Bone and joint health Image

Boning Up on Bone

By George Gillson MD PhD CCFP

The official theme of this blog for the month of August is bone and joint health. Since there are so many moving parts to this topic (pun fully intended) and so little time/space to discuss them, I thought “bone up” was a good phrase to use in the title of this post. The Merriam-Webster definition of “bone up”, is the following, in case you were wondering:

  1. to try to master necessary information quickly
  2. to renew one’s skill or refresh one’s memory

Let’s get at it.

Most people are aware that bone fracture rates increase as we age. Most of these are so-called fragility fractures which take place due to falls from a standing position or otherwise do not involve excessive impact forces. The first place the pharmaceutical industry focuses on to prevent these fractures is bone density and there are various pharmacologic interventions that have been shown to increase bone density and reduce fractures including fluoride supplementation, strontium ranelate supplementation, bisphosphonate drugs, monoclonal antibodies, and hormone replacement. These medications need to be taken for a few years to exert a significant effect and each has a particular affinity for one site such as the hip, arm, or spine (Lin 2021).  They are not without side effects.

But what about low-tech, non-pharmaceutical solutions? Muscles act to splint bones under stress, preventing them from bending too far. Loss of muscle mass increases your risk of fracture, all other things being equal.  What about balance? Keeping your balance involves being aware of how your body is moving in space.  If you’re not moving around a lot, not transitioning from standing to sitting frequently, not bending or reaching, you lose this awareness, and become more prone to falling.  Maintaining core strength is also a key aspect of keeping your balance. Flexibility also prevents fractures.  For example, if you go flying off a unicycle you will be better off if you can execute a front roll when you land rather than just splatting on the pavement. Your bones stay dense when they are stressed by movement/gravity. They respond to stress just like your muscles respond: they retain/build mass.

My point is that you can go a long way toward protecting your bones from fractures by staying fit: moving around, doing yard work, doing regular cardio exercises, maintaining muscles with regular resistance training (weights or bands) and regular exposure to low impact forces in general. And all that activity is also good for your heart and brain.

Don’t forget that muscles need cellular energy to maintain and do work.  CoQ10, ribose and carnitine are supplements you can discuss with your Integrative Health Practitioner, if you find it difficult to derive benefits from resistance training. They help to provide the energy your muscle cells need.

Speaking of low impact forces, vibration plates have been around for quite a few years now. These are gadgets featuring a platform that you stand on while doing exercises.  The platform jiggles, for lack of a better word. The more you pay for a vibration plate, the more complex the jiggling movements and the wider the range of frequencies at which the platform will vibrate.  The plates supposedly amplify the effect of resistance training and can mimic gravity if you happen to live somewhere where there’s no gravity-such as in low Earth orbit.

A complete discussion of this technology is way beyond the scope of this post but it’s worth looking into.  Here’s a quick overview from the Mayo Clinic (Motto: Since You Asked, no, we didn’t Invent mayonnaise):

Exploring Bone Structure

  1. What about the Biochemistry? I know you’ve been holding your breath. To start, I’ll review the structure of bone by comparing it to the walls of your house.  It might be helpful if you scan the diagram from left to right, then focus on the right side of it, which zeroes in to bone structure down at the sub-nanometric scale.  One nanometre is about how far my dog, Sarge, moves when I tell him he needs to go outside for a bathroom break at 11 PM after he’s been asleep in the hallway for an hour (i.e. not very far).
Exploring Bone Structure Image

The walls in most houses have wooden studs as a scaffold, with drywall (containing, among other things, a calcium-containing mineral) attached to the studs via metal screws. Similarly, many of your bones have scaffolding consisting of collagen fibres with crystals of the mineral calcium hydroxyapatite strategically attached to the collagen via protein fasteners made of a smallish peptide called gamma‑carboxylated osteocalcin (cOC). Note: cOC is NOT to be confused with AOC.

So.  Right away we’re into collagen again, discussed last month in the context of skin health, and as mentioned, there are proprietary collagen peptide formulations which target the type of collagen found in bone.  Important supplements such as Vitamin C and silicon were also discussed along with the importance of ensuring proper digestion and assimilation of nutrients in general (Having enough stomach acid is key!).

Bone broth would be a logical way to support bone health although there are some nit-picky arguments pooh-poohing this ancient nutritional practice. Not that I’m bitter. You can make bone broth yourself or buy it as a powder.

Continuing our exploration of the walls-in-your-house analogy, we need calcium to build bone but what people often don’t realize is that magnesium is just as important for bone health in myriad ways. This link is a short discussion of the Ca/Mg interplay and has information on relative dosages of these important elements. Magnesium is also critically important for cardiovascular health and maintenance of healthy blood pressure through its role as a natural calcium channel blocker. I think 500 mg/day of elemental magnesium is a good starting dose regardless of whether you are supplementing calcium.

Don’t fret.  I didn’t forget the gamma-carboxylated osteocalcin (cOC) “drywall screws”!  The synthesis of cOC is mediated by the gamma‑glutamyl carboxylase enzyme which, in turn, requires Vitamin K2 as a cofactor. The enzyme is induced by the activated form of Vitamin D.  When you make or ingest Vitamin D your kidneys activate it to a more potent, short-lived “activated” form.

I didn’t know much about Vitamin K2 until I read Dr. Rheaume-Bleue’s book a few years ago. I raced out and bought some Vitamin K2 as soon as I turned the last page. I highly recommend that you read all the pages, not just the last one. No matter what, it’s a great book.

Vitamin K2 and the Calcium Paradox How a Little Known Vitamin Can Save Your Life

Please talk to your Integrative Health Practitioner (after you ask about the CoQ10, ribose and carnitine) regarding proper dosing of both Vitamin K2 and Vitamin D. It is especially important to discuss testing to ensure you are maintaining a healthy level of Vitamin D.  Five hundred or 1000 IU per day may prevent rickets but that’s about it.  You need more than that for optimal health.

Helping Hormones

I mentioned hormones in passing.  There is a definite role for estradiol and testosterone replacement in women and men, for maintenance of bone health. One of the ways that estradiol acts is to limit resorption of bone whereas testosterone may stimulate rebuilding of bone.

The sex hormones are often the first hormones we think about for bone health but cortisol is equally important. Cortisol exerts a catabolic effect whereas testosterone is anabolic.  Too much cortisol production, for too long, leads to bone loss; hence, measures to relieve stress can be important for bone health: prayer, meditation, yoga, breathing exercises, cognitive-behavioral therapy can all play a role.

Several years ago, I stumbled across a fascinating article by Berger et al, entitled: Mediation of the Acute Stress Response by the Skeleton.  Turns out that under stress, your bones release osteocalcin which then plays a key role in the “fight or flight response” independent of what goes on in the adrenal glands!  Osteocalcin triggers the release of hormones, cytokines (cell signaling molecules) and neurotransmitters and generally suppresses parasympathetic autonomic response, enabling you to run faster and fight harder, need be. It makes sense that prolonged, significant stress can literally consume your bones, depleting osteocalcin to combat stress.

The flip side of that equation is this: if you are good to your bones through proper nutrition and supplementation, regular movement/exercise, proper rest between stressful events, (including intense exercise), your bones will have their best shot at being good to you, literally and figuratively carrying you through a long and healthy life.

Just remember that you will also need healthy joints along the way!

I’ll cover that in Part II.

P.S. I didn’t mention medications that may not be bone-friendly: serotonin reuptake inhibitors, heparin, warfarin, cyclosporine (immunosuppressant), glucocorticoids (e.g. prednisone, dexamethasone), anti-cancer drugs, excess thyroid hormone, aromatase inhibitors (inhibit estrogen formation), proton pump inhibitors (block stomach acid), some anti-seizure medications and antidiabetic medications (thiazolidinediones) The issue of medications needs to be discussed with your prescribing physician(s) as well as your Integrative Health Practitioner.

George Gillson MD PhD

Author: George Gillson, MD, PHD, CCFP
EvolveWell Medical Director


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