Dear Dr. Thys-Jacobs,

I am 52 years old and have just had my first bone density test.  I am 5’6″ and weigh 115 pounds.  I exercise a lot and am careful about my diet. I do not smoke and I do not drink alcoholic beverages.  There is a family history of kidney stones so I have never taken any calcium supplements but I do eat lots of yogurt. No one in my family seems to have had osteoporosis.  

My bone density revealed that I had osteoporosis of the forearm and only slight decrease in spine and hips.  My doctor tells me that I need a work-up to determine if I am losing calcium in my urine since this could be the cause of the osteoporosis in the forearm.  I don’t understand why I have to do these 24 hour urine collections and what can be done based on the results anyway.

Your doctor is correct in suggesting that you collect a 24-hour urine calcium sample. There are many partially reversible causes of osteoporosis. Determining if there is a secondary cause of  osteoporosis such as an excessive urinary loss of  calcium or even an abnormally low excretion of urinary calcium may improve your bone density over time with proper management.

Hypercalciuria, or the excessive loss of  calcium in the urine, can be the result of  various calcium and metabolic disorders:nprimary hyperparathyroidism, Graves disease, multiple myeloma, sarcoidosis, or vitamin D toxicity. Recent evidence even suggests that high intakes of vitamin A and retinol can lead to  excessive urinary calcium losses resulting in a higher incidence of  fracture. Even certain diets may pose a higher risk of calcium and bone loss over time.

Increasing evidence suggests that acid/base balance of the diet is also important. Acid prone diets can lead to greater bone loss. Protein and cereal grains are metabolized to acid and are acid producing or acidogenic, whereas fruits and vegetables are metabolized to bicarbonate and are alkali producing. On average, Western diets tend to be acidogenic, and to produce an excess of about 75 mEq of acid a day. In addition, aging results in a decline in renal function with a diminished capacity to excrete hydrogen ions resulting in a metabolic acidosis and bone loss.

Management of  hypercalciuria depends on identifying the etiology of  this urinary calcium loss. Treatments may include the use of thiazide diuretics which reduce the loss of calcium excreted in the urine by increasing distal tubular reabsorption or even the use of  potassium bicarbonate which has recently been shown to lower calcium excretion and bone resorption.

The measurement of urinary calcium may also demonstrate hypocalciuria or  an abnormally low calcium excretion. Hypocalciuria may identify those with malabsorption, celiac disease or even the ingestion of poorly formulated calcium tablets. If celiac disease is suspected, it may be confirmed with the determination of endomysial and antigliadin antibodies or even by an intestinal biopsy. Those with celiac-related osteoporosis have a real chance for major improvements in their bone density on a gluten free diet.

A cause of osteoporosis is very rarely discovered in most patients, but when it is discovered, such remedies can certainly offer a potential long term benefit in bone density with a reduction in future fracture.

A new member of WVFC’s Medical Advisory Board, Dr. Susan Thys-Jacobs is a practicing endocrinologist who noticed, in the early 1980s, similarities between PMS symptoms and the symptoms exhibited by people with dramatic calcium deficiency. New methods for testing vitamin and mineral levels in the blood had just been introduced which allowed her to test her theory – that PMS was simply a deficiency of calcium in the body. Her early investigations were positive and she patented the treatment of PMS with calcium.  Since her discovery, Dr. Susan has published many medical papers on the relief of PMS and has helped hundreds of women, consistently seeing life-changing results.