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Recent estimates claim that 200 million people over the age of 50 are threatened with osteoporosis. (It was “only” 44 million when I initially published a version of this article in 2007!)

Roughly 80% of them are women.

If our recent ancestors had a sturdy structure that carried them upright for a lifetime, then we have to ask ourselves, what are we currently doing wrong? How and why are we destroying our vital internal foundation?



[Please see the end of this post for a very personal and heartbreaking story related to one of the biggest “whys.”]

The term osteoporosis, derived from Latin, literally means “porous bones.” It’s a progressive condition characterized by structural deterioration of bone tissue, which indeed, is living tissue. Bones become weaker and more brittle, making sufferers inordinately prone to fractures and causing marked changes in posture.

The hips and spine are the areas of most concern due to the fact that hip fractures take a long time to heal, especially in older folks. Osteoporosis in the spine typically causes loss of height and curvature or rounding of the upper back, called kyphosis.

Not just an “age thing”

Bone mass is strongest around age 30 and then begins to weaken. If we’ve neglected to accumulate adequate bone mass during our formative years, including childhood, adolescence, and early adulthood, we’re at increased risk of full-fledged osteoporosis.

Many women believe that they only need to be worried about this post-menopause given that the onset of “the change” causes bone loss to hasten due to decreased estrogen. But evidence indicates that osteoporosis can begin early in life and it’s yet another reason to feed ourselves and our children well, with lots of bone-strengthening, whole foods that will lay a foundation for a lifetime of structure.

Due to the hormonal and physiological dissimilarities and the differing nutritional needs of men and women, again, osteoporosis affects many more women than men. In fact, half of all women between the ages of 45-75 show signs of osteopenia (low bone mass). But some experts claim that osteopenia is overdiagnosed.

In addition to estrogen loss, we tend to suffer from bone loss due to the standard American diet, poor nutrition, history of hysterectomy, alcohol use, smoking, a sedentary lifestyle, chemotherapy, and some prescription medications, including…thyroid hormone replacement. More on this below.

In addition to many of the possible factors above, men tend to also suffer with bone loss because of low T.


Another huge contributing factor? Celiac disease. See the story below.

Can’t I just take my calcium?

The standard American diet contains many “foods” (I like to call them food-like substances) that are culprits in bone loss. Some of these calcium-leaching offenders are soda (one of the worst), sugar, highly processed and refined foods, coffee, alcohol, excess salt. And again, some prescription medications, including statins, blood thinners, and chemotherapy drugs.

One of the biggest pharmaceutical offenders? Thyroid hormone replacement.

Excess protein consumption has also been associated with leaching calcium from the bones.
 Contrary to what the media and the American Dairy Association would like you to believe, increased dairy intake isn’t the sentinel for bone health. In fact, osteoporosis isn’t a health concern in cultures that consume little to no dairy. And calcium supplements are not a panacea and…get this…can cause bone loss.

How?

Firstly, calcium supplementation alone is precarious and ineffective at best. It’s been linked to impaired absorption of minerals including iron, manganese, and zinc and also associated with lethargy and calcium deposits in tissues, which can mimic cancer on x-rays and contribute to kidney stones and calcification of the arteries.

Secondly, some doctors know little to nothing about the importance of magnesium and bone health. If calcium isn’t mobilized into the bone with the aid of magnesium, it may collect in soft tissues and again, cause calcium deposits and also arthritis. This is truly a double whammy; rather than strengthening your bones, you’re possibly contributing to another troubling condition.

According to Paul Pitchford, author of Healing with Whole Foods, “For many years, magnesium also has been recognized as valuable in calcium absorption, but it’s absolute necessity has been underscored in several recent human experiments. In one, calcium and Vitamin D were abundantly supplied while magnesium was withheld; all subjects in the experiment except one became calcium-deficient. When magnesium was reintroduced in the diet, calcium levels rose dramatically.”



Thirdly, we store calcium more efficiently than magnesium, so we don’t have to consume nearly as much as the dairy industry has conditioned us to think. Because magnesium hasn’t gotten the airtime that calcium has (got milk?) and because we have a lot of ill-informed doctors out there, we’ve put the focus on the wrong mineral (calcium vs. magnesium). Those nasty culprits I mentioned above also contribute to magnesium depletion.

The thyroid hormone replacement conundrum

A long-known risk of thyroid hormone replacement use is bone mass loss. I know, with millions of people on thyroid drugs, no one wants to hear this.

I’ve been talking about this for many years, with the obvious caveat that because I’m not a licensed medical practitioner, it’s something you want to speak with your provider about.

And indeed, I’ve had a lot of clients over many years with an osteopenia/osteoporosis diagnosis.

It’s certainly not the only risk of thyroid HRT (hormone replacement therapy), but it’s one that’s in need of some serious consideration.

(People ask me all the time, but no, I’ve never taken thyroid HRT.)

And now, the risks are getting attention in the mainstream media. According to this recent Newsweek article, “Our study suggests that even when following current guidelines, levothyroxine use appears to be associated with greater bone loss in older adults.” - Dr. Shadpour Demehri, co-senior author of the study and a professor of radiology at Johns Hopkins University

According to this study, “… the associations between LT4 (levothyroxine T4) administration and loss of bone mineralization of increased fracture risk in some studies suggests the use of a cautious approach to avoid over treatment, especially in patients with or at risk of developing osteoporosis, such as post-menopausal women, or the elderly.”

Um, okay, but just because the risk is in “older adults” and “the elderly” doesn’t mean that we want to wait until we’re “older” or “elderly” to find out that our bones are porous. In other words, an ounce of prevention is worth a pound of cure.

In reference to data from the Baltimore Longitudinal Study of Aging (BLSA), the Newsweek article also states, “After an average of six years, the adults taking levothyroxine were more likely to have lost more bone mass and bone density, compared to those not taking thyroid medications.”

What to do


Currently, osteoporosis isn’t a curable condition. But you can slow loss by beefing up your foundation, which can help to ward off brittle bones. I’m certainly not anti-supplementation, but believe that we should be getting the majority of our vitamins, minerals, and nutrients from whole foods instead of pills substituting as foods.

If you’re concerned about bone health, there’s nothing wrong with taking a calcium-magnesium supplement, although I lean towards a multi-mineral myself, not only for bone health, but also for thyroid and hair support. See the end of this post for my all-time favorite food-based multi-mineral.

If you’re going to go with a standalone cal-mag, get a quality supplement where the magnesium content is half that of the calcium. 



With some awareness and forethought, you won’t have to fall prey to delicate bones, poor posture, and being fracture-prone. Again, osteoporosis isn’t curable. But if you heed the suggestions below, you may see much better outcomes and the ability to leave the “porous” to the pumice stone.

Dietary and lifestyle suggestions:

Calcium-rich foods include sardines, collard greens, spinach, turnip greens, mustard greens, beet greens, bok choy, Swiss chard, kale, broccoli, cabbage, green beans, sauerkraut, kimchi, sesame seeds, almonds, chia, amaranth, millet, blackstrap molasses, cinnamon, garlic, basil, oregano, thyme, sea vegetables, tofu, tempeh, natto, miso, and yogurt. (I’m not a fan of tofu, as it’s not fermented.)

Magnesium-rich foods include spinach, Swiss chard, turnip greens, mustard greens, collard greens, beet greens, green beans, summer squash, pumpkin seeds, almonds, brown rice, sea vegetables, lentils, lima beans, tempeh, natto, miso, and tofu. (Again, I’m not a fan of tofu, as it’s not fermented.)

Vitamin D is important for calcium absorption and the single best way to get it is with safe sun exposure. My opinion on Vitamin D supplementation has changed dramatically, given that it’s a secosteroid. That’s a whole other ball of wax that I need to write about.

Rich food sources of Vitamin D include: egg yolks, fatty wild fish (salmon, mackerel, tuna, herring, halibut, and sardines), fortified foods (milk, yogurt, some cereals, and orange juice) and shiitake mushrooms.

* * *

Seriously consider whether thyroid hormone replacement is right for you. I’m not here to suggest changes to anyone’s prescriptions. But it’s a fact that millions are on Levothyroxine (aka Synthroid, Unithroid, and Tirosint)—it’s the second most prescribed drug, next to statins. (Don’t get me started on statins, either.)

It’s estimated the 23 million are on levo. And that 21 million of them don’t need it. #slapsforehead

I’ve been a thyroid/Hashimoto’s practitioner for 16+ years. And I will tell you…it’s a myth that once you start thyroid hormone replacement, you have to be on it “for life.” This is NOT true.

Many of my clients have successfully weaned off, with the guidance of their medical providers. How and why? Because they sleuthed out underlying contributing factors, including other hormonal imbalances (mostly adrenal issues) and for well over 90% of people, a dysregulated immune system (Hashimoto’s, or autoimmune hypothyroidism). The result: the thyroid HRT becomes obsolete.

As I’ve said for years, for many people, taking thyroid hormone replacement is barking up the wrong tree. You can chase the thyroid hormones ‘til the cows come home, including getting your dosing “adjusted” every few months, but “replacing” those hormones will do nothing for your immune system, leaving you chasing your tail, likely for years.

This hot topic is why my co-author, Lisa Markley, MS, RDN, and I published The Essential Thyroid Cookbook: Over 100 Nourishing Recipes for Thriving with Hypothyroidism and Hashimoto’s. It’s a thyroid health book within a cookbook, truly a two-fer.

Right now, you can use the coupon code BONES for a 15% discount, which includes shipping.

* * *

Exercise, especially weight-bearing, increases bone density.

Limit caffeine, which hastens calcium loss through urine. A lot of people ask me what coffee I drink. This, which by the way, also contains minerals.

Quit smoking.

Limit alcohol.

Sleep like it’s your job >

Consider bioidentical estrogen replacement. This is obviously something you’d work with your medical provider on, but my strong opinion is that the best way to determine if estrogen HRT is warranted is with a DUTCH panel (dried urine testing for comprehensive hormones). If you’re interested in ordering and having a session to discuss, reach out.

Drink bone broth. The collagen is bone-supportive in a variety of ways, including mineralization and density. You can find Lisa’s Fortifying Chicken Bone Broth on page 252 of our cookbook or you can go here.

Take a collagen supplement. A lot of people also ask me what collagen I use. This.

My all-time favorite multi-mineral is Balanced Minerals by MegaFood. It’s 15% off retail on Fullscript with this link.

My personal story of severe osteoporosis

This is a story about my mom, who passed away 10 years ago this month from the complications of severe osteoporosis.

From the Newsweek article: “Bone loss is indeed a part of aging and brings with it important complications and morbidities.” Yes. Yes it does.

My mom was diagnosed with osteoporosis in her 60s. I didn’t know much about bone health at the time, but I did know about the complications—severe complications—associated with bisphosphonate drugs, of which Fosamax is one. It has a black box warning.

Her doctor wanted her on this horrific drug that’s associated with…get this…fractures, bone tissue death, and bone demineralization. #slapsforehead

Ever heard of phossy jaw? It’s phosphorus necrosis of the jaw and can cause dental decay, mouth abscesses, facial disfigurement, and brain damage. It’s a frequent side effect of Fosamax and other bisphosphonates. #slapsforehead

I said no. No no no. (She was generally anti-pharma anyway and didn’t want to take it.)

By the time she was in her early 70s, my mom’s osteoporosis was advanced. And getting worse. She’d already gone from 5’ 10.5” to 5’ 9.5”.

I flew home from the West Coast and took her to a university integrative clinic. The first thing out of this doctor’s mouth was that given the severity of the situation, my mom needed to get tested for Celiac immediately.

I was home for two weeks. When we went back for her lab results, we found out that indeed, my mom had the HLA-DQ2 gene from one parent and the HLA-DQ8 gene from the other. The doctor looked at my mom and said, “You’ve had Celiac your whole life. This is why your bones are now chalk.”

I believe my mom was 72 at the time.

The doctor then looked at me and said, “This is what you’re going to put in your siblings’ Christmas stockings this year…a note that they all have Celiac.” (This was in November of whatever year that was.)

Bless her heart, my mom went 100% gluten-free with no complaints. She did miss her donut holes a whole lot, but we were dealing with a serious situation.

The Newsweek article also states, “… some individuals can break ribs just by coughing or sneezing, or develop long-term chronic pain through partial breakages in the spine.” Yes. Yes they can.

Going 100% gluten-free helped a great deal with my mom’s overall health. Over those next few years, she stopped getting sick in the winter like she had. She started to get some strength back and her respiratory system improved—her chronic cough started to subside a fair bit. (Celiac doesn’t just destroy the villi of the gut, it also destroys the villi of the lungs.)

But it was too little too late for her bones. She proceeded to break ribs, wrists, femurs, vertebrae, and hips just by opening a window, coughing, or losing her balance and falling. She was frail and underweight, so she had no “cushion” for her falls.

She had a few vertebroplasty procedures, where cement is injected into fractured vertebrae to relieve pain and help with movement. But it was like shoring up a building with toothpicks—and she’d fracture another vertebra.

She’d sit in her comfy chair recovering from a break, only to try and be independent again and then break something else. The cycle became unending and she was chair-bound more than she was up and about. She became weaker and weaker and her respiratory system suffered because of the years of damage.

I still cringe as I think about her being in a nursing home, but it was the safest place for her to be.

She wasn’t there long.

My mom’s death certificate claims “failure to thrive.” She passed away on January 28, 2015 at the young age of 79.

So you can see why this topic is so important to me.

* * *

Many people ask me about the right way to test for Celiac. There are differing opinions, but I know that blood testing isn’t conclusive. I’m told that an endoscopy with biopsy is the gold standard, but it’s intrusive.

My non-medical opinion is that doing an HLA-DQ2 and HLA-DQ8 gene test is wise. Being positive for HLA-DQ8 also carries a risk of RA (rheumatoid arthritis).

Trust me, it’s never too soon to start thinking about maintaining your structure as you age. The risks of not doing so are too great.