Why Am I Increasing Bone Density In One Area Faster Than Others?
Lara Pizzorno is the author of “Your Bones: How You Can Prevent Osteoporosis and Have Strong Bones for Life – Naturally” and a member of the American Medical Writers Association with 29 years of experience specializing in bone health.
Recently we asked Lara if she would help us provide a series of short, ongoing videos to help you (our customers and readers) stay up to date on the latest facts and science related to bone health and overcoming osteoporosis naturally.
In this latest video, Lara answers a question that we get asked A LOT. Watch the video below (or read the transcript provided) and let us know what you think in the comments. 🙂
Hello, my name’s Lara Pizzorno. I’m the author of “Your Bones” and I’m here to share some information with you that I hope will help you to have healthier bones.
In this video, I’d like to respond to questions that have been sent in asking,
“Why am I building bone in one area more quickly than in others.”
I will as usual be providing references from the periodic PubMed literature but this question has not yet been specifically investigated in any research that I could find. From what has been published however, I have some educated ideas, and I will share them with you, and they furthermore have been confirmed by what many of us have been seeing.
Also, it’s important to know that even if your bone mineral density has not increased on your DEXA in all areas yet, this does not mean that all areas in your body are not rebuilding, just that some of them will take longer to fill in enough to show up on a DEXA scan later.
Remember, changes that show up on a DEXA typically take as much as a year to manifest there. In the meantime, you can use several lab tests, one requiring a blood draw, the other a urine test which I will go over shortly.
To confirm that you’re no longer losing excessive amounts of bone, remember we must all be continually losing a tiny bit of bone to clear out the old decrepit bone to make room for the new bone that we want to build to have healthy bones.
I also want to remind you that starting in our early 40’s a bone loss of at least 1% in bone mineral density every year is considered normal. A loss that normally increases to around 2% per year during menopause.
Both men and women start losing bone as early as in our 30’s immediately after we attain peak bone mass, and long before any drop in estrogen or testosterone production occurs.
The type of bone that we start losing first as early as in our 30’s is called trabecular bone, T-R-A-B-E-C-U-L-A-R, trabecular bone. We have two kinds of bone, trabecular bone and cortical bone, which is spelled C-O-R-T-I-C-A-L, cortical bone.
If you think of your bones as an M&M, the trabecular bone is the chocolate interior, and the cortical bone is the hard candy shell on the outside.
The spine contains a larger percentage of trabecular bone, the soft spongy bone, then the femur or your hip, the Ward’s triangle area that is measured on your DEXA. In women, the loss of trabecular bone, particularly in the spine, accelerates greatly after menopause. This is due in part to the drop in estrogen. Cortical bone loss typically does not begin until after the age of 50 in both sexes although it occurs at a faster rate in women than in men.
So starting in our 30’s right after our peak bone mass we begin to lose bone. Primarily, trabecular bone at a rate of about 1% per year.
Then, when we are around 50 which is the age at which most of us are entering menopause, we also begin to lose cortical bone and the rate of bone loss increases to about 2% per year during the transition through menopause, that is unless you’re taking Algaecal Plus, which is the only calcium related supplement that’s ever been shown to reverse this.
Nonetheless, in women the loss of trabecular bone in the spine accelerates substantially after menopause as does the rate of fractures in the wrist, spine, and hip.
So, if your DEXA shows that you are rebuilding bone in your spine more quickly than in your hip, this is great news.
In most of us, bone density increases are first seen in the spine, and why is this?
- Well, most likely because the spine contains much more trabecular bone, the soft spongy bone, than our hips or femurs which have more cortical bone.
- Another reason, we see bone building first in the trabecular rich spine, is the trabecular bone is much more metabolically active than cortical bone, which is the hard dense exterior bone, which is more prevalent in our hips and our appendages like our arms and legs.
So benefits are much more likely to be more quickly apparent in areas rich in trabecular bone like the spine.
This does not mean that cortical bone is not also rebuilding, but it just takes longer to show up.
It’s important to remember that osteoclast activity, the specialized cells that break down old bone which are called osteoclasts, typically takes about two weeks. Then the body shifts gears to get our osteoblasts, the cells that build new bone ready to go, that takes another couple of weeks. And then, the osteoclast, laying down of new bone for us takes three to four months or as long as up to six months.
So to be sure that you are on the right track, and you stop losing excessive bone, and have begun to rebuild you can check to see that this is occurring with blood tests and a urine test which can be run within a month or so after you begin to take Algaecal. And you can repeat these tests after several months more as well if you would like and if you’d like further reassurance.
The two simple tests that you can have run to check that you’re no longer losing excessive amounts of bone are called
- the C-terminal telopeptide which is shortened to CTX,
- and you can also have run a 24-hour urinary calcium excretion test.
The CTX or C-terminal telopeptide measures a specific cross-link peptide sequence that is found in bone and is the portion that is cleaved out by osteoclast during bone resorption. Serum levels of this special peptide sequence are proportional to osteoclast activity at the time that the blood sample is drawn.
The test used to detect the CTX marker is called the Serum CrossLaps test, and current research indicates that it is more specific to bone resorption than any of the other currently available tests. And there are several that check this, but the CTX is the one you should ask for. It’s the most accurate.
Initially, urinary levels of CTX were measured but they found that the urine test results fluctuated spontaneously, and in contrast the newer serum or blood tests for CTX show minimal fluctuation and very high accuracy. So be sure you ask for a blood test for the serum test for CTX.
The other test you can have run to check how you’re doing is the 24-hour urine calcium excretion test. This test checks the amount of calcium that your kidneys are removing from your body in your urine.
Excreting excessive amounts of calcium in your urine is a sign that you’re losing bone.
What you do is you collect all your urine over a 24-hour period. They’ll give you a large special container to do this. You typically follow your normal diet, and you drink fluids just like you normally would, but you may be told not to drink alcohol during the collection time. If you’re taking certain medications such as the diuretics or antacids, these could affect your test results. So you want to be sure to mention this to your doctor before you run this test.
Many labs including direct-to-consumer labs offer both the CTX and the 24-hour urine calcium excretion tests.
If these test results are good, you can relax and trust that your bones are happily rebuilding in response to taking your AlgaeCal Plus.
I hope this puts your mind at ease, and I hope this has been helpful to you. Thanks for tuning in.
Manolagas SC. From Estrogen-Centric to Aging and Oxidative Stress: A Revised Perspective of the Pathogenesis of Osteoporosis. Endocr Rev. 2010 Jun;31(3):266-300. doi: 10.1210/er.2009-0024. Epub 2010 Jan 5. PMID: 20051526
Manolagas SC. Birth and death of bone cells: basic regulatory mechanisms and implications for the pathogenesis and treatment of osteoporosis. Endocr Rev. 2000 Apr;21(2):115-37. PMID: 10782361
Huber F, Traber L, Roth HJ, et al. Markers of bone resorption–measurement in serum, plasma or urine? Clin Lab. 2003;49(5-6):203-7. PMID: 15285175
Chubb SA, Mandelt CD, Vasikaran SD. Comparison of results from commercial assays for plasma CTX: The need for harmonization. Clin Biochem. 2015 Mar 13. pii: S0009-9120(15)00078-8. doi: 10.1016/j.clinbiochem.2015.03.002. [Epub ahead of print] PMID: 25773259
Garnero P, Sornay-Rendu E, Claustrat B, et al. Biochemical markers of bone turnover, endogenous hormones and the risk of fractures in postmenopausal women: the OFELY study. J Bone Miner Res. 2000 Aug;15(8):1526-36. PMID: 10934651