Hidden Saboteurs of Bone Health

In News by Elizabeth Friedman, MS


There are two types of diabetes, and they have different mechanisms for affecting bone health. With Type 1 diabetes, the insulin-producing β-cells of the pancreas are destroyed, and there are low circulating levels of insulin-like growth factor 1 (IGF1) and other pancreatic hormones. This environment prevents the differentiation of stem cells into osteoblasts (the cells that produce bone).

In Type 2 diabetes, where cells become “resistant” to insulin, causing an increase in blood sugar, there are many different factors that all negatively impact bone health, including an increase in calcium excretion and in bone turnover and a decrease in new bone formation, leading to increased fracture risk. Murray and Coleman published a comprehensive review article in late 2019 that discussed each mechanism in elaborate detail.


Stress is known to raise cortisol levels in the body, and cortisol can interfere with the formation of bone-building cells. This lack of new bone formation can lead to decreased bone density, so keeping stress to a minimum is essential. Practicing abdominal breathing, yoga, mindfulness meditation and tai chi chuan can all help to minimize stress.


It is widely known that smoking can lead to lung cancer, emphysema, and other health concerns, but did you know that it also negatively impacts bone health? Recent research has shown that smoking tobacco can negatively impact mechanisms of bone turnover through a variety of mechanisms, which can lead to decreases in bone mass and bone mineral density. A few of the mechanisms include increases in cortisol levels, decreases in the ability to absorb vitamin D, and increases in oxidative stress, among others. Vaping has also been found to increase fracture risk by 46%.

On the positive side, smoking cessation has been shown to increase bone mineral density in post-menopausal women.


Although older studies had suggested that there may be a protective effect of alcohol on bone health, recent research has challenged that conclusion. Alcohol has been shown to alter the circulating levels of a variety of peptides that influence bone metabolism, with specific effects varying from person to person. However chronic heavy drinking lowers bone mineral density. Episodes of binge drinking in young women also negatively impacts bone health.

Here are some of the specific ways that alcohol consumption can negatively impact bone health:

  • Alcohol affects the absorption of vitamin D and calcium from the intestine.
  • Heavy consumption can decrease levels of testosterone (which helps produce bone-building cells) and estrogen (which can inhibit bone breakdown and stimulate production)
  • Chronic drinking suppresses the “osteoblastic differentiation of bone marrow cells,” which is necessary for bone building and repair.
  • Alcohol intoxication can increase the risk of falls and fractures.


Steroid medications are responsible for 20% of all osteoporosis cases. These medications negatively impact bone health in two ways: they cause existing bone cells and bone-building cells to die by inducing apoptosis, and they prolong the life of osteoclasts, which cause current bone to be broken down more quickly and resorbed. On top of these effects, steroid medications also decrease calcium absorption and increase the loss of calcium through the urine.


Diseases such as rheumatoid arthritis, lupus, and inflammatory bowel disease can negatively affect bone health due to chronic inflammation and the presence of autoantibodies. Inflammation can contribute to bone loss by releasing cytokines that provoke osteoclasts to break down bone, and autoantibodies may play an additional role in the deterioration of bone structure, but exact mechanisms have not yet been elucidated. Often, autoimmune conditions are treated by steroid medications, which help treat the inflammatory component, but negatively impact bone health themselves, as noted above.


Despite these hidden saboteurs, there are things you can do to optimize your bone health and reduce bone loss as you age.

  • Eat a variety of whole nutrient-rich foods including organic/biodynamic fruits and vegetables.
  • Stay hydrated. Water allows the bones to absorb the nutrients needed to maintain healthy bones.
  • Minimize stress through daily exercise, movement practice, and mindfulness meditation.
  • Stop smoking/vaping and minimize alcohol consumption.
  • Detoxify to counteract the effects of smoking/vaping and alcohol.
  • If you are taking steroids, work with your doctor to use for the shortest time possible, as fracture risk decreases rapidly when steroids are withdrawn.
  • Consider LRA testing to discover and remove any hidden immune burdens.
  • Consider predictive biomarker testing to measure various indicators and predictors of bone health:

Vitamin D levels: Without adequate levels of vitamin D3, the body may not be able to absorb enough calcium from the diet, leading to a deficiency that can weaken bones over time.

Inflammation: High-sensitivity C-Reactive Protein (hsCRP) is a predictive biomarker for inflammation. Bones and muscles are especially vulnerable to inflammation and oxidative stress, so higher levels of hsCRP are associated with an increase in fracture risk.

Oxidative Stress: When excess free radicals accumulate in cells, oxidative stress is the result, and can lead to cellular and tissue damage and chronic inflammation, which can break down bone. Several factors can contribute to oxidative stress, including environmental toxins, poor diet, smoking, and chronic disease. Assessment of oxidative stress is an invaluable component of preventive approaches to optimizing bone health, overall health, and longevity.

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