Bare Bones & Hormones — Part II

Inevitable or Avoidable?

It’s August. It’s hot. This has been one of the hottest summers on record here, not just locally in New England, but here in the United States. Maybe even here on the planet. So, I’m a little peaked. Now, I almost never drink carbonated soda. I mean never. I don’t buy it. I might order it at a restaurant. But that’s it. I know that the phosphates in soda can contribute to bone loss. So, it’s not my drink of choice. But, hey, once in a great while, what’s the harm? So, I bought some diet cola. And I’m sucking it back and it’s very refreshing, and I’m drinking it while sitting at the computer, doing research on calcium absorption for this post. And I read this:

“Over the long term the effects of colas are devastating to the body…. It would take 32 glasses of alkaline water at an alkaline pH of 9 to neutralize the acid from one 12 oz. cola or soda. Drinking a cola or soda, the body will use up reserves of its own stored alkaline buffers, mainly calcium from the bones and DNA….” — from Goldrust.net

All righty then! Guess this is the last time I drink soda. That sucking sound I hear must be my bones turning into dust. The good news is that if I go back to drinking my own low-cal, home-made lemonade instead, it turns out I will be helping the situation immeasurably. More on that later.

“Holy Porosity, Batgirl!”

When I started researching this follow-up to my last blog post, I had no idea what a can of worms I’d be opening up. That’s because a lot of what I thought I knew about bone loss and hormones was wrong or incomplete. Now, I could write a book, which means there isn’t enough room in one post to do justice to either subject. What I will do is focus more on bone loss in this post and more on its relationship to hormones and breast cancer in later ones.

Just trying to define the terms used in a discussion of bone loss is dicey. Physicians, physiologists and other experts disagree over what constitutes a disease or condition requiring treatment. So, even our own doctors may not know what they should or should not be advising us to do. Generally speaking, everyone seems to agree that we humans develop our peak bone mass somewhere between the ages of 20 and 30. The implication is that it’s all downhill after age 30, or that once we start to lose bone mass, the best we can hope for is to prevent the situation from getting worse. If that were strictly true, then none of us would ever recover from a fracture — or any other injury, for that matter — and there would be no point whatsoever in the entire industry of medications, supplements and exercises that has arisen out of trying to improve bone mass. Well, guess what? It’s not all downhill after age 30, at least as far as our bones are concerned. Bones are, in fact, a living tissue which is continuously breaking itself down and building itself up on a daily basis. The breaking down part is achieved by cells called osteoclasts, the building up part by osteoblasts. Bone loss occurs when there is more of the former than the latter.

  • There are a number of links referenced in this post that connect you to PDF’s you can download, by the way. So, do click on them for further information or to download something to pass on.

But why does that happen in the first place? What causes us to break down bone tissue faster than we can rebuild it? Turns out it’s not as straightforward as you might think. The villain that takes the heat most often is the estrogen loss that occurs around menopause. While it’s true that statistically, most of the people who develop osteoporosis in Western countries are women over 55, not all women over 55 develop osteoporosis, and not all folks who do develop it can attribute it to a lack of estrogen. Diseases, medications, poor nutrition, too much soda, not enough exercise, excessive alcohol and cigarette smoking all put someone at risk for bone loss. A parental or personal history of fractures puts you at risk. Stress, lack of sleep, not enough veggies, and too much caffeine can contribute. Frequent surgeries, gastrointestinal problems, long-term use of steroidal drugs and not enough vitamin D are also risk factors. The good news is that you can do something about quite a lot of these items and minimize the impact of the rest of them. For more information about risk factors, visit the National Osteoporosis Foundation website. You can also download their “Hormones and Healthy Bones” brochure for a more complete overview.

To Scan Or Not To Scan

If you ever calculated a mean or an average in math class, then you had a close encounter with a bell curve long before you ever had to think of having your first bone density scan. Trust me, getting a bone density scan is a lot easier than plotting a bell curve. But the T scores that get bandied about when you do get a bone density scan come from the data used to plot the bell curve to the left here. This bell curve represents normal female bone density between the ages of 20 and 29, which is that prime-time mentioned above when we have achieved maximum bone mass. The middle, or median, of this curve is represented by zero, meaning that half of all adult women under 30 have a bone density at or above the median, and the other half have a bone density at or below the median. Logical, right? When we get a bone density scan, our scores are plotted against this bell curve, and wherever our score falls is our T score, which is just a number indicating how far our score deviates from the median. If your bone density score is -2.5 or less, or 2.5 or more standard deviations below the median, then you are considered to have osteoporosis. That’s the left-most part of the bell curve in the bright aqua section. If your T score is between -2.5 and -1.0, then you have some bone loss, but you don’t yet have osteoporosis. This category of bone loss was given the name “osteopenia” in 1992 by the World Health Organization.

Having a low T score does not necessarily mean that you will fall and break your hip or that your spine will be riddled with compression fractures. To understand how your T score fits in with your overall fracture risk, the World Health Organization developed FRAX, which is a fracture risk assessment tool. You can find the tool here on this FRAX page; be sure you place your mouse over “calculation tool” at the top of the page and choose the appropriate continent and ethnicity.

Dr. Nelson B. Watts, Director of the University of Cincinnati Bone Health and Osteoporosis Center, does not like the term “osteopenia” [See "What is osteopenia....?"] and states that it is all too often used incorrectly and ineptly, needlessly scaring women and men who are fine, who have a normal amount of bone loss for their age or condition and who do not need treatment. His colleagues at the nearby Cleveland Clinic Foundation, Drs. Holly Thacker and Bradford Richmond, beg to differ. In their rebuttal to Dr. Watts, they assert that, “[o]steopenia describes the common finding on radiographs that should alert the clinician to an underlying bone pathology, whether it is osteoporosis or multiple myeloma. Understanding the technical factors that can produce the appearance of osteopenia is essential to the correct observation.” As the daughter of a woman whose osteoporosis killed her, I certainly feel that it is helpful for me personally to know whether or not I am osteopenic, so that I have time to do something to prevent my bones from developing osteoporosis. That prevention does not, however, have to be medication, and the treatment of osteopenia as a disease is what Dr. Watts objects to. As it happens, I agree with all three doctors. Osteopenia is at best just a reflection of a normal life process and at worst a helpful early warning to investigate further and, if need be, make some changes to prevent further bone loss. But osteopenia is not in and of itself a disease. And osteoporosis, as Dr. Watts points out, is only one item in the FRAX calculation of fragility which determines who is at risk for fractures.

What Does It All Mean?

First of all, it means that there will be a Part III, IV and probably V in this series. What it all means for now is that most of us are not in as much trouble as we might have thought. There are, in fact, ways to prevent, minimize or reverse bone loss that do not involve ingesting drugs or consuming vast quantities of broccoli and dairy foods. But the complete story will have to wait for Part III.

I won’t leave you hanging completely, however. Remember that lemonade I referred to earlier? Well, that lemonade leads to a few bits of information that can have a profoundly good affect on our bone heath.

Turns out that if you stopped drinking most if not all carbonated sodas and beverages, you’d be doing your bones a lot of good. ‘Carbonated’ is a misnomer, really. They should all, in fact, be called ‘overly-acidic, highly phosphorated’ beverages. The average 12-oz. can of cola has a pH of about 3.0 — neutral is 7.0. The body doesn’t like that much acid floating around. Our bodies like to be slightly alkaline or at least neutral. When we drink soda, however, we are sloshing a lot of acid liquid into our bodies that slides past our stomachs and gets taken up rapidly by our bloodstream. Our bodies then have to neutralize all that acid to restore our body’s pH balance. And the way they do that is by grabbing up calcium ions. And the handiest repository of calcium in our bodies is our skeletal bone. So, the more soda you drink, the more your body will be snatching calcium out of your bones to neutralize all that acid. It’s true that we do need some phosphorus to maintain our bones, but not that much. What phosphorus does is facilitate osteoclastic activity — remember osteoclasts? Those are the cells that break down our bones. And we’re trying to help our osteoblasts keep up, remember?

Meanwhile, we’re having a hellaciously hot summer and we need to drink something. It may seem counter-intuitive, but the juice of one lemon or lime is a wonderful substance for helping us maintain our bodies’ alkaline preferences, thus leaving our calcium where it belongs. That’s because lemons and limes, which we regard as acidic, contain citric acid, which — unlike the acids in soda — is converted to citrates in our digestive system before being turned loose in the blood. And the blood likes citrates because they help our bodies stay happily alkaline. We all know by now that berries are full of cancer-fighting anti-oxidants, so I’d say a nice pitcher of raspberry lime rickeys would be a perfectly acceptable substitute for a nasty ol’ six-pack of Mountain Dew.

See? Your momma was right: be good and eat your fruits and veggies.


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This entry was written by Kathi, posted on Wednesday, August 11, 2010 at 10:08 am, filed under Breast Cancer Info & Support, Health & Healthcare, Living with, despite & beyond cancer, Making A Difference, Nitty Gritty and tagged , , , , , , , , , , , . Bookmark the permalink . Post a comment below or leave a trackback: Trackback URL.

One Response to “Bare Bones & Hormones — Part II”

  1. Thank you for writing this series Kathi. And, you’re right about parts 3, 4, 5…. This is a very evolving subject – not in the least regarding the validity of DXA and the adequate reading of DXAs (and vitamin D tests), the understanding of the issue beyond the T-score (on the part of health care providers and everyone else), the risks and benefits of the medications used, understanding the definition of “osteoporosis” (including your important discussion of “osteopenia”)…. You’re an excellent writer, my friend. I look forward to more!

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