Osteoporosis Osteoporosis is a common problem. It even comes up in the neurology clinic. One of the ways it comes up frequently with my practice is when I am prescribing anti-seizure medications. Several of these medications may interfere with vitamin D metabolism which may turn out to increase the risk of thinning of the bones or osteoporosis. This may lead to more hip fractures which is a major cause of disability in the elderly. Some of The Factors That Cause Increases In Rates of Bone Fractures Medications like anti-seizure medications and some diuretics Sedentary lifestyle High amounts of animal protein in the diet Factors That Contrary to Popular Opinion Are Not Necessarily Useful For Prevention of Fractures Dairy consumption -- Overall most studies show no evidence dairy consumption prevents fractures. Calcium supplementation -- Unfortunately not consistently shown to have benefit. Some Factors That Decrease Bone Fracture Rates Weight bearing exercise Sun exposure and possibly supplementation with vitamin D High consumption of fruits High amounts of plant proteins in the diet Vitamin D For Those of You on Ant-Seizure Medications For my patients on anti-seizure medications, especially the older medications like Phenytoin, I suggest that they increase their intake of Vitamin D. There is some controversy though on how much to suggest. At this point, I am suggesting 800-1200 IU per day. It would be best if the amount of vitamin D were greater than the calcium if they come together in a supplement. I do not suggest taking more than 600 mg extra per day in calcium supplements. Of course you can obtain your vitamin D from sun exposure. The key point would be to avoid burning, remaining outdoors just long enough to get the vitamin D and then covering up. Lightly pigmented folks will need during the summer to spend only 15-20 minutes a couple of times per week, while more darkly pigmented folks will need to spend upwards of an hour. If you have a history of severe sunburns, then avoid over-exposing those areas. Weight Bearing Exercise I am suggesting the use of weighted vests for those find getting to the gym on a regular basis too difficult. Dr. Fuhrman has a brand on his website that looks comfortable. Weighted Vest from Dr. Fuhrman. There are likely many different brands available on the web. For those of you that hit the gym, regular weight lifting has been showing to increase bone mineral density. So has Yoga, Tai Chi, brisk walking, hiking, dancing, racket sports and golf (if you walk). References: 1) Long-term exercise using weighted vests prevents hip bone loss in post-menopausal women. J Gerontol A Bio Sci Med Sci 2000 Sep; 55(9) M489-91 Conclusion: A 5-year program of weighted vest plus jumping exercise maintains hip BMD by preventing significant bone loss in older post-menopausal women. Furthermore, this particular program appears to promote long-term adherence and compliance, as evidenced by the commitment of the exercisers for more than 5 years. 2) The relation between dietary protein, calcium and bone health in women: results from the EPIC-Postdam cohort. Ann Nutr Metab 2005 Sep-Oct; 49(5): 312-8 Conclusion: High consumption of protein from animal origin may be unfavorable, whereas a higher vegetable protein intake may be beneficial for bone health. Our results strengthen the hypothesis that high calcium intake combined with adequate protein intake based on a high ratio of vegetable to animal protein may be protective against osteoporosis. 3) A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in post-menopausal women American Journal of Clinical Nutrition vol 73, No1, 118-122, Jan 2001 Conclusion: Elderly women with a high dietary ratio of animal to vegetable protein intake have more rapid femoral neck bone loss and a greater risk of hip fracture than do those with a low ratio. This suggests that an increase in vegetable protein intake and a decrease in animal protein intake may decrease bone loss and the risk of hip fracture. This possibility should be confirmed in other prospective studies and tested in a randomized trial. 4) Milk, dietary calcium and bone fractures in women: a 12-year prospective study AM J Public Health 1997 Jun; 87 (6): 992-7 Conclusion: These data do not support the hypothesis that higher consumption of milk or other food sources of calcium by adult women protects against hip or forearm fractures. 5) Effect of calcium supplementation on hip fractures Osteoporos Int 2008 Conclusion: Until there are further trial results to clarify this area, the present findings suggest that reliance on high calcium intakes to reduce the risk of hip fracture in older women is not appropriate. Some studies may even suggest that supplementation with high doses of calcium increase risk of fracture. 6) Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr. 2007 Dec; 86(6): 1780-90 Conclusion: Pooled results from prospective cohort studies suggest that calcium intake is not significantly associated with hip fracture risk in women or men. Pooled results from randomized controlled trials show no reduction in hip fracture risk with calcium supplementation, and an increased risk is possible. For any non-vertebral fractures, there was a neutral effect in the randomized trials Return to Diseases

Osteoporosis

Osteoporosis is a common problem. It even comes up in the neurology clinic. One of the ways it comes up frequently with my practice is when I am prescribing anti-seizure medications. Several of these medications may interfere with vitamin D metabolism which may turn out to increase the risk of thinning of the bones or osteoporosis. This may lead to more hip fractures which is a major cause of disability in the elderly.

Some of The Factors That Cause Increases In Rates of Bone Fractures

Medications like anti-seizure medications and some diuretics

Sedentary lifestyle

High amounts of animal protein in the diet

Factors That Contrary to Popular Opinion Are Not Necessarily Useful For Prevention of Fractures

Dairy consumption -- Overall most studies show no evidence dairy consumption prevents fractures.

Calcium supplementation -- Unfortunately not consistently shown to have benefit.

Some Factors That Decrease Bone Fracture Rates

Weight bearing exercise

Sun exposure and possibly supplementation with vitamin D

High consumption of fruits

High amounts of plant proteins in the diet

Vitamin D For Those of You on Ant-Seizure Medications

For my patients on anti-seizure medications, especially the older medications like Phenytoin, I suggest that they increase their intake of Vitamin D. There is some controversy though on how much to suggest. At this point, I am suggesting 800-1200 IU per day. It would be best if the amount of vitamin D were greater than the calcium if they come together in a supplement. I do not suggest taking more than 600 mg extra per day in calcium supplements.

Of course you can obtain your vitamin D from sun exposure. The key point would be to avoid burning, remaining outdoors just long enough to get the vitamin D and then covering up. Lightly pigmented folks will need during the summer to spend only 15-20 minutes a couple of times per week, while more darkly pigmented folks will need to spend upwards of an hour. If you have a history of severe sunburns, then avoid over-exposing those areas.

Weight Bearing Exercise

I am suggesting the use of weighted vests for those find getting to the gym on a regular basis too difficult. Dr. Fuhrman has a brand on his website that looks comfortable.

Weighted Vest from Dr. Fuhrman.

There are likely many different brands available on the web.

For those of you that hit the gym, regular weight lifting has been showing to increase bone mineral density. So has Yoga, Tai Chi, brisk walking, hiking, dancing, racket sports and golf (if you walk).

References:

1) Long-term exercise using weighted vests prevents hip bone loss in post-menopausal women. J Gerontol A Bio Sci Med Sci 2000 Sep; 55(9) M489-91

Conclusion: A 5-year program of weighted vest plus jumping exercise maintains hip BMD by preventing significant bone loss in older post-menopausal women. Furthermore, this particular program appears to promote long-term adherence and compliance, as evidenced by the commitment of the exercisers for more than 5 years.

2) The relation between dietary protein, calcium and bone health in women: results from the EPIC-Postdam cohort. Ann Nutr Metab 2005 Sep-Oct; 49(5): 312-8

Conclusion: High consumption of protein from animal origin may be unfavorable, whereas a higher vegetable protein intake may be beneficial for bone health. Our results strengthen the hypothesis that high calcium intake combined with adequate protein intake based on a high ratio of vegetable to animal protein may be protective against osteoporosis.

3) A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in post-menopausal women American Journal of Clinical Nutrition vol 73, No1, 118-122, Jan 2001

Conclusion: Elderly women with a high dietary ratio of animal to vegetable protein intake have more rapid femoral neck bone loss and a greater risk of hip fracture than do those with a low ratio. This suggests that an increase in vegetable protein intake and a decrease in animal protein intake may decrease bone loss and the risk of hip fracture. This possibility should be confirmed in other prospective studies and tested in a randomized trial.

4) Milk, dietary calcium and bone fractures in women: a 12-year prospective study AM J Public Health 1997 Jun; 87 (6): 992-7

Conclusion: These data do not support the hypothesis that higher consumption of milk or other food sources of calcium by adult women protects against hip or forearm fractures.

5) Effect of calcium supplementation on hip fractures Osteoporos Int 2008

Conclusion: Until there are further trial results to clarify this area, the present findings suggest that reliance on high calcium intakes to reduce the risk of hip fracture in older women is not appropriate. Some studies may even suggest that supplementation with high doses of calcium increase risk of fracture.

6) Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr. 2007 Dec; 86(6): 1780-90

Conclusion: Pooled results from prospective cohort studies suggest that calcium intake is not significantly associated with hip fracture risk in women or men. Pooled results from randomized controlled trials show no reduction in hip fracture risk with calcium supplementation, and an increased risk is possible. For any non-vertebral fractures, there was a neutral effect in the randomized trials

Return to Diseases