1. Background:
I was a strict vegetarian for more than a decade. I didn’t want to kill animals. The other motivation was to control my cholesterol, which is elevated for some members in my family. People asked where I would get calcium, response, dark leafy greens. Think about it; where do cows get their calcium – from grass – they don’t drink milk.
I stay active; I run, swim, lift weights at the gym, walk or yoga. A vegetarian diet isn’t always calorie dense, and at times, my body weight would get low for my height. During my service in the Marine Corps, I would run up to 50-miles per week, often running a half-marathon at least once a week.
When I left Ottawa Canada, and relocated to San Diego, I went to the doctor for my annual physical. Lab tests indicated that my vitamin D levels were very low, low enough that I was put on a high prescription dose for a week.
2. Incident:
In May 2020, I returned to Connecticut, driving across the country from Green Gulch Farm in Muir Beach. It was a dismal drive, all the national parks were closed due to the pandemic.
During the summer, I prepared my teaching materials before the fall semester began at University of Connecticut. I was running more than normal, short runs every day, on asphalt, and one long run every week with my twin brother, on packed dirt.
I was running one morning in late July, I reached the turn-around point, and was heading back. I don’t remember anything snapping or popping, but felt tremendous discomfort in my lower left leg; it was uncomfortable enough that I had to stop running and walk home.
I had been working outside, clearing some land at my parent’s house, perhaps I rolled my ankle. I often rolled my ankles when I was in the Marine Corps. There was no swelling or bruising; nothing kept me off my feet; I wasn’t limping. Slowly, the pain subsided.
In September, my university insurance benefits began. I visited my GP and asked for an x-ray, as there was some lingering pain, and indeed, it showed some type of stress fracture in the lower left shin, you could see in the imaging where the bone was bruised and healing.
In November, during my annual physical, my GP suggested that I get a DEXA scan to check my bone density. The results came back after Thanksgiving, and showed that I had severe osteoporosis, he referred me to a specialist.
DEXA, invented in 1994, transmits two low-dose X-rays which are absorbed differently by bone and soft tissue. The density profiles are used to calculate bone mineral density.
T-scores on a bone density report are normally distributed, and show how much a person’s bone mass differs from the bone mass of an average, healthy 30 year-old adult.
Normal: -1 to +4
Osteopenia: -1 to -2
Osteoporosis: -2.5 to -4
Z-scores compare a person’s bone density to the average bone density of similar age and gender. However, Z-scores doesn’t account for body weight. Typically, a bigger or heavier person has a higher score than a smaller or lighter person.
While the T and Z-scores share insight on a person’s bone density, it doesn’t share insight on a person’s risk of bone fracture. FRAX was developed by the World Health Organization in 2008 as a tool to assess fracture risk. FRAX integrates clinical risk factors and bone mineral density to calculate a 10-year fracture probability. FRAX has come under scrutiny in recent years as not being a reliable measure for fracture risk.
In general, there are higher rates of osteoporosis in countries where there are more DEXA scans. Some argue that drug companies use DEXA scans to promote the use of its pharmaceutical drugs.
Countries with the highest rates of osteoporosis, are in higher latitudes, with less sun exposure, and less naturally occurring Vitamin D, which is important for bone health.
Countries with the lowest rates of osteoporosis are at lower latitudes with more sun. It’s also worth noting that Scandinavian Europe has some of the highest consumption of dairy products, while Africa, has some of the lowest consumption of dairy products.
Highest: Denmark, Sweden, Norway
Middle: United States, Japan
Lowest: South Africa, Tunisia, Morocco
It is estimated that astronauts may lose 1% bone density each month in a weightless environment. Some professional athletes, including swimmers, runners, and cyclists, may also be more prone to osteoporosis.
3. Specialist:
It took three months to get an appointment with the endocrinologist. After my first appointment, she completed many lab tests to identify the cause for my low bone density.
Bone remodeling is carried out by osteoclasts (clasts > chew), cells that resorb bone and dissolve minerals, and osteoblasts (blasts > build), cells that make new bone matrix.
Initially, I appeared to have a hyper-active parathyroid gland. A hyper-active parathyroid gland induces osteoporosis by making too much parathyroid hormone, allowing the body to “rob” calcium stored in bones. The body has four parathyroid glands, each is no larger than a grain of rice. A surgeon removes the hyper-active gland, which returns the body to “normal.” The doctor repeated the lab tests, which is required before scheduling surgery; the lab tests came back normal.
Since the lab work came back normal, the specialist referred my case to the Mayo Clinic in Minnesota. The recommendation was to take the prescription drug, Forteo, an anabolic steroid to increase bone density.
Forteo is a daily injection drug, used for two years; it has to be refrigerated. It costs $57,000 per year without insurance; $25,000 per year with insurance. The medication includes the most severe, FDA “black box warning” as it may cause bone cancer and necrosis of the jaw. While the medication increases bone density, the risk of bone fracture decreases only 4%.
Boniva, an older class of bisphosphonate drug, increases bone density by stopping the breakdown of old bone (osteoclasts). However, one side effect of the drug is that the risk of bone fracture actually increases, because a person’s bone becomes rigid and brittle.
4. Self-treatment:
I decided to take responsibility for my own health, and evaluate alternative approaches, including diet and exercise.
Katy Bowman, an expert in biomechanics and kinesiology, suggests that daily exercise is not enough, it’s only minutes out of the day, especially for an office worker, often sitting immobile at a desk. Bowman suggests that instead of sitting at a desk, that a person stand, or sit on the floor. She eschews “soft” furniture, arguing that it makes our bodies soft. She even recommends sleeping on the floor. Bowman argues that sleeping on the ground tells the body to make hard bones because of the constant pressure. As often as possible, I sleep on the floor, on my back, on a thin, one-inch pad.
Often times, medical experts recommend calcium for strong bones, but in fairness, there are other (trace) minerals that may be more important, including, strontium, boron, and silica.
Vitamin D3 is critical for bone health, particularly, for people who live in northern latitudes, who receive less sunlight. I take vitamin K2 (MK7) and D3 together, which also plays a critical role in bone health. K2 directs the calcium into the bones, and not the bloodstream.
Magnesium is just as important as calcium, and plays an important role in bone health; it’s been suggested that many people are deficient in magnesium. It’s also been suggested that magnesium deficiency plays a role in migraines, too.
Speaking of migraines, NSAIDs are also believed to lead to bone loss, by creating an acidic environment. Given my frequency of migraines, this likely was a contributing factor. Sometimes, digestive disorders may contribute to osteoporosis, due to malabsorption.
Stress is also believed to be a contributing factor for osteoporosis; I consider most of my CFO career as being stressful. Hopefully, stepping aside is less stressful, and allows some improvement in bone density. It’s been suggested that much of our bodies re-build themselves at the cellular level. Bones essentially re-build themselves every seven to ten years; so hopefully, I may see some improvement in the next few years.
In my case, I’m not sure that there was any one factor causing osteoporosis, but likely, multiple factors that contributed to the condition.
I take supplements, but I try to obtain most of my calcium from food, in particular, small bony fish, like sardines, or salmon, where the calcium is found in the skin and bones.
At any given time, I alternate between Garden of Eden, AlgaeCal, Jarrow BoneUp, Ancestral Supplements Living Bone, or Ancestral Supplements Bone Marrow.
I perform yoga throughout the day, one exercise that I invented is simply rolling on the floor. When I run, I ensure that the surface is packed dirt, and not asphalt or cement, to reduce the risk of stress fractures. I jump rope with a two-pound weighted rope. I also exercise each day with a 20-pound kettlebell.
5. Conclusion:
I share this information with you for your benefit, so that you are aware of this condition. The rates of osteoporosis are increasing in the United States, with more than 50-million cases. It is a silent condition; it doesn’t hurt. You don’t know that you have the disease, until you do. Osteoporosis effects women and men, no one is spared.
My father has decreased bone density; the doctor wanted him to take Boniva. He took it for a few months, but stopped, because it didn’t make him feel well. My aunt, his twin sister, also has osteoporosis, she takes Boniva. My twin brother, an omnivore, had a DEXA scan last year, out of precaution, he has decreasing bone density, too.
Peak bone density occurs when we are 20 to 25 years old. While it is not possible to increase bone density to this level, it is possible to treat and improve bone density, but also to improve bone strength. In other words, a thin person, with smaller bones and lower bone density, could still have bones that are strong, flexible, and resilient.
A person might say that s/he fell and broke their hip. In reality, their hip broke, and s/he fell.
Patient heal thyself. I’m responsible for my own health, no doctor, no pharmaceutical. Bones remodel slowly; DEXA scans are not rescheduled in less than two years. I anticipate taking a new DEXA scan in 2023, three years after the initial scan. Partly, because it took some time to research and stumble upon my own self-treatment. Quantitative computed tomography (QCT) is an alternative approach to measuring bone density.
I never would have selected migraines, suicide ideation, or osteoporosis. That’s what I have, and, I will play the cards that I was dealt, to the best of my ability.
garthmonroe 