Jack Kruse is a physician who specialises in OP and says the following :
"Osteoporosis is conventionally thought of as a disease of aging. That has to stop because it is old school conventional wisdom. What is closer to the truth is the patients diet. The worse the patients diet is the more likely osteoporosis will be present regardless of age. The younger generation has massive unrecognized osteopenia present because they have lived surrounded by processed food. This is due to the SAD which causes high inflammation levels, low vitamin D levels (from lack of D in the diet), pregnenolone steal syndrome (reducing formation of D in body) and liberal use of sunblock and lack of outdoor activity to gain sun exposure.
WHAT IS THE OSTEOPOROSIS RX TREATMENT:
1. Cortisol must be neutralized after its elevation can be found. The most common reason is LR today in the USA from a SAD loaded in carbohydrates. LR nullifies Wolff’s law. Diet modification to a high fat and high protein paleolithic diet is treatment option number one in most cases. Renal osteodystrohy is one of the few causes where protein has to be limited, but fats can be used liberally to support bone mass. Pastured butter (K2 source) and grass fed meats with eggs and bacon and coconut oil is preferred. All the hormones that are anabolic for bone formation are derived from LDL cholesterol in our diet. Vegans should pay close attention to those biologic facts. PUFA’s and carbohydrates should be extremely limited during treatment to avoid future fractures because they generate inflammatory cytokines that favor disease progression.
2. Age and weight are not completely indicative of real bone risk. Inflammation is and it should be followed clinically to assess risk. Bone density testing is worthless unless a wrist module is added to it. I have had patients in their 20’s paralyzed from osteopenic fractures.
3. Smoking carries a 100 fold risk of developing osteoporosis. It must cease for any treatment to work
4. Excessive drinking also elevates the risk. More than 4 oz a day is a problem.
5. I personally avoid all conventional osteoporotic drugs because of side effect risks. In surgical cases I now completely avoid the use of all synthetic derived bone morphogenic proteins in older patients with osteoporosis. (InFuse by Medtronic)
6. I use high dose Vitamin D3, K2, Magnesium, in doses based upon lab data and on the severity of disease.
7. I replace all sex steroid hormones to the top quartile found in young adults. Bio-identical HRT are preferred. I avoid synthetic hormones at all costs. Often this is tough because many physicians are not aware of the organic chemistry of why synthetic hormones are suboptimal for the human steroid receptor.
8. Exercise is an excellent treatment for osteoporosis. But one must remember that if one has LR exercise exacerbates the risk of fracture because Wolff’s law is null and void. The Exercise Rx (written below) requires Wolff’s law to be operational to work. Too often it is not. Exercise will increase growth hormone secretion which is very anabolic for bone mass accrual. Most older people have horrendous GH levels measured by IGF-1 levels. In people with IGF-1 levels below 100, I recommend use of arginine, ornathine, turmeric and resveratrol because all increase bone mass. Resveratrol increases bone morphogenic proteins directly.
9. Walking is a great start for those who are debilitated.. I tell my patients to park far away from doors to facilitate walking. I encourage water aerobics because of its low impact and its good skeletal effect’s even when Wolff’s law is null and void. I also encourage yoga and meditation for endogenous control of cortisol. Biofeedback is also a consideration if it is in the budget.
10. Strict avoidance of NSAID’s and steroids for all osteopenics or spine fusions die to bone mass losses. These medications also cause a leaky gut and gut dysbiosis is a major cause of persistent inflammation and bone loss.
11. Any stressor should be aggressively treated. I usually will double doses of D3, K2 and Mg during ICU or the preoperative times.
12. In older patients I trim back all meds that cause osteoporosis and I advocate strongly for hormone replacement. Progesterone is the critical for women and testosterone for men. Estrogen and testosterone are added often to women’s treatment plan by their PCP’s or Ob/GYN’s
13. I try to limit radiation exposure to all patients with osteopenia because of its effects on bone stock.
14. I have all thoracic fracture patients follow up with their lung specialists because each fracture limits pulmonary functioning by 5-8% and is a major cause of disability.
15. Any spine fracture should be aggressively treated surgically as soon as it is diagnosed on STIR MRI.
16. I keep an open dialogue with patients and family about bone risks going forward and make sure they know what to discuss with their PCP’s going forward.
17. An ounce of prevention really saves a point of cure with this disease. Mobiltity is the key to optimal recovery. We want patients moving naturally as soon as possible to stimulate bone formation after the diet is optimized.
18. I do not advocate any use of Calcium with this disease because I mandate a change of diet and this diet provides ample Calcium and there is no need for supplementation.
19. In the severe cases I will ask for an endocrine consult to consider Forteo and PTH if it is warranted. This is quite rare but can be a huge help in complicated spine fractures in older patients.
20. I advocate sun exposure for natural Vitamin D production in patients with low 06/3 ratios. This is outlined in my Vitamin D blog.
FALL PREVENTION AND THE EXERCISE RX:
After the diet is re tooled to a paleolithic diet and the underlying leptin resistance is dealt with everything should be done to prevent falls that can cause fractures. This is where exercise comes in. I am a major advocate of lifting weights for both men and women no matter their baseline condition with this condition. If the patient is wheelchair bound they can lift dumbbells while they watch TV and wear weighted ankle and wrist bracelets. The reason is simple. This will restore bone faster than any single thing we can offer once the dietary problem is repaired. Men and women with osteoporosis need to take care not to fall down. Falls can break bones and are a major source of disability. Once mobility is limited the death rate can begin to grow exponentially. The goal is to restore natural mobility as soon as possible in this disease."
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