Bone density – diagnosis, nutrients and lifestyle factors

The NHS reports that osteoporosis affects over three million people in the UK.  In addition, according to prevalence data from the UK Adult Dental Health Survey, 37% of the adult population has moderate levels of chronic periodontitis, while 8% of the population suffers from severe periodontitis.1

Low bone mass is a feature of both these conditions and thus increased risk of osteoporotic fracture and periodontal bone and tooth loss.2 In this blog we will discuss nutrients and lifestyle factors that can have a positive effect on bone density.

Skip to Key Takeaways

Generally osteopenia and the early stages of osteoporosis are non-symptomatic and therefore symptoms are typically not experienced until the later stages of osteoporosis.  As reported by the NHS, a DEXA scan is normally offered in the following circumstances:

  • If a person has had a fracture after a minor fall or injury
  • women who have had an early menopause, or have had their ovaries removed at a young age (before 45) and haven’t had hormone replacement therapy (HRT)
  • post-menopausal women if they smoke or drink heavily, have a family history of hip fractures or who have a body mass index (BMI) of less than 21
  • men or women with a condition that leads to low bone density, such as rheumatoid arthritis
  • women who have a history of large gaps between periods (more than a year)
  • men or women taking oral glucocorticoids (such as cortisone, prednisolone) for three months or more

DEXA scan

DEXA scans measure bone density and assess the risk of bone fractures. Unlike ordinary X-ray images, DEXA scans can measure tiny reductions in bone mineral density. This makes it possible to diagnose osteoporosis in its early stages, before fractures occur. A DEXA scan uses a low dose of radiation and the bone mineral density is then compared to the bone mineral density of a healthy young adult and someone who is the same age and sex as the person being tested. The difference is calculated as a standard deviation (SD) and is called a T score.

Standard deviation is a measure of variability based on an average or expected value. A T score of:

  • above -1 SD is normal
  • between -1 and -2.5 SD is considered as decreased bone mineral density compared with peak bone mass and often defined as osteopenia
  • below -2.5 is defined as osteoporosis

Osteopenia

Osteopenia refers to having bone mineral density (BMD) that is below normal levels but not low enough to be classified as osteoporosis. Osteopenia increases the risk of developing osteoporosis and is considered a precursor to osteoporosis.

Osteoporosis

Osteoporosis is a complex skeletal disease characterised by low bone density and micro-architectural defects in bone tissue, resulting in increased bone fragility and susceptibility to fracture.

Gingivitis  

Gingivitis is an extremely common disease in which the gums become red and swollen and bleed easily. However, gingivitis that is left untreated may progress to periodontitis, a more severe gum disease that can result in tooth loss.

Periodontal disease

Periodontitis is a chronic inflammatory disease of bacterial aetiology that affects the supporting tissues around the teeth.  In the early stages, some patients are not aware of any problems. However, as the disease progresses, patients may complain of bleeding gums, a bad taste in their mouth and, in later stages, become aware of loose teeth. If it is not treated, the result can be both loss of teeth and function which can negatively impact a patient’s quality of life.

Although osteoporosis is not the main cause of periodontitis, it may be a factor that leads to enhanced periodontal pocket depth and greater risk of tooth loss in post-menopausal women.3,4  One study, which excluded pregnant, lactating and post-menopausal females, aimed to compare the mandibular bone mineral density of patients with chronic periodontitis with that of periodontally healthy subjects.  The study found that the mandibular bone mineral density of the subjects with periodontitis was significantly lower than that of the periodontally healthy subjects.5 A 2012 review of literature on the relationship between osteoporosis and periodontal disease indicated a greater propensity to lose alveolar bone (i.e. bone in the jaw ridge) in subjects with osteoporosis, especially in those with pre-existing periodontitis. This would indicate that osteoporosis or low systemic BMD should be considered a risk factor for periodontal disease progression.

Interventions to increase bone density

Many studies have concentrated primarily on the role of calcium in bone health and paid less attention to other micronutrients.

Diet

Carbonated drinks

Some studies have found that carbonated cola beverages, but not other carbonated soft drinks, are associated with low BMD in women.  This may be due to the caffeine and phosphoric acid content in colas.6 However, other studies suggest that all carbonated soft drinks are inversely related to BMD.7

Another consideration is sparkling water with no added flavours. Studies are limited in this area but in 2001 the Birmingham School of Dentistry examined seven different brands of mineral water, pouring them over extracted teeth to see what happened. They found that sparkling water had a pH of between 5 and 6 compared with still water which was neutral at 7.  Sparkling mineral waters showed slightly greater dissolution than still waters, but levels remained low and were of the order of one hundred times less than the comparator soft drinks. De‐gassing of a sparkling mineral water reduced its dissolution, but the conclusion was that carbonation of drinks may not be an important factor per se in respect of erosive potential.8

Nutrients

Research suggests a positive link between fruit and vegetable consumption and bone health.  In a cross-sectional study, it was reported that intakes of zinc, magnesium, potassium, fibre and vitamin C are associated with higher bone mass in pre-menopausal women. 9 A review in North America identified that Physicians are aware that vitamin D, calcium and exercise are essential for maintenance of bone health but are less likely to be aware of dietary insufficiencies of magnesium, silicon, vitamin K, and boron – all of which are important contributors to bone health. 10

Vitamin D

Most people think that vitamin D is a vitamin but, in reality, the active form of vitamin D is one of the most potent hormones in the body.  It is produced as a pro-hormone in the skin after sunlight exposure and is then converted to the potent hormone form.

Vitamin D is famous for its role in helping the body absorb the calcium needed for strong bones and in maintaining an adequate level of calcium in the blood. Vitamin D stimulates the synthesis of osteocalcin by bone tissue, a hormone that promotes bone mineralisation (it also has other effects in the body).

The Scientific Advisory Committee on Nutrition reports that low vitamin D status can reduce the mineralisation of teeth during development and increase the rate of progression of bone loss associated with periodontal disease, which may result in more rapid tooth loss.11

A number of studies have reported that a decreased intake of vitamin D and calcium is linked to periodontal disease.12-14

Furthermore, research suggests that patients in periodontal maintenance programmes, taking vitamin D and calcium supplementation, have a trend for better periodontal health compared to patients not taking supplementation. One such study found a positive influence of vitamin D and calcium supplementation in the management of periodontitis.15

Calcium

Calcium is often associated with bone health but its benefits go far beyond helping to build and maintain a strong skeletal structure. Calcium is also needed to regulate heart rhythms, aid in muscle function, regulate blood pressure and cholesterol levels, and it is involved in numerous nerve signalling functions.

Calcium needs to be obtained from natural food sources to have the most benefits and, because of this, the use of calcium supplements for preventing bone-related diseases is now being reconsidered. There have been many studies pointing to the fact that calcium supplementation alone may not directly positively influence osteoporosis risk.16, 17

Magnesium

Magnesium regulates the transport and metabolism of calcium and is central to the structure of bone.  Fifty-five to sixty percent of the body’s magnesium is found in the bone.

Vitamin K2

Vitamin K2 plays a key role in the synthesis of at least two proteins involved in calcium and bone metabolism, namely osteocalcin and matrix Gla-protein (MGP).

The biosynthesis of osteocalcin, which promotes bone mineralisation, is vitamin K-dependent. The other key protein, MGP, inhibits vascular mineralisation. Vitamin K2 is needed to activate MGP so that it can perform its inhibitory function. Thus, the combination of vitamin D3 and K2 encourages transportation of calcium from the arterial walls to the bone.18-19 Impairment of MGP will cause arterial calcification, which is currently regarded as the strongest predictor of cardiovascular events.20-21

Boron

Boron has been shown to be an important trace mineral22 because it is essential for the growth and maintenance of bone, 23 greatly improves wound healing, 24 beneficially impacts the body’s use of oestrogen, testosterone, and vitamin D, 25 boosts magnesium absorption,26 reduces levels of inflammatory biomarkers, such as hs-CRP and TNF-α, 27 and raises levels of antioxidant enzymes, such as superoxide dismutase, catalase, and glutathione peroxidase.28

Boron plays an important role in osteogenesis, and its deficiency has been shown to adversely impact bone development and regeneration.29 Boron influences the activity of many metabolic enzymes, as well as the metabolism of steroid hormones and several micronutrients, including calcium, magnesium, and vitamin D. Boron supplementation has repeatedly been shown to markedly reduce urinary excretion of both calcium and magnesium and to increase serum levels of oestradiol and calcium absorption in peri-menopausal and postmenopausal women.30-31 Boron also beneficially impacts vitamin D utilisation. Research shows people with lower boron concentrations in their bones and synovial fluid experience higher rates of arthritis compared to those with higher levels.32

Lifestyle Recommendations

Weight-bearing exercise

A number of studies have focussed on weight-bearing exercise and its impact on bone mineral density.  This is any exercise in which body weight is supported through the feet and legs (or hands and arms).

Examples of weight bearing activities for adults include:

  • brisk walking, including Nordic walking
  • moderate resistance weightlifting
  • stair climbing/step classes
  • carrying or moving heavy loads like groceries
  • exercising with resistance bands
  • heavy gardening, such as digging and shovelling
  • cross-training machines

Key takeaways

  • Generally, osteopenia and the early stages of osteoporosis are non-symptomatic
  • Osteopenia refers to low bone mineral density but not low enough to be classified as osteoporosis
  • Osteoporosis is characterised by low bone density resulting in increased bone fragility and susceptibility to fracture
  • Gingivitis (gum disease) that is left untreated may progress to periodontitis, a more severe gum disease that can result in tooth loss
  • Research suggests a positive link between fruit and vegetable consumption and bone health
  • Vitamin D is well-known for its role in helping the body absorb the calcium needed for strong bones and in maintaining an adequate level of calcium in the blood
  • Calcium supplementation alone may not directly positively influence osteoporosis risk
  • The combination of vitamin D3 and K2 encourages the deposition of calcium into bone (i.e. bone mineralisation), rather than soft tissues such as the arteries (i.e. vascular mineralisation). Vascular mineralisation is undesirable and associated with an increased risk of cardiovascular disease
  • Boron influences the activity of many enzymes, as well as the metabolism of steroid hormones and several micronutrients, including calcium, magnesium, and vitamin D
  • Weight-bearing exercise has a positive impact on bone mineral density. This is any exercise in which body weight is supported through the feet and legs (or hands and arms)

If you have any questions regarding the topics that have been raised, or any other health matters please do contact me (Jackie) by phone or email at any time.

jackie@cytoplan.co.uk, 01684 310099

Jackie Tarling and the Cytoplan Editorial Team


Related Cytoplan products

Bone Support – calcium from calcified seaweed along with magnesium, boron and vitamins D3 and K2.

Cyto Gold – multivitamin and mineral with 142mg of calcium per tablet and 20µg of vitamin D3.

Pregna-Plan – multivitamin and mineral with increased levels of vitamin D3 and calcium to meet needs during pregnancy.

CoQ10 Multi – all-round multivitamin and mineral, without calcium but with excellent levels of vitamin D3. Also contains vitamin K2.

Vitamin D3 and K2 – contains 100ug (4,000 i.u.) Vitamin D3 and 100ug Vitamin K2 (Mk-7) and is designed to support levels of K2/D3 and is ideally used in conjunction with any of our multi formulas.

High Potency Vitamin D3 – a Wholefood supplement from lichen ideal for vegetarians and vegans. Vitamin D3 is the most bioavailable form of this nutrient.

Biofood Magnesium – an essential mineral, a cofactor for over 300 enzymes. Nearly 70% of the body’s supply is located in the bones – magnesium supports the maintenance of bone health and is necessary for the proper functioning of muscles.

Magnesium Citrate – the best of the non-food forms of magnesium. As a citrate it is readily absorbed into the bloodstream via the citric acid cycle.

Wholefood Calcium – a natural multimineral, this product contains seaweed harvested off Ireland’s southwest coast. It is an organic Wholefood supplement with no additives that yields 200mg elemental organic per capsule.


Reference available upon request.


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One thought on “Bone density – diagnosis, nutrients and lifestyle factors

  1. Great summary. The association with gingivitis is especially important.

    Suggest that you advise people to measure their levels and to know their targets, e.g. many MDs now measure vit D levels, but tell people they are fine if the level is 30, which is far below the optimal bone health level. Dr. Bredesen’s 50-80 target is much better; only if people know their targets and levels can the properly manage Calcium, Magnesium, Boron, K2, and Vit D

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