Like many chronic diseases, osteoporosis progresses for many years before receiving a diagnosis. While we often think of osteoporosis as primarily affecting women during perimenopause and post-menopause, it’s important to note that about 80% of osteoporosis cases are in women and 20% in men.
 
Research shows that approximately 70% of women 50 years and older have some bone loss, and this might be an underestimate considering the many commonly prescribed medications, such as antidepressants and acid-blocking medications, that can damage bone health even earlier in life.

That’s why I’m excited to introduce you to my friend and colleague Dr. John Neustadt, a naturopathic doctor and graduate of Bastyr University. He’s an expert in bone health and prevention of osteoporosis, as well as a researcher, speaker, and author of the book, Fracture Proof Your Bones: A Comprehensive Guide to Osteoporosis. 

Understanding the Bone Density Test and Their Limitations

Osteoporosis is identified with a bone density imaging test called a DEXA (dual-energy X-ray absorptiometry) scan. It is a specialized X-ray of the hip and lumbar spine, which have different types of bone. 

When patients receive a diagnosis of osteopenia or osteoporosis it can be frightening. They’re often told very forcefully by their physician that they must take medication immediately or risk breaking a bone. The situation is serious – globally, osteoporosis is second only to cardiovascular disease as a health risk, and every 30 seconds, someone with osteoporosis breaks a bone. 

If you have osteoporosis and fracture a hip, there’s up to a 65% chance of death within a year. However, it’s important to understand that while serious, this isn’t an emergency. There’s time to educate yourself and create a holistic bone health plan.

The bone density test, which is almost exclusively used for treatment and monitoring, actually predicts less than half of people with osteoporosis who will break a bone. Research from the 1990s, further quantified in 2008, concluded that a bone density test only predicts 44% of women with osteoporosis who will fracture and only 21% of men. 

Every medical organization that has examined the data has concluded that fracture risk depends on factors largely other than bone density.

Treating Osteoporosis: The Truth About Medications

In postmenopausal osteoporosis (when diagnosed after menopause), the first-line therapy typically involves oral bisphosphonates like Fosamax. However, the research clearly shows that for primary fracture prevention – that is, if you haven’t had an osteoporosis fracture before – it only prevents vertebral fractures and doesn’t prevent hip fractures, which are the most dangerous. 

About 80% of people discontinue these medications within two years due to side effects. When someone stops taking bisphosphonates, they’re typically put on a different drug, but the benefits of switching are unclear.

For those who have already had a fracture with osteoporosis and are trying to prevent another, other medications are used, providing significant fracture reduction in both spine and hip. In these cases, Dr. Neustadt typically prefers what are called the anabolic medications, like Prolia or Forteo, over bisphosphonates.

It is important to know that medications for osteoporosis are approved for short term use, and when you stop taking them, you are likely to lose bone density again unless you take action to prevent it. That’s why the rest of this discussion about a holistic approach is essential. 

Diet and Exercise Impact on Bone Health

Diet has a profound impact on bone health and strength. While many people focus solely on calcium-rich foods, the reality is that overall dietary pattern matters most. 

The Mediterranean dietary pattern has been consistently shown to benefit bone health in decades of research. It’s a plant-forward diet that’s been studied for 70-80 years, and Dr. Neustadt mentioned he has never seen one negative study on it. 

He states that the higher the adherence to this way of eating, the greater the benefits. Specifically for hip fractures – the most dangerous type – the Mediterranean diet is associated with a 21% reduction in hip fracture risk, which is better than many medications.

Dr. Neustadt also commented about his patients’ diets. Even when patients tell him they’re eating a great diet with plenty of plants, he often finds they’re not getting enough protein. 

Research clearly shows that consuming adequate amounts of protein, even just the recommended daily amount, can account for 2-4% of bone density. While bone density tests only measure the mineral component of bone (calcium and other minerals), bone is a complex tissue with many components. 

The major structural protein in bone is collagen, and there are 180-200 additional proteins in bone. The minerals bind to these proteins like lights on a Christmas tree, allowing them to stay in place. The connective tissue and collagen give bone its ultimate strength.

Dr. Neustadt also mentions how important exercise and movement are for bone health. Research shows thatjust walking 7,000 to 7,500 steps a day is associated with a 50-70% reduction in all-cause mortality, including death from osteoporosis. 

Simple activities like parking further away from store entrances, walking with friends, or gardening can make a significant difference. From a naturopathic perspective, we look at things holistically – diet, exercise, and even sleep can improve bone health.

Good Bone Health: The Importance of Sleep and Gut Health

Not getting enough sleep is associated with poor bone density, bone loss, and osteopenia/osteoporosis. This is likely due to multiple factors, including the role of melatonin in bone metabolism and the impact of sleep on inflammation and stress hormones. Prioritizing good sleep hygiene is therefore an essential component of any bone health program.

Interestingly, melatonin, which is involved in sleep, has been shown in clinical trials to improve bone density when taken at 1-3 milligrams per day. There are melatonin receptors on bones, and most melatonin isn’t even produced in the brain but by cells in the intestines.

Speaking of intestines, there’s strong research linking gut health to bone health. While the best probiotic formulation for bone health is still unclear (all clinical trials so far are in animals), we know that when there’s a problem in the gut – such as chronic inflammation or a hyper-permeable gut (aka leaky gut) – it directly damages bone, increases bone breakdown and loss, and increases fracture risk. 

Additionally, gut health affects our ability to absorb nutrients from both food and supplements.

Understanding Calcium Supplements

When it comes to calcium supplements, Dr. Neustadt mentioned that the form of calcium matters significantly. All calcium must be connected to a carrier to be absorbed into the body. The most common forms are calcium carbonate and calcium citrate. 

• Calcium carbonate requires stomach acid to break apart the calcium from the carbonate molecule for absorption. This becomes problematic when someone has low stomach acid, which occurs more frequently as people age or due to conditions like autoimmune disease, acid-blocking medications, or atrophic gastritis.
• Calcium citrate, in contrast, is absorbed in a more basic environment and doesn’t require stomach acid. It breaks apart easily, allowing calcium absorption plus providing some vitamin C from the citrate. When you have low stomach acid, calcium citrate is even better absorbed than calcium carbonate. 

Most people are supplementing with too much calcium. The USDA recommends 1,200 milligrams of calcium for women, and the average American woman gets 800 milligrams from diet alone. Taking a supplement with 400 milligrams of calcium per day is sufficient for most people. 

Getting more than 2,000-2,500 milligrams per day from all sources can actually be dangerous. The focus should be on getting adequate amounts from both diet and supplements combined, not mega-dosing with calcium supplements.

The importance of Vitamin K2

However, Dr. Neustadt says that the most crucial component in bone health supplementation isn’t calcium – it’s vitamin K2, specifically the MK4 form. MK4 has been approved in Japan for bone health since 1995 at a dose of 45 milligrams per day. 

Clinical trials have shown it not only improves bone density and stops bone density decrease but also maintains strong bones as indicated by over 70% fewer fractures. While there’s another form of vitamin K2 called MK7, which some claim is better due to its longer half-life, the research tells a different story. 

MK7 has never been shown in published clinical trials to improve bone density or stop bone loss – it only slows down the rate of loss. More importantly, there are no clinical trials showing MK7 reduces fractures.

MK4, on the other hand, has more than 25 clinical trials showing its effectiveness at 45 milligrams per day. It’s been proven to stop bone density decrease and improve bone density in postmenopausal women with osteoporosis, as well as in people taking medications like Prednisone or undergoing dialysis. Multiple meta-analyses have confirmed that MK4 improves bone density and reduces fractures. 

When we look at the research on MK4, we see benefits that extend to other aspects of health. Patients often report improvements in nail strength, joint comfort, and overall wellbeing. In Japan MK4 is even prescribed for bone pain. 

The Holistic Approach to Bone Health

Good bone health isn’t just about bone density tests. We need to look at what you eat, how you exercise, your stress levels, sleep, gut health, and nutrition. For example, ongoing stress can weaken bones, and a healthy gut helps your body absorb the nutrients your bones need.

• Chronic stress can increase inflammation in the body and lead to elevated cortisol levels, which can contribute to bone loss. This is why a comprehensive approach to bone health must include stress recovery techniques. Whether it’s through regular exercise, meditation, or other stress-reduction practices, stress recovery is an essential component of maintaining healthy bones.
• The connection between gut health and bone health continues to be an area of fascinating research. While we know that a healthy gut microbiome is essential for nutrient absorption and bone health, the specific mechanisms are still being studied. What we do know is that addressing gut health through diet, stress management, and appropriate supplementation can have significant benefits for bone health.

When you follow these holistic approaches for bone health – including proper diet, exercise, sleep, and targeted supplementation – you’re not just protecting your bones. The research shows that these same strategies reduce your risk for cancer, heart disease, diabetes, and Alzheimer’s disease. By taking care of your bones, you’re investing in your overall health and creating the foundation for an active, vibrant life as you age.

Taking care of your bones naturally helps you stay active and confident as you age, instead of worrying about breaks. Dr. Neustadt finds that his patients who were once afraid to be active often return to their favorite activities after following a complete health plan.

In Summary: A Comprehensive Osteoporosis Plan

Strong muscles are crucial since most bone breaks happen from falls. Regular exercise and eating enough protein help in two ways: they make your bones stronger and help you keep your balance. Dr. Neustadt suggests eating 0.6 grams of protein for every pound you weigh, each day.

When it comes to supplements, taking more isn’t always better. While calcium alone helps a little, taking the right amounts of calcium, vitamin D, and vitamin K2-MK4 together works much better. Try to get 800-1,000 milligrams of calcium daily, mainly from food. If you need supplements, calcium citrate is easier for your body to use.

The most important supplement is vitamin K2-MK4 (45 milligrams daily) with vitamin D3. This combination is safe for long-term use, unlike some medicines. Good sleep also helps bone health, and taking melatonin (1-3 milligrams) can improve both sleep and bone strength. See below for recommended products.

For exercise, start by walking 7,000 to 7,500 steps each day. You can split this into shorter walks throughout the day. What matters most is doing it regularly, not how hard you exercise. Balance exercises are also important to prevent falls.

Some medicines like acid blockers, antidepressants, and steroids can affect bone health. Don’t stop taking these without talking to your doctor, but you might need extra bone support if you take them for a long time.

This complete approach works well – many people improve their bone strength naturally while staying active. The key is making small, lasting changes that help not just your bones, but your whole body. When checking your progress, look at your overall health, energy, strength, and balance, not just bone density numbers.

Conclusion and Next Steps for Sustainable Bone Health

When developing a bone health program, it’s essential to consider your individual needs and circumstances. The research shows that what works best is a personalized approach that takes into account your current health status, lifestyle, and specific risk factors. 

For example, if you’re taking medications that affect bone health, you might need additional support through supplementation with MK4 and other bone-supporting nutrients.

It’s important to be aware that conventional approaches often fall short. Many doctors don’t fully understand how to interpret bone density tests properly or know which medications are most appropriate for different situations. Studies have shown this to be true. That’s why it’s crucial to educate yourself and work with healthcare providers who understand the complexities of bone health and can provide comprehensive support.

The future of bone health lies in this integrated approach. As we continue to learn more about the complex interactions between different aspects of health and bone strength, it becomes increasingly clear that focusing solely on bone density or calcium intake is insufficient. Instead, we need to consider the whole picture – from the foods we eat to the way we move, sleep, and  recover from stress.

Remember, this isn’t just about preventing fractures – it’s about creating a foundation for optimal health that allows you to stay active, independent, and engaged in all the activities that make life meaningful. When we have strong, healthy bones, we can continue to travel, exercise, play with grandchildren, and engage in all the activities that make life enjoyable. This is why taking a proactive approach to bone health is so crucial.

Dr. Neustadt has developed a supplement company called NBI, and products based on the information discussed here and in his book. The NBI products, including OsteoK minis and MK4 are available at DoctorDoni.com. 

You can find Dr. Neustadt on Instagram @johnneustadt and Facebook @John Neustadt. And you can find his book “Fracture Proof Your Bones: A Comprehensive Guide to Osteoporosis” here. 

I’m so glad to be able to connect with John and be able to bring a natural and holistic solution to my patients and listeners who are wanting to prevent osteoporosis and fractures. It is important to know that it is possible to reverse bone loss, because you’re not likely to hear that from your standard doctor’s office. Keep in mind, they are not educated about diet, exercise, supplements, or stress recovery. 

I’ve been helping patients to reverse osteoporosis and bone loss for over 24 years. I see amazing outcomes, including improvements in bone density, and help my patients to avoid the need for medications. If you would like more help, you can set up a one-on-one appointment here.

If you are looking for high quality supplements to improve bone health you can find my 2 favorites here: Osteo-K Minis and Osteo-MK4. Both of these supplements are great to maintain strong bones, support healthy bone density and promote healthy bone marrow.

To learn more about my approach to healing from all of this using my Stress Recovery Protocol which involves optimizing cortisol and adrenaline levels to heal the adrenals, as well as neurotransmitters, using nutrients, herbs and C.A.R.E.™ – my proprietary program to support clean eating, adequate sleep, stress recovery and exercise – I encourage you to read all about it in my latest book Master Your Stress Reset Your Health.

If you would like to learn how to do a detox to improve your overall health and wellness I definitely encourage you to check out my New 14-Day Detox Program. This program includes

two protein shakes per day with 18 grams of protein, and two meals per day with a meal plan that I created based on making sure you get at least 20 grams of protein in each meal.

It also includes antioxidants, and videos from me to teach you to use mindfulness, as well as to replace toxins in your food and home. In this way, you can reset your diet, lifestyle and cell health all carrying on with your daily activities and routine.

Thank you all for joining me for this fascinating discussion about bone health. If you found this information helpful, please make sure to subscribe so you don’t miss future episodes of How Humans Heal. 

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