Bone Health

Dem Bones Dem Bones 

When we look at the skeleton, we might think that bones are dead matter and do not count for much. Bones, however, are a living substance and one of the most active tissues in the body. They support all the other body structures, as well as protect delicate structures such as the brain, spinal cord, lungs, heart, and major blood vessels. They are also the levers to which the muscles of the body are attached – without them the muscles would not be able to move us around. Finally, they are critical in blood cell production.

Despite their importance, it is often forgotten that the bones are more than just a collection of calcium crystals that simply require more calcium to remain healthy. In reality, bone is a composite made up of connective tissue, proteins, and many different minerals. As complex structures, bones need complex nutritional support to stay strong and healthy. At approximately 30 years of age, bones reach “peak mass,” which means they stop forming density, and natural bone loss occurs at a rate of approximately 0.3–1% per year. Bone loss occurs at the same rate in both men and women until menopause, when bone loss in women becomes two to six times faster.

Bone remodeling (i.e., bone formation and resorption) continues throughout life. Basically, three types of cells are involved in bone remodeling:
Osteoclasts are bone-resorbing cells that break down bone.
Osteoblasts are bone-forming cells that help to build new bone.
Osteocytes are bone cells that manufacture type 1 collagen and other substances that make up the extracellular matrix of the bone. 

Osteoporosis is heavily influenced by chronic, low-grade inflammation and metabolic dysfunction, particularly involving lipid and glucose metabolism. The interplay between these factors often causes bone resorption to outpace bone formation, accelerating bone loss. 

Bone loss occurs when there is increased osteoclast activity or decreased osteoblast activity. Bone strength depends not only on the quantity of bone tissue but also on the quality. This is determined by the shape and architecture of bones, by the turnover rate between osteoblasts and osteoclasts, and by mineral content and collagen.

The Missing Link – Collagen
Collagen production naturally begins to decline in our mid-20s, decreasing by about 1% per year. By the time people reach their 60s, 70s, and beyond, their body’s natural collagen production is at a very low level.

The bone matrix is a system that involves calcium and other minerals to provide stiffness, and the collagen fibres provide the toughness and ability to absorb energy. The mineral portion comprises 70% of the bone matrix, and collagen makes up 30%. This combination of collagen and calcium makes bone both flexible and strong, which in turn helps bone to withstand stress.

Another important role collagen plays in the bone matrix is driving calcium into the bones. Each collagen fibre contains “calcium-binding sites,” whereby the more collagen there is in the bone, the more calcium is absorbed. Variations in collagen production or a deficiency in collagen can therefore affect the strength and mechanical properties of bone, and increase fracture risk.

Keratin and collagen type I are major proteins in nail and bone, respectively. Both of these proteins undergo compositional modifications in relation to bone thinning.

Collagen also forms 60% of cartilage, which provides flexibility to joints, maintains structural integrity, reduces pain, and improves mobility.

Osteoporosis
Osteoporosis, while traditionally considered a metabolic disease, it is now recognized as having a significant chronic low-grade inflammatory component as well. Inflammation plays a key role by activating osteoclasts via proinflammatory cytokines, leading to increased bone loss, especially in conditions like arthritis or age-related inflammation.

In osteoporosis, bones become porous and are easily fractured or broken. When bone breaks down faster than it can be rebuilt, this leads to the increased fragility commonly seen in older adults, along with the accompanying fractures, particularly of the hip, spine, and wrist. It is one of the most debilitating and costly illnesses that may confront us as we age. 

Fractures from osteoporosis are more common than heart attack, stroke, and breast cancer combined, and osteoporotic hip fractures consume more hospital bed days than stroke, diabetes, or heart attack. What is also alarming is that less than 20% of fracture patients in Canada currently undergo diagnosis or adequate treatment for osteoporosis.

Some Osteoporosis Facts:

• Over 2.3 million Canadians live with osteoporosis.
• One in four Canadian women and one in eight men over the age of 50 will be diagnosed with osteoporosis,
• Over 80% of all fractures in people 50+ are caused by osteoporosis.
• 1 in 3 hip fracture patients will re-fracture within one year.
• A Canadian study found that roughly one in five women and one in three men die within one year following a hip fracture. Mortality is largely attributed to complications from being confined to bed, or exacerbation of pre-existing conditions.
• 80% of patients with a history of fractures are not recommended further testing to rule out osteoporosis
• Hundreds of thousands of Canadians needlessly have a fracture each year because their osteoporosis goes undiagnosed and untreated. 

A recent study reported that only 44% of people discharged from hospital for a hip fracture return home; 10% go to another hospital, 27% go to rehabilitation care, and 17% go to long-term care facilities. Osteoporosis can result in disfigurement, lowered self-esteem, reduction or loss of mobility, and decreased independence.

 Osteoporosis is referred to as a “silent disease” because often there are no signs or symptoms. However, some early warning signs that can indicate decreased bone density include:

• Chronic back pain; deep bone
• Oral bone loss - and bone loss, tooth loss
• Extreme fatigue
• Loss of height - loss of 2 cm (3/4") measured by ones healthcare provider or 6 cm (2-1/2") overall from when one was younger may indicate a spinal fracture.
• Kyphosis (dowager's hump) 
  
• Night cramps in the legs and feet
• Poor nail growth or brittle nails
• Compression or stress fractures
• People with osteoporosis are more likely to have vertigo. It is believed to be caused by loose calcium carbonate crystals that move in the sensing tubes of the inner ear. 

Risk Factors for Osteoporosis

• Natural aging and hormonal changes in men and women
• Excessive alcohol intake (> 4 drinks per day for men; > 2 drinks per day for women)
• Caffeine intake (> 2.5 cups per day
• Gastrointestinal disease (celiac)
• Thyroid disorders
• Chronic steroid use
• Smoking
• Family history of osteoporotic fracture
• Low body weight
• Low calcium, vitamin D, vitamin K2, magnesium and collagen 
• Low level of physical activity 
• Caucasian or Asian

Most adults over 65 years have some degree of osteoporosis whether they are aware of it or not. The good news is there are many things a person can do to prevent osteoporosis from getting worse. Strengthening the bones, no matter what stage of the disease, is absolutely crucial in order to prevent fractures in the first place or to prevent fractures from recurring. Routine bone density testing to check for osteoporosis is generally recommended for all women aged 65 and older and all men aged 70 and older.

 If you have not had a bone density scan, or had vitamin D levels tested, then request these tests from your health practitioner. This is a big step in taking proactive steps to prevent fractures. 

Taking Care of Dem Bones, Dem Bones

Magnesium and vitamin D may be as important, if not more important, than calcium supplementation when it comes to strong bones. Aging itself is a risk factor for magnesium deficiency, which accelerates aging through effects on various systems: muscular, cardiovascular, hormonal, kidney, bone, immune, stress, and antioxidant. Vitamin D is well known for its role in building strong bones and teeth, as it promotes calcium absorption and use in the body. Vitamin D deficiency is common in older adults with osteoporosis; increased Vitamin D has proven useful for reducing fractures and maintaining bone health.

A meta-analysis of five double-blind trials (including a total of 9292 individuals at least 60 years of age) found that supplementation with 700–800 IU daily of vitamin D reduced the incidence of hip fractures by 26%.

Around the age of 70, magnesium absorption is only two-thirds what it is at age 30. Magnesium is essential for the activation of vitamin D and acts as a necessary cofactor for the enzymes in the liver and kidneys that convert vitamin D into its active form. Without adequate magnesium, vitamin D supplementation may be less effective.

Calcium is a well-known component for the prevention of osteoporosis as well as for the maintenance of good bone health. However, remember that calcium alone may have only a slight protective effect for bone health, and that a combination of the key bone builders such as vitamin D, K2 and collagen are fundamental in any healthy bone program. The requirements for calcium increase as people age because of reduced intestinal calcium absorption due to low stomach acid.

Based on the concerns that calcium supplementation increases the risk for kidney stones and cardiovascular disease, aim to meet requirements for calcium through diet when possible. The recommended daily intake is 1000 mg/d for men and 1200 mg/d for women.

Collagen peptide supplementation, particularly when combined with calcium, vitamin D, and regular exercise, is associated with continuous improvements in BMD, bone turnover markers, and muscle function, as shown by a 2025 meta-analysis. Collagen helps to regulate osteoblasts (cells that build bone), reducing the speed of bone breakdown.

All these variables are important for fracture prevention and collagen is an effective adjunct therapy for managing osteoporosis.

Vitamin K2 is an important component of bone formation and remodelling. It is required to produce osteocalcin, a protein found in large amounts in bone. Osteocalcin attracts calcium to bone tissue, enabling calcium crystal formation to occur and thus supporting bone mineralization. Many studies have found that vitamin K2 levels are significantly lower in those diagnosed with osteoporosis, and that decreased vitamin K2 intake is associated with an increased incidence in hip fractures in both men and women.

Boron is a trace mineral essential for the growth, maintenance, and structural integrity of bone tissue. Boron improves the body’s ability to use calcium, magnesium, and vitamin D, which are critical for preventing bone loss and increasing bone mineral density. Studies have found boron to reduce urinary excretion of calcium by 44%; reduce urinary magnesium excretion; and increase serum 17 beta-estradiol and testosterone levels.

Protein: Healthy protein sources should be encouraged, including chicken, turkey, fish, legumes, nuts and seeds, and eggs. Organic, hormone-free, antibiotic-free lean animal meats should be eaten whenever possible. Nutritional factors that speed up calcium loss from the bones and contribute to osteoporosis include high salt intake, refined sugars and grains, excess coffee and alcohol, and soft drinks. If you are not getting enough protein in your food, protein powder can easily be added to smoothies – a simple way to increase daily protein requirements.

 Exercise Is NOT an Option!

If you did not have a regular exercise routine in your younger years, it may be difficult to know where or how to start. Just do it … get up and start by going for a small walk. If you require a walker, then use the walker.

 Improvements in mental health, physical health, cognitive function, and quality of life are associated with regular physical activity. It is also a protective factor for cardiovascular disease, stroke, diabetes, and dementia.

 Strength training has been shown to increase lean body mass and improve physical performance, which has a positive effect on preventing frailty and falls.  Falls commonly occur as a result of bone fracture not the other way around – fractures do not cause the fall.

 Most people want to remain independent as long as possible. A healthy lifestyle that includes exercise, whole foods, and supplements can keep (or put) people on the path to healthy aging and independence.

 Please talk to the knowledgeable staff at the Vitamin Shop to help you with supplements.