If you are over the age of 50, especially if you are a female, you are no doubt familiar with the importance of maintaining a healthy skeleton. What might be less clear, however, is exactly how to do it.

Medications are available, but they carry known and sometimes severe side effects. Hormones such as estrogen and testosterone can improve bone mass, but, they remain contraindicated for some —and all these treatment options must be considered on an individual basis with a discussion between you and your treating physician.

There are, however, steps for us all to take to improve the health of our bones, including key nutrients which have shown in study to decrease the rate of bone loss and improve bone mass. It is first important to understand diagnoses associated with bone loss.

The most common of which is slight bone loss called osteopenia. Osteopenia is extremely common – most women over the age of 50 qualify for this diagnosis. Dual energy X-ray absorptiometry, called DEXA or DXA, is the most common way to measure bone mineral density (it can also be called a bone mineral density test). DEXA compares the density of your bone to the density of a 30-year-old’s of the same sex and race.

The result of a DEXA is a T-score, which your doctor can use to diagnose you. A T-score of -1 to -2.5 (more than one standard deviation from the norm) is considered osteopenic. A T-score of less than -2.5 is considered osteoporotic. Osteoporosis is also prominent: the National Osteoporosis Foundation (NOF) estimates as many as 54 million Americans have osteoporosis.

DEXA scans for most healthy women are recommended to begin at the age of 65. This might seem odd since I just mentioned that most women over 50 are already osteopenic. Most experts agree that osteopenia does not need to be treated with pharmaceuticals, so having a diagnosis of it prior to 65 really doesn’t change treatment outcome.

Obviously, taking precautions prior to the age of 65 and even before our first DEXA is advantageous, and hopefully can prevent an eventual conversation about the possible need for risky medications later if osteoporosis is discovered. For most, adjustments in diet, lifestyle, and supplementation can go a long way in improving bone health.

Nutritionally, seek foods high in calcium, including fortified foods, or leafy greens. Vinegar helps to pull calcium out of leafy greens to aid in absorption, so a salad with oil and vinegar is a great bone-building meal. Magnesium is also an important nutrient for bone health and can be found in almonds, avocados, spinach, and pumpkins seeds, among other foods.

Perhaps even more important than adding bone-stimulating nutrient-rich foods is adding an effective bone-building exercise regimen. Weight-bearing exercises (forcing your muscles to either hold your weight or other weight) pulls against the surface of a bone causing it to add more bone material and become stronger. Walking, tennis, and weight lifting are great approaches. Biking and swimming are not effective for bone building and if these are your sport of choice, make sure to add some weight bearing alternatives in to your routine.

In addition to nutritional additions and exercise, simple supplementation can be vital to altering your path to osteopenia or osteoporosis. Calcium dosages can vary. For most, a dosage of 400mg-600mg of calcium is sufficient. Calcium used to be dosed much higher, but it has been seen that for most this probably isn’t necessary or advantageous. Do pick calcium that is in the citrate, aspartate, or malate form, as opposed to an oxide, which is not as absorbable.

Magnesium and Vitamin D are also important to bone health and should be included in combination with your calcium (dosages for both should be individualized to you). But perhaps the most important component to include for your bones is vitamin K. The form of vitamin K2 that has been most studied to grow stronger bones in people with osteoporosis is the MK4 form of vitamin K2. According to researcher Dr. John Neustadt, more than 25 clinical trials on MK4 have shown that it stops and reverses bone loss and reduces fracture risk by more than 80%. The trick is that these studies showing efficacy of K2 as MK4 typically dose the MK4 at 45milligrams (mg) per day. Many of the supplements that have K2 contain closer to 50 micrograms (mcg). So the effective dose is about 1000 x greater than the dosage commonly found in supplements.

This high dosage can be cause of concern for some because it is so much higher than our current recommended amounts. According to Dr. Neustadt’s compilation research, however, MK4 is safe even at doses much higher than the top amount used in these clinical trials. As a reference, the lethal dose is about 6000 x more than the 45mg seen to be effective. You can find options on the market for MK4 at the higher dosage, but you must read your labels and understand the goal dosage you are looking for.

The other common concern for Vitamin K2 is based on its role in blood clotting and fear that it will lead to additional clotting. Vitamin K is involved in blood clotting, but adding additional Vitamin K into your system doesn’t increase clotting more than a normal level. Basically, once the body has enough K for clotting mechanisms, extra K moves on to do other things in the body, including promoting bone health. Vitamin K DOES interfere with Warfarin (Coumadin) and other blood thinners, and as such, all types of Vitamin K should be avoided by those using these medications. For the rest of us, however, MK4 along with calcium, Vitamin D, and magnesium can lead to positive bone changes unparalleled by any other nutrient.

Learning that you are osteopenic or osteoporotic can be very stressful. Treatment options and risks can be scary and overwhelming, and they must be researched well and discussed with your doctor. However, beginning bone supportive nutritional changes, exercise, and supplementation is easy and safe for almost all of us. And the sooner you make these changes, the less likely that you have to decide between imperfect options later.

Stay healthy & be well!
-Amy Whittington, NMD

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