A safe and reliable strategy for preventing and correcting osteoporosis has recently become a critical health issue for all of us over the age of fifty. Research studies published in the New England Journal of Medicine have recently exposed a link between long-term use of Fosamax (a bisphosphonate drug used to treat osteoporosis) and unusual transverse fractures of the thigh bone, indicating that prolonged therapy with these drugs tends to weaken bone integrity rather than strengthening it. (1) Even as this clinical data comes to national attention, the public remains largely uninformed concerning two main issues about bone health. First, most cases of osteoporosis are preventable through proper nutrition and exercise especially when initiated during childhood and carried throughout an individual’s lifetime. Secondly, there are safe and reliable alternative methods of increasing the vitality and strength of bone without inhibiting any type of vital bone cell activity, as has been the case with the use of bisphosphonate drugs. My clinical favorite of these alternatives, “Chinese Soup Broth to Make Healthy Bone” appears to restore and maintain bone vitality without side effect. This article will investigate the pertinent issues.
Bone Vitality
Bone is composed of protein and collagen (connective tissue). When calcium from the blood stream is deposited onto this structure, it forms a porous yet rigid framework that supports and protects the body’s internal organs. This formation also provides attachments for muscles and ligaments that make controlled movement and weight bearing activities possible. All bones consist of living and dead cells that are embedded in this mineralized “living matrix” called osseous tissue.
Three types of cells – osteoblasts, osteocytes and osteoclasts – form, maintain, repair and breakdown bone matrix in a lifelong process described as “bone remodeling”. The activities of these cells must always be in relative balance to each other. Their dynamic equilibrium determines bone strength and vitality from conception through old age.
Osteoblasts are the most immature bone cells. They cover all available bony surface. As they migrate into the bone matrix, they bring calcium from the bloodstream with them, thereby laying down new bone. Soon, they mature into osteocytes, responsible for regulating how bone responds to stress or mechanical load. The more strain that is placed on a bone, the more calcium is deposited into that area. Repeated activity increases the amount of calcium deposited in the bone, making it thicker and stronger.
Osteoclasts, remove “old bone” during normal remodeling cycles, releasing calcium back into systemic blood circulation. Their activity has a secondary effect of regulating calcium balance between what is contained in bone and what is circulating in the bloodstream and available for other uses.
Damage Control
If an individual doesn’t exercise on a regular basis, osteoblasts and osteoclasts are not called up for duty. As a result, bone matrix becomes too porous, kind of like Swiss cheese, insufficient to support the weight of normal body activity.
If an individual exercises too strenuously, or falls, the force can generate “micro-fractures” in the bone. In a healthy individual, a micro-fracture is quickly repaired by a vigorous crew of osteoblasts and osteocytes. In an older or unhealthy person, the lack of osteocyte activity leads to deeper cracks and fissures, degrading bone integrity and making is susceptible to fracture.
Osteoporosis
Osteoporosis (literally “porous bones”) describes a pathological state where the bone remodeling process has stopped, thereby disrupting essential micro architecture and leading to an excess of bone “resorption” relative to bone formation. In some, but not all women, this state leads to an increased risk of fractures, and poor healing. Osteoporosis is most common in women after menopause, but may develop in men and pre-menopausal women in the presence of particular hormonal disorders, and other chronic diseases. The highest risk of bone fracture occurs in women over the age of 75.
Western Medical Treatments for Osteoporosis
From a western point of view, the therapeutic goal has been to strengthen the bone so that it won’t fracture. One early approach was to prescribe female hormone replacement. Estrogen stimulates the deposition of calcium into bone, thereby increasing bone density, but with considerable adverse side effects – mostly in the form of cancers and heart disease.
A second approach was initiated in the mid 1990′s. A special class of drugs called bisphosphonates was developed to inhibit osteoclast activity. Rather than being “resorbed” into the bloodstream, old bone is allowed to build up over more old bone, thereby increasing overall density with the intention of reducing the potential for fractures. Bisphosphonates used to treat osteoporosis currently include Fosamax (Alendronate), Actonel (risedronate), Didronel (Etidronate), Aredia (Pamidronate), Boniva (Ibandronate), Reclast (Zoledronic acid), Skelid (Tiludronate) and Zometa (Zoledronic acid).
On average, these drugs appear to increase bone mass density by 3 to 5% over three years time. Some side effects have been reported such as osteonecrosis of the jaw, musculoskeletal pain, stomach irritation, thyroid and adrenal cancers, and fertility impairment.
Even more recent evidence suggests that after four or more years of use, the trend reverses itself and structural integrity diminishes. A significant number of unusual transverse fractures of the thighbone have occurred in patients during minimal activity. If we recall our theory of bone vitality, bone is constantly being remade. This latest research contends that “patients taking bisphosphonates do not remodel their bone”. Without sufficient osteoblast and osteocyte remodeling, “micro-damage accumulates in the bone, making it more susceptible to fracture. What we need is to rejuvenate the skeleton” (1)
While drug treatment for osteoporosis can save many lives in the short term. I suggest careful evaluation of risks versus benefits by both practitioners and patients. If the disease is observed early, it can be reversed by more holistic therapies that take into account the need for homeostasis in bone cell activity, regular exercise and a fresh food diet.
Osteopenia
A disturbing trend in the past few years has been the apparent change in medical terminology between osteoporosis and osteopenia (literally “thin bone”). Concurrent with the development of convenient technology to measure bone density, too many women have been prescribed bisphosphonate medications (albeit in lower doses) with the false understanding that they have a “disease” that requires medication. It is important to note that osteopenia is not a pathology. Osteopenic bones are thin, but are perfectly capable of repairing micro-fractures as they occur. Nor does osteopenia require medical treatment. It was a diagnostic term “coined” by medical experts at the World Health Organization osteoporosis meeting in Rome in 1992 to differentiate between a slight thinning of the bones that occurs naturally as people age and a pathological loss of bone mass. Osteopenia typically does not result in bone breaks and it can be reversed with weight bearing exercise, nutritional therapies and a fresh food diet.
Traditional Chinese Medical (TCM) Approach:
Traditional Chinese medical theory approaches a disease state from a multi-faceted point of view, taking into consideration the relative balance between all aspects of the organism and its environment. If we use the metaphor of a tree to describe a particular medical condition, the Chinese physician will commence his investigation by inspecting the leaves, stems and branches as well as the tree’s trunk and root system. He will also assess the local earthly environment and the sources of air and water before arriving at a diagnosis of what has become out of balance. Even if a set of symptoms describes a disharmony in the trunk and branches, such as “osteoporosis”, the physician will devise a treatment plan that replenishes resources for the tree’s use and rebalances all the systems that are responsible for sustaining the tree’s vitality.
According to the Chinese ancients, the health and vitality of bone matrix is dependent on the amount and quality of Kidney Jing (literally “essence resource”). Jing is the metaphoric “water” source for growth and remodeling activities during the life of the tree. In simple human terms, along with many other activities, Jing tells the osteoblasts to get to work making new bone and supplies the osteoclasts with energy to break down old bone.
During her lifetime, a woman can deplete her Kidney Jing, especially during pregnancy and delivery, overworking, stress or excess sexual activity. As a result, she will lose bone density. Fragile bones, however, are not the only symptom she will suffer. Other signs of Jing loss include premature graying of hair, balding, loose teeth, poor hearing, low back and knee pain.
In TCM theory, the liver system stores blood and controls the vigor of sinews and tendons. If her liver resources are depleted, she may also experience dizziness, dryness, blurred vision, tinnitus, thirst, night sweating and arthritic tendons and joints.
These same women (or men) may also complain of muscle aches and weakness, poor digestion and fatigue. In TCM theory, spleen/pancreatic Qi (literally “energy”) is responsible for transforming and transporting food resources to all parts of the body, including the bones. It also recycles blood and maintains the health of vessels and muscles.
Chinese Herbs treat Osteoporosis
Given this larger picture of possible signs and symptoms, Chinese medicine aims to re-supply each of the organ systems that are responsible for healthy bone – the liver, spleen, pancreas and especially kidney Jing. Chinese herbal formulas have been used with great success for over two thousand years to achieve this end. Herbal specialists know precisely which roots, plants, fruits and natural substances replenish these resources. When these substances are simmered in water, they release their therapeutic nutrients into the water, turning the resulting broth into a medicine of great value.
Soup Broth: An Essential Form of Food Therapy For Osteoporosis
Most Chinese hospitals deliver herbal prescriptions to their patients in thermos bottles of warmed broth. Patients using soup broth therapy recover their health more quickly and are able to maintain a higher level of vitality for a longer period of time. Tablets and capsules, although useful, are more slowly absorbed into the body and take longer to achieve their intended effect.
“Chinese Soup Broth to Make Healthy Bone and Prevent Osteoporosis®”
This broth recipe has been handed down from one Chinese doctor to another for centuries. In many of my osteoporosis patients, it has entirely replaced the need for bisphosphonate medications. Pork neck bones and carefully selected herbs are slowly simmered for many hours before being strained into multiple containers that can be stored in the freezer until needed. One recipe makes a sixteen day supply (8 pints). Dosage is 4 ounces of warmed broth taken twice daily, usually for a year or more. The pork neck bones (2 lbs. per recipe) can be obtained from a local butcher. My Publix butcher orders them by the case, keeping them in the freezer until I come in to pick them up. The raw herbal materials are available at my clinic pre-assembled, and can be mailed anywhere in the country.
Although the exact formula is proprietary, ingredients in the basic broth include Chinese wolfberry, longan fruit, red jujube date, codonopsis root, astragalus root, angelica sinensis root, American ginseng root, glehnia root, fresh ginger root and deer antler gelatin.
For my patients who also suffer from arthritis or hip/joint disease, I recommend adding chicken bones to the recipe along with a couple of extra herbs such as Dipsacus root and Drynaria rhizome. According to Chinese herbology, these additional herbs nourish the kidney and liver systems responsible for mending sinews and bones, strengthening tendons and ligaments and relieving pain in arthritic joints.
Over the last five years, the only difficulties encountered with this type of therapy have been in terms of convenience and effort required on the part of the patient. Making a new batch of soup broth every sixteen days can be time consuming, although I simmer mine in a crock-pot overnight and find it easy to complete the next morning. In my experience, every patient who has continued with the therapy for more than nine months has increased his/her bone density by 15 – 30%. All patients have also committed themselves to 30 minutes a day of exercise, a fresh food diet and some vitamin/mineral supplementation.
Helpful Tips for Lifestyle and Nutrition
The following is a summary of recommendations to maintain good structural health. For a more complete discussion of the issue, I recommend reading an excellent book, Better Bones, Better Body by Susan Brown, PhD.
• Consume a sufficient amount of calcium from diet. Milk and foods made from milk are not the only sources of calcium. Other good choices are calcium-rich, lowfat foods from the other food groups. Some fruits and vegetables that are high in calcium include kale, collard greens, bok choy, broccoli, and oranges. Other calcium-rich foods that are low in saturated fat include calcium-treated tofu and cooked dried beans.
• Supplement approx. 800-1000 mg. Calcium citrate daily in a comprehensive vitamin/ mineral formula designed for men or women over the age of 50. (Calcium supplementation is most effective if it is combined with 800-1000 IU of Vitamin D-3 and other minerals such as magnesium (500 mg), potassium (100 mg) and boron (3 mg).
• There is some clinical evidence that supplementing Vit K-2 and strontium ranelate is helpful in bone remodeling (2)
• Remember that the phosphoric acid and carbonic acid in carbonated sodas compel bone matrix to release calcium back into the blood to buffer the acidic load from these types of beverages, thereby making bone less dense!
• Women need to consume foods rich is plant estrogen such as soybeans and Mexican yams (dioscoria) or herbal preparations for menopausal complaints. These herbal formulas such as Liu Wei di Huang Wan, Jin Gui Shen Qi Wan, Ge Jie Da Bu Wan, or Du Huo Ji Sheng Pian all treat the major deficiencies that predispose a woman to osteoporosis. Each formula emphasizes a particular imbalance within the deficiency. Your acupuncture physician can prescribe these for you after diagnosing your particular imbalance.
• Exercise 30 minutes daily by walking or mild aerobic exercises. Tai Chi or Yoga also strengthens bones and joints without increased risk of injury. Weight bearing exercises at least three times a weeks are especially effective in improving bone strength. When muscle pulls on bone, it encourages osteoblasts to lay down more calcium in that area, thereby creating denser, stronger bones. These activities also improve heart health, muscle strength, coordination and balance. Check with your health care provider before you start a new exercise program to make sure it is suited to you.
• Spend ten minutes daily in outdoor sunshine to increase absorption of natural Vit. D. This amount of exposure has not been shown to advance either type of skin cancer.
• Consume 4-8 oz. Chinese Soup Broth to Make Healthy Bone and Prevent Osteoporosis® every day!
Click Here to Download the Recipe
For an appointment to evaluate your symptom pattern and customize a treatment plan specifically for you, please contact:
Melinda Leeson, DOM. (Doctor of Oriental Medicine), HMC (homeopathic physician)
7029 S. Tamiami Trail, Suite A. Sarasota, FL 34231 Telephone: (941) 926-9082
© Copyright 2010 Melinda Leeson, P.A.. All Rights Reserved. This content may be copied in full, with copyright, contact, creation and information intact, without specific permission, for personal use only in a not-for-profit format. Copying any portions of this article for publication, either print or electronic, is not permitted without prior written permission from Melinda Leeson, P.A.
Special Note:
Statements made in this article have not been evaluated by the Food and Drug Administration. They are the results of my personal clinical research and experience. Please consult your healthcare professional before trying the broth mentioned herein or any other nutritional supplement.
Footnotes:
(1) As recently as March 2008, medical research studies revealed a link between long term use (5 or more years) of Fosamax and unusual lateral fractures of the thigh bone during low-energy activities. Dr. Rossenwasser, an orthopedic surgeon at New York-Presbyterian Hospital (Columbia Campus) studied patients taking Fosamax for a number of years. In his paper presented to the 2010 Conference of the American Academy of Orthopedic Surgeons he stated “in the early treatment period, patients using bisphosphonates experienced improvements in all parameters, including decreased buckling ration and increased cross-sectional area … However, after four years of use, these trends reversed, revealing an association between prolonged therapy and declining cortical bone structural integrity.”
Another presenter, Dr. Joseph Lane (Chief of metabolic bone disease at the hospital for Special Surgery), “normally your bone is constantly being remade … These patients don’t remake their bone. The development of new collagen is slowed and altered in some way. As certain women acquire micro-damage, it accumulates in the bone, making it more susceptible to fracture. What we need is to rejuvenate the skeleton.” (For sources, see below)
(2) Strontium ranelate for preventing and treating postmenopausal osteoporosis. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: O’Donnell S, Cranney A, Wells GA, Adachi J, Reginster JY. CD005326. DOI: 10.1002/14651858.CD005326.pub3.)
Vit K-2 menaquinone-7 (45 mg). J Orthop Sci. 2000;5(6):546-51. PMID: 11180916. Abstract; Iwamoto J, Takeda T, Ichimura S.
Sources:
Bisphosphonates and Fractures of the Subtrochanteric or Diaphyseal Femur
Black DM, Kelly MP, Genant HK, Palermo L, Eastell R, Bucci-Rechtweg C, Cauley J, Leung PC, Boonen S, Santora A, de Papp A, Bauer DC
Published by N Engl J Med; at www.nejm.org on March 24, 2010 (10.1056/NEJMoa1001086).
Evolving Data about Subtrochanteric Fractures and Bisphosphonates
Shane E. Published in N Engl J Med; at www.nejm.org on March 24, 2010 (10.1056/NEJMe1003064).
Atypical Fractures of the Femoral Diaphysis in Postmenopausal Women Taking Alendronate
Lenart BA, Lorich DG, Lane JM
Published in N Engl J Med 358:1304, March 20, 2008
Quantity vs. Quality: Long-Term Use of Bone-Building Osteoporosis…
Rossenwasser et al. Presented to the American Academy of Orthopaedic Surgeons 2010 Conference.
Bisphosphonate use associated with low-energy femoral fractures
Annie Hayashi. AAOS Now (American Academy of Orthopaedic Surgeons) January 2010 Issue
How A Bone Disease Grew To Fit The Prescription, NPR All Things Considered, Michele Norris December 21, 2009 NPR®
Better Bones, Better Body: Beyond Estrogen and Calcium: a Comprehensive Self-Help Program for Preventing, Halting and Overcoming Osteoporosis, 2nd Edition 2000 by Susan Brown PhD. Keats Publishing, Los Angeles. See her website at www.betterbones.com
