A Bag of Bones

Dr. Laura Roxann Alexander
10 min readAug 31, 2022

In previous decades, osteopenia and osteoporosis have been considered diseases of the elderly and post-menopausal women. However, in the last 60 years, both osteopenia and osteoporosis rates in people under age 65 have risen, much like many of the chronic lifestyle diseases that plague America and the western world. The incidence of hip fractures in women increased by 60% between 1970 and 1997 in Finland and in men by 108%! Skeletons dating from 1729 to 1852 were found to have significantly slower rates of bone loss at the hip than modern-day women. If bone health was just a matter of vitamin D and calcium, then why are we losing bone faster now than hundreds of years ago?

Skeletal system basics

Bone volume is 25% water, 35% collagen, and 35–40 % minerals. Bone tissue stores growth factors, triglycerides, immune cells, hormones, and heavy metals. Bones are not inert. Bones are very much alive and constantly turning over, breaking down old and brittle bone and building new live strong tissue. Bones provide structure, movement, and protection of organs and glands. Bones, ligaments, tendons, cartilage, collagen, and calcium make up the skeletal system and it is complex. Bones do not exist in a separate plane, without any connection to the rest of the body. The entire body and all its systems can impact bone growth and remodeling. Poor digestion, hypothyroidism, hormonal imbalances, bacterial overgrowths, and chronic stress can affect the bone’s ability to remain strong and flexible throughout our lives. Intake, digestion, and absorption of protein are absolutely essential for the skeletal system to remain strong. Low muscle mass and low protein diets can lead to significant bone loss and bone breakdown.

Strong and flexible

Bone is a composite-like material made of minerals dispersed in a protein matrix of primarily of collage. Bone is not just a block of calcium. Bones have to be both strong and flexible for optimal function. Think of how a tree bends and sways with the wind without breaking. The composite gives bones the strength and flexibility. The protein matrix is the backbone of the composite and the presence of minerals reinforces the matrix. Bones attach to muscles giving strength. Bones attach to joints allowing flexibility. This matrix is constantly remodeling itself via specific cells located within the tissue that lay down new tissue or break apart old bone tissue. Strong bones require a balance of both osteoblasts, to build bone, and osteoclasts, which break down bone. During remodeling, hormones like osteocalcin and growth factors are released from the bone tissue and make their way into the blood to exert whole body endocrine effects, including stimulating testosterone production, increasing neurotransmitter synthesis, increasing glucose uptake into muscle cells, and decreasing lipid accumulation in the liver. Basically, bone growth and remodeling stimulate energy metabolism and tissue sensitivity. Bone remodeling not only makes the skeletal structure stronger, but it contributes to the strength of our entire well-being.

Sarcopenia

Muscle mass begins to decline as early as age 40 in both men and women. By age 70, the weight of the skeletal muscles is about half of what it was at 21–30 years of age. Muscle mass is a key predictor of longevity. Muscles and bones are connected by ligaments and connective tissue. Preserving muscle mass as we age also preserves our bone strength and flexibility.

Sarcopenia is a condition characterized by loss of skeletal muscle mass and function. It was once thought to be primarily a disease of the elderly, but just like osteopenia and osteoporosis, sarcopenia in people under age 65 is rising steadily. Sarcopenia is characterized by progressive and generalized loss of skeletal muscle mass and strength and correlates with a physical disability, poor quality of life, and death. Factors that lead to the development of sarcopenia are age (but really we can’t even say that anymore), gender (sorry fellow females but that's us), and level of physical activity (couch potatoes beware). You might be thinking losing muscle mass is not big deal, however, losing lean body mass usually correlates with an increase in body fat even if you might be at a “normal” weight. I like to call this phenomenon “skinny fat.” I was skinny fat once upon a time. Meaning, that most would say I was skinny or thin, however, when I looked in the mirror I looked flabby, had no muscle definition to speak of, and felt weak. I was also a long-distance runner. I was perplexed as to how this could be. I was running almost every single day and yet I looked flabby in the mirror. I was losing muscle and maintaining fat, which is a cycle that many people can be trapped in when excessive cardio is their only form of exercise.

Besides age-related sarcopenia, a newish condition known as sarcopenic obesity is commonly found in adults over 35 and in some cases younger. Sarcopenic obesity is dangerous in that there is marked weakness and impairment in the ability to move our skeletal system as well as maintain bones. Adipose tissue creates an inflammatory state all by itself because it is endocrine tissue, meaning it can produce estrogen and cortisol which are released into the bloodstream and can have an impact on bone turnover and bone loss. Calcium is released from bones when inflammation is high. The increase in the weight of the body versus the strength of the bones, joints, and ligaments creates stress on those parts of the skeletal system most vulnerable to injury, like the knees and hips.

Building Muscle Builds Bones

This is a huge correlation between sedentary lifestyles and loss of muscle mass and strength. The old adage, “If you don’t use it you lose it.” The body is highly efficient and will also choose efficiency and conservation over waste. Why? Because it is all about survival. Muscle is highly active and energy-sucking tissue. If you don’t use that muscle on a regular basis, the body will not put time and energy into maintaining that tissue. Therefore, to maintain muscle, we must grow and put a little bit of stress on the muscle tissue itself so the body spends time repairing, and growing, and you could even say investing in that tissue. We make it important and it becomes important, the body sees fit to keep it.

The first step in preventing bone loss and sarcopenia is to ensure appropriate physical activity that stimulates muscle and bone growth. Cardio is not the answer here. Nor is the popular HITT training. Resistance training is the number one most effective type of exercise that will keep muscle and bone loss from rapidly declining as we age. High-intensity exercise and even moderate to high endurance training can be beneficial for weight loss in the beginning but over time can slow metabolism, increase impact-related injuries, and increase inflammation. The body can become very efficient at steady-state cardio-type activities. There is no build, grow, repair signal sent during these exercises, which is exactly what is needed for strong bones.

Bone Loss is Inflammation in Action

Remember our friends the osteoclasts? The specialized bone cells that stimulate bone turnover? Osteoclasts are in fact specialized macrophages (immune cells). Osteoclasts are highly sensitive and responsive to local and systemic inflammation. Inflammation stimulates more osteoclast activity and progressive bone density loss.

Catabolic activity (breakdown) supports survival by releasing protein, calcium, and phosphorus from bones. The overall systemic inflammatory load will directly impact bone health. That means if you have irritable bowel, autoimmune disease, chronic allergies, asthma, pain syndromes, diabetes, high blood pressure, you name it, then your risk for bone density-related problems increases as well. Virtual any disease that is inflammatory in origin will impact your ability to maintain bone density as you age. The answer? Decrease overall systemic inflammation!

What other minerals and nutrients are needed for bone health?

Bones need nutrients just like any other tissue. Bones need more than just calcium, a lot more.

  1. Protein is used to make the collage framework of bone. This includes a variety of plants and animal proteins. Especially good sources of glycine and proline which make the up the bulk of the collagen framework.
  2. Vitamin D increases calcium absorption from the intestines. A word of caution in regards to using high dose vitamin D supplements OTC because excessive vitamin D can cause magnesium and vitamin K2 depletion.
  3. Vitamin K2 is required to activate proteins involved in keeping minerals in the bones. A healthy body can convert K1 to K2 and this conversion is highly dependent on the microbial friends in our gut. K2 sources are animal fats like grass-fed butter and eggs and cultured foods. Typically not found in a western diet.
  4. Although calcium is the primary mineral contributing to bone density, excessive calcium supplementation can have a negative effect on overall health. The body is only able to absorb about 200mg of calcium at a time and excess calcium can be stored in soft tissues like our arteries and veins and lead to damage to the arterial lining as well as plaque formation. Most people actually get enough calcium in their diet without the addition of high-dose supplementation.
  5. Magnesium is a master mineral. Not only is magnesium used in hundreds of enzymatic reactions in the body, but it also helps convert vitamin D to its active form and stimulates calcium movement into the bones from the blood.
  6. Phosphorus is a major part of the mineral matrix along with calcium. However, phosphorus and calcium levels must remain in balance for bone density and blood concentration levels. Unfortunately, phosphorus is abundant in the American diet and is used as a preservative in most, if not all, ultra-processed foods. It is also found in soda. There are many studies showing those who drink large quantities of soda have an increased risk of osteopenia and osteoporosis. As blood levels of phosphorus increase, calcium is released from the bone to balance phosphorus levels in the blood. This cycle leads to bone loss of the mineral matrix.
  7. Zinc also plays a key role in the mineralization of bone and can be a common deficiency, especially in those who have low stomach acid and low protein intake.
  8. Many more minerals and vitamins play roles in maintaining bone health. Copper, strontium, boron, silicon, and vitamin C also contribute to the overall strength of our bones and muscles.

Bone Disease from lifestyle choices

  1. High blood sugar levels result in high cortisol levels and inflammation. Calcium is moved out of the bone and into the systemic circulation to repair damage along the arterial wall. The calcium creates a plaque or patch on the wall to keep it from further damage. Higher and higher blood sugar levels increase the need for more systemic calcium resulting in bone demineralization.
  2. High soda, coffee, and caffeine can cause an imbalance in phosphorus and result increase in calcium levels in the blood.
  3. The widespread use of proton pump inhibitors is another contributing factor to bone loss. Proton pump inhibitors decrease stomach acid production by as much as 80–90% in most cases. Basically breaking the digestive process on purpose. We must have optimal stomach acid to break apart minerals and vitamins from the amino acid carriers. Not only do these medications result in mineral, protein, and vitamin deficiencies but they can lead to osteoporosis, small intestinal overgrowths, dementia, hypothyroid disease, and frailty.
  4. More sedentary lifestyles that lack any form of resistance training result in muscle loss and therefore bone loss.
  5. Chronically high-stress levels increase cortisol levels, impair bone growth, and break down the bone matrix. If you have to run for your life, there is no point in maintaining tissue. Stress will break the body, in both short and long-term scenarios.
  6. We live in a toxic world. There is no getting around that therefore we must do our best to support the detoxification of toxins each and every day. Toxins that are not appropriately metabolized and excreted through urine or stool must be stored away from vital organs to protect us. Bone can be a storage depot for lead, aluminum, and even endocrine-disrupting chemicals. As we age and begin to lose bone, those chemicals that were stored for years and years can now be released into the bloodstream and damage tissues and organs. Maintaining bone density can protect our systemic body from these toxins.

Falls Cause Fractures

The number one reason for age-related fractures is falling. Frailty, poor balance, unsteady gait, and low muscle strength are contributors. Not the density of your bones. Around one-third of generally healthy individuals aged 65 or above will fall at least once a year. Asking the simple question, “Do you have impaired balance,” can predict about 40% of all hip fractures. So the question is then, how do we prevent falls? Sarcopenia and osteoporosis are an incredibly bad combination because there is not enough muscle to move the skeletal frame and brittle bones that are weak and an increase in tension in the joints (from lack of muscle) which increases the risk of falling and becoming out of balance very easily. It could be as simple as stepping off the curve wrong that leads to a broken hip.

How do we prevent these dynamics as we age? Instead of eating more calcium, consider yoga, taichi, regular stretching, chiropractic care, balance and mobility training, and of course resistance training.

Love your bones

If we are to shift the course of declining bone health, education on how to create and maintain an environment where bones, organs, tissues, and the entire body thrives needs to be widespread. Bone density decline is a normal part of aging but that does not mean it is inevitable that osteoporosis is in the future as well. We can stop the decline of our bones by changing the way we see health and aging in general. Why wait until the house is on fire? We could have intervened earlier, maybe when the kitchen was smokey and prevented the spread. Start now. Love your bones and your muscles by feeding the entire body with nutrient-dense foods, getting restful sleep, and practicing exercises that build instead of deplete.

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Dr. Laura Roxann Alexander

Pharmacist.Personal Trainer.Lift heavy, skip the run.Let food by thy medicine and medicine be thy food.