Combating Osteoporosis

By Milton Crane, MD
Milton G. Crane, an Internal Medicine Specialist and former career investigator in endocrinology with the U.S. National Institutes of Health, was the Director of Research at Weimar Institute, Weimar, California when the article was written.  Originally published in The Journal of Health and Healing, it appears with their permission.


A Fear of the Elderly
A major fear of both elderly women and men—the sequellae of a hip fracture. A common harbinger of death—the development of pneumonia in one whose mineral-deficient hip has fractured, and cannot be pinned to restore one soon enough for resumption of normal activity: a sneaky robber of bone strength that has set up a fatal scenario where ordinary activities such as picking up a grandchild, or bumping into a firm object, or even walking, can fracture a hip, a vertebra, or a rib.
That is osteoporosis!

What Causes Osteoporosis?⁽¹⁾⁽²⁾

Scientists now know that bone tissue is constantly being remodeled, constantly undergoing a balance between factors that tear it down and those which build it up. In youth the bone-builders dominate; but in age, the destructive forces, if unchecked, exceed the builders. The net effect is a gradual loss of protein and mineral from bone. The protein matrix fibrils give the shape. Several minerals including calcium, phosphorus, magnesium, strontium, fluorine, and boron, make up a crystal called apatite, and give the bone strength.

This crystal is poorly-defined, but it has the important physical attribute of being piezoelectric. This means that when it is squeezed or bent, a positive electrical charge develops on the surface. The protein fibrils of the bone are also piezoelectric. The difference is that the protein fibrils of the bone develop a negative electrical charge on their surfaces.

When a person walks in gravity, the apatite crystals and the protein fibrils are kept charged, and they are firmly associated together as strong bone. Astronauts in outer space lose much of their bone mineral strength because they cannot walk in gravity.

Bone Remodeling
Two sets of "carpenters" work as a team to maintain and/or restructure bones. These enable bone fractures to heal. One set, the osteoclasts, are busy tearing down the bone. Right behind them, we hope, come the second set of "carpenters," the osteoblasts, to rebuild the bone. If there is too much delay in rebuilding the bone protein, the unused building material, like "cross-link protein," goes out in the urine in higher amounts. One of these is called "D-Pyrilinks."⁽³⁾ By measuring this in the urine we can determine if an individual is in danger of losing bone matrix before evidence of osteoporosis becomes apparent by changes in x-ray of bone density. We should be able to halt the development of the stooped-over cripples, and of fragile bones in older people.

Feeding the Bones
Certain bone cells, called osteocytes, feed all the bone cells. The osteocytes work minuscule pumps to force fluid through the little tubules in the bone. These are told what to do by the parotid Fluid Movement Hormone (FMH). High levels of sugar (glucose) in the blood cause the brain to shut down this FMH, and these little bone cells cannot pump nutrients through the little canals in the teeth or bones.^(4),(5) Also, if the arteries to the bone are narrowed with cholesterol, etc., the bones do not get fed properly.

Protein Intake
Protein intake is important because a high level increases the urinary elimination of calcium.⁽⁶⁾ Our daily need is 40 to 5O grams of a good biologically active protein, and that is enough.⁽⁷⁾

How to Make Good Protein Matrix
Of course one needs a steady supply of all nine of the essential amino acids to make good protein. Vitamins B12 and Be, and folic acid, are needed to make other amino acids.⁽⁸⁾ These can be readily obtained from the dark green leafy vegetables or by a combination of a grain with a legume, along with a supplement of B12. The biggest problem for most people is that when we get up to about 35 to 40 years of age, our output of anabolic (build-up) hormones begins to decline with increasing age. The main ones are testosterone, estrogen, progesterone, growth hormone, and certain others. Unfortunately, progesterone has been ignored as an anabolic hormone until the past decade.⁽⁹⁾
Most physicians prescribe estradiol for the menopause in women. This is a good estrogenic hormone, but it does not serve the purpose completely for bone remodeling. It helps decrease the action of osteoclasts which work to tear down bone; but estrogens do not increase the bone-building by osteoblasts. Estradiol taken by mouth, may cause sodium retention, thus blood pressure may increase.^{(11), (12)} This estrogen alone also increases the risk of cancer.
Natural progesterone is not effective by mouth, but recently a skin cream (Progest®) has been formulated which enables progesterone to be absorbed through the skin.⁽¹⁵⁾ Tests are available to show that with 1/2 tsp of this cream (progesterone 450 mg per oz) twice a day, 20 days per month, the bone protein matrix can be built up and maintained near normal.⁽⁹⁾ This can be monitored by measuring the "D-Pyrilinks" in the urine.⁽³⁾ It has also been shown that a synthetic progesterone, medroxyprogesterone can prevent the loss of bone that is a complication of prednisone given for certain chronic ailments.⁽¹⁴⁾
This is good news, for as mentioned above, it permits early detection of bone loss.

Calcium and Magnesium Intake
These minerals are very important. Total vegetarians are at risk of not getting enough calcium and magnesium unless they eat freely (one to two cups a day, cooked volume) of low-oxalate greens like collards, kale, Chinese cabbage, mustard, and turnip greens.^(15),(16) The high-oxalate greens such as spinach, chard, beet tops, and rhubarb have plenty of calcium, but it is bound with oxalate and not available for bones and tissues. The calcium comes in as calcium oxalate and goes out in the urine as an oxalate.

Calcium Magnesium Supplementation
Many persons are concerned about getting enough calcium. If you need to take calcium, I suggest that you get tablets which have calcium citrate or chelate along with magnesium, zinc, copper, and manganese in the same tablet. Crush the tablet or chew it with your meal. Otherwise it may not be digested.
Calcium carbonate is a cheap source of calcium, and is the most commonly used chemical form. Calcium carbonate is a good anti-acid, however it uses the stomach acid and thus impairs the digestion of protein in the stomach. It also interferes with the union of R-binder with vitamin B12 in the stomach, and thus impairs the absorption of that vitamin with intrinsic factor. Prolonged use of anti-acids allows intestinal germs to increase in the small bowel and even start living in the stomach.
The Mexican natives add lime to their tortillas, and the Navajo and Hopi Indians add juniper ash to their cornmeal. This increases the calcium intake from 20 to 300-fold respectively.⁽¹⁷⁾ Calcium is an oxide from these sources and is readily available for bone metabolism.

Vitamin D
Vitamin D has long been known to be important for good bones and teeth. Vitamin D enables the gut to absorb calcium, and the body to build bone. Special cells in the skin can make vitamin D from cholesterol when they are exposed to sunlight. The vitamin can then be stored for long periods of time in the fatty tissue.

Putting it All Together
We know that the bones are constantly being rebuilt to heal fractures, etc. The six major factors of bone metabolism should be brought into focus to prevent osteoporosis. This includes special attention to keep the circulation to the bones open and moving by proper diet and exercise. Judicious exercise would best be made in sunlight for vitamin D. The osteocytes feed all the bone cells.
Careful attention should be given to the use of suitable anabolic hormones, such as natural progesterone, to maintain adequate formation of bone protein matrix. Osteoclasts and osteoblasts team up to rebuild bone. Special tests can measure bone breakdown products, including deoxypyrodinolines, and saliva progesterone levels. These, along with bone density by x-ray, are very helpful in guiding the management of osteoporosis.

REFERENCES
(1).    Aviola LV. Federation Proc, 40:2418-2422,1981.
(2).    Baylink DJ, Chesnut CH, et al. Postmeno-pausal Osteoporosis, Proceedings of Hahnemann University Symposium. Transmedica Inc., NY, 1982.
(3).    Robins SP. Collagen crosslinks in meta-bolic bone disease. Acta Orthop Scand, 66:171-175, 1995.
(4).    Leonora J, Tieche JM, Celestin J. Physiolog-ical factors affecting secretion of parotid hormone. Am J Physiol, 252:E477-84, 1987.
(5).    Leonora J and Steinman R. Personal communication.
(6).    Allen L, Oddoye EA, Margen S. Protein-induced hypercalcuria, A long term study. Am J Clin Nutr, 32:741-49, 1979.
(7).    Brenner BM, Meyer TW, Hostetter TH. Dietary protein intake and progressive nature of kidney disease. NEJM, 307:652-659,1982.
(8).    Crane MG, Register UD, et al. Cobalamin (CBL) studies on two vegetarian (vegan) families. Vegetarian Nutrition: an Interna¬tional J, 2:87-92,1998.
(9).    Lee J. Osteoporosis reversal, the role of progesterone. International Clin Nutr Rev, 10:384-391, 1990.
(10).    Lee JR and Hopkins V. What Your Doctor-May Not Tell You About Menopause, Warner Books, Inc., New York, 1996.
(11).    Crane MG and Harris JJ. Estrogens and hypertension: Effect of discontinuing estrogens on blood pressure, exchange-able sodium, and the renin-aldosterone system. Am J medical Sci, 276:33-55, 1978.
(12).    Crane MG and Harris JJ. Effects of estrogens and gestagens on exchangeable sodium, in Oral Contraceptives and High Blood Pressure, Fregly MJ and MS Fregly, Gainesville, FL, The Dolphin Press, 1974:159-169.
(13).    Peat R. Nutrition for Women, 3rd edition, Blake College Pub., 1980.
(14).    Greco EO, Weinshelbaum A, Simmons R. Effective therapy of glucocorticoid-induced osteoporosis with medroxyprogesterone acetate. Calcif Tissue Int, 46:294-99, 1990.
(15).    Marsh AG, Sanchez TC, et al. Vegetarian lifestyle and bone mineral density. Am J Clin Nutr, 48:837-841, 1988.
(16).    Crane MG. Dietary Intake and urinary excretion rate of calcium, magnesium, and zinc. Unpublished data.
(17).    Lang SS. Amazing Corn. American Health,8:94-100,1989.