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Osteopenia

Osteopenia- low bone density

This is one of the most common diagnoses for our female patients in and approaching menopause. Men may also develop low bone density, however.  Many patients prefer to not take medication if they can help improve bone density with lifestyle changes.

Only you can decide the best options for you based on your individual factors-diet, weight, exercise, activity level and current bone density scores. My generalized recommendation is to evaluate your influential lifestyle choices to determine which changes you could make that would help your situation and start with those conservative care choices.

Here are the factors you can control and use to improve your bone density:

  1. Diet intake of Vitamin D 400-1000 IUs per day (form Vitamin D3) and Calcium 1200-1500 mg per day (citrate is the best absorbed form) and Magnesium 310-420 mg per day (forms glycinate, malate, or citrate are most bioavailable). These are the daily recommended intakes and your needs could vary drastically based on your individual circumstances. But at the minimum you should be consuming these amounts combined from supplement and diet.
  2. Adequate fat intake for Vitamin D absorption, as Vitamin D is a fat soluble vitamin and requires fat for absorption.
  3.  Sun exposure for Vitamin D production via your skin.
  4.  Weight bearing exercises- sw

    Osteopenia- low bone density

    This is one of the most common diagnoses for our female patients in and approaching menopause. Men may also develop low bone density, however. Many patients prefer to not take medication if they can help improve bone density with lifestyle changes.

    Only you can decide the best options for you based on your individual factors-diet, weight, exercise, activity level and current bone density scores. My generalized recommendation is to evaluate your influential lifestyle choices to determine which changes you could make that would help your situation and start with those conservative care choices.

    Here are the factors you can control and use to improve your bone density:

    1. Diet intake of Vitamin D 400-1000 IUs per day (form Vitamin D3) and Calcium 1200-1500 mg per day (citrate is the best absorbed form) and Magnesium 310-420 mg per day (forms glycinate, malate, or citrate are most bioavailable). These are the daily recommended intakes and your needs could vary drastically based on your individual circumstances. But at the minimum you should be consuming these amounts combined from supplement and diet.
    2. Adequate fat intake for Vitamin D absorption, as Vitamin D is a fat soluble vitamin and requires fat for absorption.
    3. Sun exposure for Vitamin D production via your skin.
    4. Weight bearing exercises- swimming and biking are not considered weight bearing exercise. Any other exercise in which you are bearing your own weight or more (weight lifting) is considered weight bearing exercise. Your chiropractor can help you get moving.
    5. Calcium and Magnesium are both needed for proper bone health. Low Magnesium levels inhibit the absorption of Calcium.
    6. Elimination of Type 2 Diabetes-establish a normal range BMI and diet changes to normalize blood sugar levels.

    Diet Sources Vitamin D:

    Include dietary sources of Vitamin D in your daily food intake:

    Egg yolks, dairy products and salmon and sun exposure without sunscreen are more potent choices for Vitamin D increase. Many foods are fortified with extra Vitamin D as well. Read the labels.

    Vitamin D toxicity is a valid concern. There are so many unmeasurable influences on Vitamin D absorption and production in the body (like sun exposure and fat intake since Vitamin D is a fat soluble vitamin), so large doses of Vitamin D need to be carefully monitored.

    Supplements can fill in food intake gaps. Vitamin D3 is most often the form found in supplements. I usually recommend 1000 IUs per day for those with blood test confirmed Vitamin D deficiency. An alternative would be 5000 IU capsules once or twice per week. Any higher dosage needs to be supported by strong, measured blood test deficiencies. All other contributing reasons for Vitamin D deficiency should be ruled out before dosing at higher levels. This treatment should be carefully monitored. Vitamin D toxicity can lead to irreversible kidney and heart damage.

    Reference: Recommended Dietary Allowances 10th Edition, page 97

    Diet Sources Calcium:

    Include dietary sources of Calcium in your daily food intake:

    Dairy products, kale and broccoli are a few of your better sources for calcium intake. Many foods are fortified with extra calcium, like orange juices. Look for the labels.

    NOTE: Calcium inhibits the absorption of iron. So supplements and fortified foods, like many breakfast cereals, that contain fortified iron should be carefully chosen if iron deficiency is a challenge. Please see the Thalassemia trait page for more on false iron deficiency.

    Hypercalcemia and hypercalciuria can occur with excessive intake of calcium or lack of absorption of calcium. This can lead to damage to the kidney, heart and other vital organs. Additionally excessive calcium in the body may lead to the creation of kidney, ureter or bladder stones.

    Reference: Recommended Dietary Allowances 10th Edition, page 181

    Diet Sources Magnesium:

    Include dietary sources of Magnesium in your daily food intake:

    Avocados, DARK CHOCOLATE (woo woo!), spinach, almonds, black beans, figs and yogurt are some more common choices. See Dr. Axe’s website for exact amounts—and have some DARK CHOCOLATE!

    Reference: https://draxe.com/magnesium-deficient-top-10-magnesium-rich-foods-must-eating/

    GET TESTED

    Vitamin D blood test is called 25-hydroxy (25 OH) vitamin D test and normal levels are 20-50 ng/ml. Vitamin D is considered to be toxic if more than 150 ng/ml are detected.

    Serum Calcium is the blood test for calcium levels. Total serum calcium for adults range from 8.4-10.2 mg/dl.

    The thyroid and parathyroid hormones can have a strong influence on the levels of Vitamin D and calcium. The finding of low Vitamin D and serum calcium should be combined with all other blood work results. Dysfunction of the thyroid and parathyroid gland hormones can create abnormal findings of serum calcium and Vitamin D. If these hormones are not being produced within normal ranges, then your diet and supplement choices will not be able to correct these low levels.

    Estrogen levels can influence calcium absorption. Low estrogen during menopause and amenorrhea can decrease calcium absorption in the intestinal tract. Estrogen replacement is a controversial topic due to the increased risks of cardiovascular disease and cancers. This hormone should be evaluated to provide the individual situation for you.

    Magnesium can be tested with a serum magnesium blood test. The normal range for magnesium is 1.5-2.5 mEq/L.

    Reference: Fischbach, Frances (2000) A Manual of Laboratory & Diagnostic Tests, sixth edition. Page 338 for calcium, page 414 for vitamin D and hormones

    imming and biking are not considered weight bearing exercise. Any other exercise in which you are bearing your own weight or more (weight lifting) is considered weight bearing exercise. Your chiropractor can help you get moving.
  5. Calcium and Magnesium are both needed for proper bone health. Low Magnesium levels inhibit the absorption of Calcium.
  6. Elimination of Type 2 Diabetes-establish a normal range BMI and diet changes to normalize blood sugar levels.

Diet Sources Vitamin D:

Include dietary sources of Vitamin D in your daily food intake:

Egg yolks, dairy products and salmon and sun exposure without sunscreen are more potent choices for Vitamin D increase.  Many foods are fortified with extra Vitamin D as well. Read the labels. 

Vitamin D toxicity is a valid concern. There are so many unmeasurable influences on Vitamin D absorption and production in the body (like sun exposure and fat intake since Vitamin D is a fat soluble vitamin), so large doses of Vitamin D need to be carefully monitored.

Supplements can fill in food intake gaps. Vitamin D3 is most often the form found in supplements.  I usually recommend 1000 IUs per day for those with blood test confirmed Vitamin D deficiency. An alternative would be 5000 IU capsules once or twice per week. Any higher dosage needs to be supported by strong, measured blood test deficiencies. All other contributing reasons for Vitamin D deficiency should be ruled out before dosing at higher levels. This treatment should be carefully monitored. Vitamin D toxicity can lead to irreversible kidney and heart damage.

Reference: Recommended Dietary Allowances 10th Edition, page 97

Diet Sources Calcium:

Include dietary sources of Calcium in your daily food intake:

Dairy products, kale and broccoli are a few of your better sources for calcium intake. Many foods are fortified with extra calcium, like orange juices. Look for the labels.

NOTE: Calcium inhibits the absorption of iron. So supplements and fortified foods, like many breakfast cereals, that contain fortified iron should be carefully chosen if iron deficiency is a challenge. Please see the Thalassemia trait page for more on false iron deficiency.

Hypercalcemia and hypercalciuria can occur with excessive intake of calcium or lack of absorption of calcium. This can lead to damage to the kidney, heart and other vital organs. Additionally excessive calcium in the body may lead to the creation of kidney, ureter or bladder stones.  

Reference: Recommended Dietary Allowances 10th Edition, page 181

Diet Sources Magnesium:

Include dietary sources of Magnesium in your daily food intake:

Avocados, DARK CHOCOLATE (woo woo!), spinach, almonds,  black beans, figs and yogurt are some more common choices. See Dr. Axe’s website for exact amounts—and have some DARK CHOCOLATE!

Reference:  https://draxe.com/magnesium-deficient-top-10-magnesium-rich-foods-must-eating/

GET TESTED

Vitamin D blood test is called 25-hydroxy (25 OH) vitamin D test and normal levels are 20-50 ng/ml. Vitamin D is considered to be toxic if more than 150 ng/ml are detected.

Serum Calcium is the blood test for calcium levels. Total serum calcium for adults range from 8.4-10.2 mg/dl.

The thyroid and parathyroid hormones can have a strong influence on the levels of Vitamin D and calcium. The finding of low Vitamin D and serum calcium should be combined with all other blood work results. Dysfunction of the thyroid and parathyroid gland hormones can create abnormal findings of serum calcium and Vitamin D. If these hormones are not being produced within normal ranges, then your diet and supplement choices will not be able to correct these low levels. 

Estrogen levels can influence calcium absorption. Low estrogen during menopause and amenorrhea can decrease calcium absorption in the intestinal tract. Estrogen replacement is a controversial topic due to the increased risks of cardiovascular disease and cancers.  This hormone should be evaluated to provide the individual situation for you.

Magnesium can be tested with a serum magnesium blood test. The normal range for magnesium is 1.5-2.5 mEq/L.

Reference: Fischbach, Frances (2000) A Manual of Laboratory & Diagnostic Tests, sixth edition. Page 338 for calcium, page 414 for vitamin D and hormones

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