Osteoporosis is a serious medical condition that is unfortunately getting more common.
There are several medications available for the treatment of osteoporosis, but they have some potentially very serious side effects.
So what are some non-prescription things that you can do to strengthen your bones to treat or prevent any bone loss that you may be having?
In this article I will discuss the 9 best natural treatments for osteoporosis and discuss the research behind each one of them.
Let's get started...
Osteoporosis is a condition where a person loses bone mass. It is either due to losing too much bone or not making enough bone.
Bone is living tissue. It is constantly being broken down and replaced. When it is getting broken down faster than it is being made, the bones will gradually become weaker which makes it easier for them to fracture even with normal daily activities.
Unfortunately, osteoporosis is extremely common and is becoming more prevalent.
1 in 7 women over 50 have osteoporosis. About 25% of women over age 65 have osteoporosis of either the hip or lumbar spine. About 5% of men over age 65 have osteoporosis.
About half all women and 1 out of every 4 men over 50 will have an osteoporosis-related fracture in their lifetime.
This is a very serious issue, because after a hip or vertebral fracture, mortality is much higher in those people than in the general population even as late as 10 years after the fracture!
Most of those deaths are not directly due to the fracture. Instead, the fracture is an indicator of a decline in the health of that person and often leads to other conditions that result in death.
The density of a bone is measured using a machine called a DEXA scan (dual-energy x-ray absorptiometry). There are other tests that are used, but the DEXA is considered to be the gold standard.
In this test, 2 x-ray beams are shot through 2 different bones in the body (usually a hip and the lumbar spine). The more dense the bone, the less the x-ray will be able to penetrate. The machine is then able to measure the degree of penetration.
A DEXA scan will give you a T-score and a Z-score for each bone that was tested.
Without going into a boring statistics lecture, I will try to explain what these test scores mean.
Whenever you look at a characteristic found in a large population of people, the results will follow a predictable distribution across a graph.
If you place the values on a graph, it will produce what is commonly called a Bell Curve.
This is true when you measure bone densities as well. However, in this case the positive side of the graph is ignored and only the negative side is considered.
The middle (mean) of the bell curve is the bone density of a healthy 30 year old female, which is the time when the bone density is at it highest point.
The T-score is how many standard deviations from the mean (or middle of the graph) the tested bone scored. The Z-score compares your bone density to a normal score for a person of your same age and body size.
The diagnosis of osteoporosis is made when the T-score is less than or equal to -2.5, which is way over on the far left of the bell curve. That means the density of the bone tested is less than the bone density of 95% of the population!
If the T-score is -1.0 to -2.4, the diagnosis of osteopenia is made. While not considered to be as dangerous as osteoporosis, it still indicates that the person is losing bone mass, especially the lower the T-score. Those patients should be monitored closely and proactive measures should be taken to reduce any further bone loss.
Okay, so you've had a DEXA scan and your T-score is in the osteoporosis range.
Your doctor will probably recommend that you start taking a medication called a bisphosphonate. However, when you get home and read the package insert that came with the medication, what you read may scare you to death!
These medications are far from benign. The potential side effects range from mild to life-threatening. They include:
While this class of drugs has been shown to reduce the risk of osteoporosis-related fractures, that reduction might come at a cost. Needless to say, it would be best if this class of medications was avoided completely.
I believe there are several things that you can do that are natural and much safer than these drugs.
Let's discuss the best ones below:
If you ask your doctor what is the best way to keep your bones strong, he or she will most likely say something like this: "Eat good, healthy foods and exercise regularly."
That is good, sound advice for just about everyone. However, it is hard to get enough of some nutrients from food, even if you are eating a whole food, nutrient-dense diet.
Because of over-farming, genetic engineering, etc., the nutritional value of food simply isn't what it used to be. Even if you are eating a purely organic diet, you will probably be deficient in some nutrients.
This is especially true if you have any digestive or other gastrointestinal issues, which can impair the absorption of what nutrients are in your food.
So what can you do to keep your bones strong and help regain bone loss if your DEXA scan shows you have osteoporosis or severe osteopenia?
The first thing that I recommend for all patients with osteoporosis is to participate in weight-bearing exercise on a regular basis.
This includes walking, jogging, dancing, using an elliptical, stair climbing, gardening, etc.
This type of exercise puts a direct burden on the bones and muscles of the lower body which helps to slow mineral loss.
Studies show that this can beneficial for people with osteoporosis:
- Weight bearing exercise increases both bone density and quality of life.
- Walking has been shown to preserve bone density in the hip.
- Jogging and weight lifting reduce bone loss in postmenopausal women.
Other exercises such as biking and swimming are great for cardiovascular health, but they are not beneficial for strengthening bones.
Vitamin D has many functions in the body, including the regulation of calcium and phosphorous absorption.
If vitamin D is low, parathyroid hormone (PTH) increases and triggers osteoclasts to release calcium into the blood via bone reabsorption. Over time, this can lead to bone loss and osteoporosis.
Vitamin D also stimulates intestinal epithelial cells to synthesize calcium-binding proteins that support the absorption of calcium in the blood.
Vitamin D increases the number and activity of osteoblasts (the cells that build bone) and reduces the activity of osteoclasts (the cells that break down bone).
Vitamin D is synthesized when sunlight hits the skin.
Vitamin D deficiency is now recognized as an epidemic.
Experts state that 75% of population is deficient in vitamin D. When using the goal of 50-80, that number goes to about 95%.
Deficiency is more common in dark-skinned people, the elderly, and people from the north.
You can determine if you are low in vitamin D by asking your doctor to order a 25-hydroxy-vitamin D level with your next blood work.
The "normal range" for a 25-hydroxy-vitamin D is 30-100 ng/ml, but it is optimal to have it in the 50-80 range.
So what can you do about it?
Good dietary sources of vitamin D - fatty fish (salmon, mackerel and tuna), dairy products (if you aren't sensitive), eggs, and shiitake mushrooms.
In my experience, the majority of people will need to take a vitamin D supplement to get the levels in the optimal range.
A study published in JAMA in 2013 showed that vitamin D supplementation reduced the risk of fractures by 16%.
Vitamin D3 is the best supplementation of choice to increase your vitamin D level. Click here for my preferred brand.
If your 25-hydroxy-vitamin D level is <30 ng/mL, I typically recommend that you take 10,000 iu (2 capsules) of the ADK daily for 90 days then reduce it to 5000 iu (1 capsule) daily after 90 days. If your level is >30 but <50, I recommend only taking 1 capsule daily (5000 iu).
You may notice that my recommended amounts are WAY higher than the recommended daily amount (RDA) given by the Institute of Medicine (IOM) in 2011. They state that everyone should aim for a 25-OH-vitamin D level of 20 ng/ml, which would equate to taking 600 iu of vitamin D3 daily (800 iu daily if you are over age 70).
If you are interested (and are a statistics nerd!), the following video of a talk given by Keith Baggerly, PhD, will show how the IOM made a mathematical error in their calculations when they determined the RDA for vitamin D.
Dr. Baggerly showed that the actual amounts of vitamin D3 needed are 10x that amount! In other words, most people under age 70 need about 6000 iu of vitamin D3 daily, while people over age 70 need about 8000 iu daily.
Please note that for vitamin D to work properly, it is just as important that the vitamin K2 and magnesium levels are optimal as well. I will discuss each of these nutrients below.
Magnesium is important for building bone, absorbing calcium, and forming ATP. It also serves as a cofactor in the production of vitamin D in the skin.
It is estimated that 75% of the population is deficient in magnesium.
Low levels of magnesium in the blood correlates with a low bone density.
Patients with osteoporotic fractures were also found to have lower magnesium levels than patients without osteoporosis.
Magnesium deficiency may impair the production of parathyroid hormone and 1, 25-dihydroxyvitamin D, which negatively affects the mineralization of bone.
Good dietary sources of magnesium - nuts, whole grains, dark green vegetables, fish, meat, and legumes.
Magnesium is often deficient in the standard American diet because of lack of those foods plus soil depletion from over-farming.
What about magnesium supplements?
Supplementing with 250-400mg per day of Mg is recommended. Click here for my preferred brand.
Magnesium glycinate is preferable over magnesium oxide because it causes less incidence of loose stools.
Please keep in mind that magnesium may interact with other supplements and medications.
Magnesium can also help with insomnia, headaches, chronic constipation, restless leg syndrome, and anxiety.
Studies have shown that vitamin K2 is absolutely essential when it comes to achieving optimal bone and cardiovascular health.
According to some experts, 98% of the population is deficient in K2.
There are no commercially available tests to determine the level of vitamin K2 in the body.
Elderly patients with osteopenia are usually deficient in K2. They need K2 to help reduce bone loss that comes with age and to maintain bone health.
In Japan, 360mcg of K2 is the primary treatment for osteoporosis – NOT bisphosphonates!
Vitamin K2 appears to help the body deposit calcium in appropriate locations like the bones and teeth and prevents it from being deposited in bad places, such as arterial walls.
Vitamin K2 has also been shown to reduce the risk of prostate cancer by 35%.
It has also been shown to reduce the risk of coronary heart disease.
Good dietary sources of vitamin K2 - cheese, eggs, natto, butter, salami, chicken breast, ground beef
What about vitamin K2 supplements?
The MK-7 form of vitamin K2 is by far the most potent.
Since most people are also deficient in vitamin D, I have found that it is easiest to take a supplement that has vitamins A, D3, and K2 together in a single supplement capsule.
These supplements work synergistically to strengthen bone.
Strontium is a naturally occurring mineral present in soil and seawater. It is an alkaline earth metal similar to calcium and barium.
99% of the strontium found in the human body is in our bones.
The Spinal Osteoporosis Therapeutic Intervention study showed a 41% relative risk reduction of vertebral fractures in patients taking strontium.
This study showed a reduction in nonvertebral fractures when using strontium.
Strontium appears to decrease bone resorption and increase bone formation.
It has been shown to increase bone density in both men and women.
A radioactive form of strontium is used to treat bone cancer and prostate cancer.
Dietary sources of strontium - seafood, milk, grains, beans, spinach, celery, carrots and potatoes
What about strontium supplements for osteoporosis?
Strontium is generally well tolerated, but some concerns are begin raised in Europe over whether there is an increased cardiovascular risk when it is used long term. It has been available as a prescription treatment for osteoporosis in Europe since 2004.
Strontium is available in the US as strontium citrate. Click here for my preferred brand.
You will want to make sure your vitamin D level is optimized.
Do not use strontium if you are on kidney dialysis or if you have a history of severe heart disease.
This may be a viable treatment option for osteoporosis, but please be aware that long-term safety studies are lacking.
At this point, I would reserve its use for only short term use (1-3 years) until long term studies are available.
Boron is a trace mineral found naturally in some foods and in the environment.
Boron reduces the excretion and absorption of calcium, magnesium, and phosphorus, which results in a reduction in bone loss.
Boron up-regulates the production of steroids such as vitamin D, estradiol and testosterone.
Dietary sources of boron – fruits, vegetables, soybeans, and nuts. The amount of boron in these foods depends on the soil where they are grown.
What about boron supplements for osteoporosis?
It is always best to get boron from your diet.
A safe daily intake is about 1-10mg. Click here for my preferred brand.
Doses above 3mg per day are not recommended in breast cancer patients.
Repeated doses of small amounts can accumulate in the body, so pulse dosing is recommended over continuous dosing.
Testosterone is a hormone that grows tissue in the body.
It is responsible for muscle growth, bone growth, hair growth, sexual function, sexual drive (libido) and is essential for overall health and feelings of well-being.
Both men and women need testosterone.
Testosterone pellet therapy has been shown to increase bone mass four-fold compared to oral estrogen.
Testosterone can be used as a bioidentical cream, an injection, or as a bioidentical subcutaneous pellet. All of these can only be provided by a licensed medical professional.
Isoflavones are found in soy products. The best of these are what are called fermented soy. They include natto, tempeh and miso. All of these are soy products that have gone through a long fermentation process that make them easier to digest.
Natto is fermented soybeans that is sticky and has a very strong flavor.
Tempeh is a fermented soybean cake with a firm texture and a nutty flavor.
Miso is a fermented soybean paste with a salty, buttery texture. You have probably had miso soup at your favorite Asian restaurant.
They are loaded with vitamin K2 which I discussed above. They also contains boron.
Soy isoflavones significantly increase the bone density of the lumbar spine.
Diets high in soy may decrease bone resorption in postmenopausal women.
A synthetic derivative of isoflavones called iproflavone was shown to prevent rapid bone loss following early menopause.
Consuming 2-4 ounces per day of fermented soy is a reasonable thing to do to prevent and treat osteoporosis.
Keep in mind that many people are allergic or sensitive to soy. If that is you, then this is not a good choice.
Isoflavones may also inhibit thyroid hormone synthesis. So if you have a thyroid condition, your thyroid levels needs to be monitored if you consume fermented soy to treat your osteoporosis.
Unfermented soy which is found in tofu and other processed forms is not a healthy food option and should be avoided as a general rule.
Most doctors are taught in their training to recommend calcium supplementation to help maintain bone mass. I myself commonly told my patients in the past to take 1200mg of calcium citrate per day, especially postmenopausal women.
However, several studies have brought the benefit of calcium supplementation into question.
In this study, taking higher amounts of calcium beyond the recommended dietary allowance did not result in an increase of hip or spine bone density.
Calcium supplementation in a different study did not result in a decrease in the incidence of hip fractures in older women and even appeared to increase the risk.
A study published in JAMA in 2013 was a meta-analysis of 29 studies which showed no significant reduction in the risk of fractures with calcium supplementation. Vitamin D plus calcium did reduce the fracture risk.
Not only have these studies failed to show a benefit on bone density, some other studies have shown some dangerous consequences of taking calcium supplements:
A Johns Hopkins investigation in 2016 showed that taking calcium supplements may lead to an increased risk of plaque buildup in the coronary arteries.
Another study of 12000 men showed a 20% increase in CVD death in those taking 1000mg of calcium daily.
Eating foods that are high in calcium does not seem to have the same risk. It is felt that the calcium from food is absorbed at a slower rate. The burst of calcium from supplements may facilitate the calcification of arteries.
Another theory is that taking more calcium than the body needs may cause it to either be excreted in the urine which increases the risk of kidney stones, or circulated in the blood where it could attach to atherosclerotic plaques or valves.
This meta-analysis showed an increase in prostate cancer risk with a high calcium intake, but it is hard to know if it was due to the calcium or due to the high dairy intake.
A high calcium intake is well known to cause constipation. It might also interfere with the absorption of iron and zinc.
In people with a sensitivity or allergy to dairy or other foods that are good natural sources of calcium, supplementation may be necessary. However, I would personally limit that to only 400-600mg per day of calcium citrate.
Osteoporosis is an extremely common and dangerous condition.
It needs to be monitored closely and aggressively treated when possible.
Like most conditions that affect the human body, eating a whole-food, nutrient-dense diet and exercising regularly (especially weight-bearing exercise) are the mainstays of treatment.
Optimizing the levels in the body of vitamin D, K2, and magnesium are essential to maintain and restore bone density.
Other options for increasing bone mass include strontium, boron, and soy isoflavones. Optimizing testosterone levels can also help.
Calcium supplements are controversial. I would typically suggest avoiding them and instead focus on eating foods that are naturally high in calcium.
Now it's your turn...
Have you been diagnosed with osteoporosis?
What treatments have worked for you?
Leave your questions and comments below...
Dr. Whelchel is a family physician who specializes in functional medicine, especially hormone optimization. He has over 20 years experience in private practice managing patients with various medical issues. His passion is helping patients reach their full potential of wellness and quality of life. He grew up in the Texas Panhandle where he currently lives. He is married and has 3 awesome children.