Rethinking the causes of osteoporosis


It's often suggested that the major causes of osteoporosis in women are low calcium intake and lower estrogen levels at menopause. A cross-cultural perspective, however, shows that this is not always true. People in many countries have lower calcium intakes than in the US, yet osteoporosis is less prevalent in these cultures. As an example, the Japanese calcium intake has only recently risen to 540 mg per day, much less than the US RDA for post-menopausal women of 1,200 mg per day. And yet the US hip fracture rate is twice that of Japan!

Anthropologists also have long noted that many native African populations exhibit very low fracture rates while consuming 300 mg of calcium a day. This low calcium intake was recently verified in anthropological study on Gambian women.  In fact, overall research has shown that countries with the highest calcium intakes have the highest hip fracture rates. 

The same holds true for estrogen. A decrease in estrogen at menopause is universal in women worldwide, but osteoporosis is not. Mayan women in Central America, Bantu women of Africa, and Japanese women all have lower estrogen levels than women of various ethnic groups in the United States, but they all experience many fewer fractures than American women. Also, the few years before menopause is a time of rapid bone loss for most women, yet a woman’s estrogen level at this time can be higher than during her reproductive years. So attributing osteoporosis to the natural decrease in estrogen at menopause is too simplistic.

But if neither calcium nor estrogen levels causes osteoporosis, what does?

How We Lose Bone

In adulthood, bone mass and strength are maintained through the balance of bone breakdown and bone buildup forces. Both building up new bone and breaking down old bone are essential, as bone needs to repair itself and “remodel” itself on a daily basis. Excessive bone weakening and osteoporosis occur when, over time, the forces of bone breakdown are much greater than the forces of bone buildup.  

It’s all a question of balance…















What Are the Real Causes of Bone Loss? The New Science

Many of our common lifestyles and cultural patterns actually add to our total load of bone breakdown forces. Unwittingly, we’ve taken on ways of being, eating, doing and acting that weaken bone. As my mentor, Dr. Russell Jaffe, summarizes: “Osteoporosis is a hidden tax of high-tech living.”

The Total Load Model of Bone-Depleting Factors

The 5 Categories of Bone-Weakening Factors

The forces contributing to or directly causing osteoporosis are divided into five categories:

  • Dietary causes and nutrient inadequacies 
  • Lifestyle factors
  • Medicines that cause osteoporosis
  • Medical procedures that cause osteoporosis
  • Diseases that cause osteoporosis

Dietary causes and nutrient inadequacies: 

  • Low intake of the 20+ key bone nutrient 
  • Widespread nutrient inadequacies  
  • Low antioxidant intake combined with high antioxidant need 
  • Chronic low-grade metabolic acidosis from our low mineral diet
  • Low vitamin D blood levels/deficient sunlight exposure
  • Low protein intake among seniors

Lifestyle factors that cause osteoporosis:

  • Sedentary lifestyle/Lack of exercise
  • Stress: Emotional/mental stress, hormonal/nervous system imbalances
  • Eating disorders, excessive weight loss, weight cycling
  • Smoking
  • Excessive alcohol use

Medicines that cause osteoporosis:

  • Prednisone and other steroid medications (glucocorticoids), including steroid inhalers 
  • Proton pump inhibitor antacids
  • SSRI antidepressants
  • Antiseizure medications
  • Excessive thyroid hormone doses
  • Heparin
  • Lithium
  • Medroxyprogesterone
  • Thiazide diuretics
  • Aromatase inhibitors
  • Cytotoxic drugs
  • Gonadotropin-releasing hormone
  • Immunosuppressants
  • Warfarin
  • Canagliflozin
  • Methotrexate
  • Vitamin A (retinoid) medications
  • Thiazolidinediones
  • Immunosuppressant agents

Diseases that cause osteoporosis:

  • Digestive disorders such as Crohn’s and celiac disease
  • Autoimmune disorders like multiple sclerosis, ulcerative colitis, rheumatoid arthritis, Graves’ disease, type 1 diabetes 
  • Ovarian dysfunction (irregular periods or early menopause)
  • Parkinson’s disease, spinal cord injuries, stroke, or other movement disorders 
  • Breast cancer
  • Prostate cancer
  • Leukemia and lymphoma
  • Sickle cell disease
  • Thalassemia
  • Depression
  • Eating disorders
  • Diabetes
  • Low testosterone
  • Low estrogen
  • Female athlete triad
  • Liver disease
  • Polio
  • Organ transplants
  • Scoliosis 
  • Inflammatory bowel disease

Medical procedures that cause osteoporosis:

  • Gastric bypass
  • Cancer treatments with estrogen antagonists
  • Weight loss surgery

How to reduce your total load of total bone-weakening factors

An excellent first step is to assess your individual load of bone-depleting factors. Take a moment and look at our wobbly camel, struggling under multiple bone-depleting burdens. 
Where do you want to start in your journey of building bone strength? Which burdens can you modify?  There are some things you cannot change, but there are others that you can—so start there. A simple start might to be make a new exercise commitment, to set the goal of eating 3 to 4 cups of vegetables a day, or to begin meditating and reducing emotional stress.  All of the bone-building—and bone-depleting—factors are interrelated, and even small changes over time add up and can make a big difference! 

And it’s not unusual to find that changing one factor in a small way can also improve one of those other factors that you can’t change directly — for instance, changing your diet or reducing your stress burden may not only help your bones, but also improve digestive or autoimmune disorders, giving you a doubly beneficial effect.

Here at the Center for Better Bones we offer our comprehensive time-tested natural Better Bones, Better Body Program. Join us for a deeper dive into building Better Bones and a Better Body at any age!