old at this point. Literally just walking osteoporosis so bad that the bone broke, just snaps, without falling. It’s not real common, but it can happen. Obviously, we want to get after this at an early age so that’s the biggest part of osteoporosis, is the bone being brittle.


Chris: Yes. Basically, the bone is brittle. Basicly, it's like sandstone. Doctors have certain x-ray techniques that they use a variety of different ones but when they look at it, the bone actually looks porous. Bone is a flexible living material and it’s constantly building up and breaking down through all of our lives. What happens over time, by 30, that’s kind of when it really kind of stops increasing. That's pretty young and that's when we want to start to pay attention.


Brad: So, that’s across the board? Male, female, age 30?


Chris: Yes, doesn’t matter. It’s a little bit later for males but I think 30 is reasonable. A lot of times, a lot of the hormones that govern this are what kind of drives the bone formation and at least the bone loss and reformation. When it gets worse for women, menopause, so about 50 is when it really gets bad. For men, our testosterone levels drop off at about age 65, so that’s when that osteoporosis window there. So, what do you do between 30 and 50?


Brad: Right but at that rate, it started but it’s typically very low. You’re not even to osteopenia yet.


Chris: No, not yet. But this is where we can start to pay some dividends. It’s kind of like having a bank and you put money in every week to keep saving it for your retirement. You can think of using calcium the same way.


Brad: That’s a good way to look at it. I like that.


Chris: If we go with that, we are going to try to put calcium in our bank, so to speak and what are we going to do? We are going to do it through diet and exercise are really kind of the primary ways.


Brad: Okay, so drink a bunch of milk.


Chris: Well, yes you can, as long as you’re not lactose intolerant. There are other things we can use. There are supplements that we can use and the most common one is going to be calcium carbonate. That’s a tablet form. These are all over the counter products. Basically, the calcium carbonates, it would be in an antacid like Tums, that’s it’s primary driving force. You can find it in certain vitamin supplements too. One of the keys with making calcium to absorb the best is to make sure it’s coupled with vitamin D. You’re probably going to want to add a thousand IUs of vitamin D.


Brad: I’m not an expert at this, I’m thinking, well, vitamin D, calcium, isn’t both of that in a good healthy milk?


Chris: Sure, can be. Now, food is fortified with D in a lot of cases because D is hard to extract out of the diet. It’s very challenging. The most D that we get is standing right outside in the sunshine. So, in about 10-15 minutes of controlled exposure, and we have to be careful with skin cancer risk but 10-15 minutes without sunscreen, your body generates about 20,000 IUs of vitamin D or 500 micrograms.


Brad: So that’s quite a bit?


Chris: It’s a lot.


Brad: You’re not going to drink that much milk?


Chris: You will never ever, your stomach will explode. Which is a bad day. So, from that standpoint, you’re going to have some serious gastrointestinal stuff.


Brad: For people who don’t want to take pills, even though the pills are across the counter and they’re made out of natural ingredients. Are they made out of natural ingredients?


Chris: Yes, there’s a lot of different ingredients. When you think of calcium carbonate, it’s basically limestone. I mean, rock. It can come from crab shells. There’s a lot of different sources of it. People are very very finicky on what they get for their calcium.


Brad: So, the pills oftentimes are basically natural ingredients, or they can be.


Chris: Yes, they come from the earth.


Brad: I kind of got off track there. Is there other diet supplements or vitamins that are going to help the bone density?


Chris: Absolutely. So, we talked about calcium and D. There’s different forms of calcium, so that again, you’ve got a calcium citrate. Sometimes calcium carbonate, which is the most common one, can upset your stomach a little bit. It can cause things like gas, constipation. It can be rough on you.


Brad: That’s the pill form? It’s calcium carbonate.


Chris: Yes. Then we want to go to something more like calcium citrate. That doesn’t really require, and I should probably backtrack on calcium carbonate. It’s the hardest one to break down also. It requires stomach acid, so you want to make sure you take that with food. When you start to eat, it turns up more stomach acid. What it does is it breaks down that calcium. It absorbs in your intestines better, so it gets into your system better. Some people that bothers their stomachs, so calcium citrate is a lot gentler for them. The knock-on calcium citrate is that you don’t get quite as much calcium. So, you’ll have to take a little bit more to get that 1000 milligram dose. You can go to any pharmacy, you can go to the web, Amazon, whatever source to get it. You can look for calcium supplements. There are