My doctor says I have osteoporosis, and I suppose according to my bone density test, I do. However I have never been convinced that I am at high risk to break a bone. Besides being very active, and exercising, I think my nutrition and supplements will help ward off problems for a while. Let me explain what I have found out about bones.
Bones are not just calcium and minerals. In fact, bones are made up of collagen as the structural matrix. The collagen can be considered to be the scaffolding for the bone. Approximately 40% of bone is collagen matrix. The remaining 60% of the weight of the bone is “hard” minerals, mainly calcium and phosphate. The calcium and minerals are embedded inside gaps between the collagen strands. The collagen has a very strong structure (it is a triple helix!). Here is what it looks like:
Bones have high compression strength (you can push on them and put weight on them), but low tensile strength (they don’t stretch very well). While bone is essentially brittle, it does have a significant degree of elasticity, contributed chiefly to the collagen. Collagen gives bone its elasticity and contributes to fracture resistance.
Where does vitamin C come in? Vitamin C (ascorbic acid) helps build the strands of collagen. The vitamin C attaches additional amino acids onto the collagen strands. It does this using specific enzymes. The enzymes need vitamin C as a co-factor (helper).
Vitamin C serves as a cofactor in several vital enzymatic reactions, most notably the synthesis of collagen, the major protein of connective tissues, such as skin, bone, cartilage, and tendon.
Vitamin C helps the collagen strands bind together in the triple helix as shown above. Vitamin C helps the collagen strands become crosslinked and stronger. If there is insufficient vitamin C there will be insufficient crosslinking between the collagen strands. Your collagen structures will be weak. Weak collagen means less elasticity in bones and more brittleness. This contributes to fractures.
So if collagen is the elastic part of bones, what about the rest of bone- the 60% that is the “hard parts”? The presence of calcium phosphates and other minerals imbedded in the collagen is what makes bone hard. That is why getting enough calcium as a growing infant and young person is important. It puts calcium into the collagen matrix. The soft bones of an infant turn into harder bones as an adult. (Infants bones have to be flexible in order for the infant (fetus) to get through the mothers birth canal!) Did you ever notice that infants do not get broken bones even though they are falling down and bumping into things all the time? (You rarely see an infant with an arm in a cast!!) Older children and adults can get broken bones as their bones are mineralized with calcium which makes them brittle.
When you are a senior citizen and get a bone density test in the doctor’s office, the DEXA machine is looking at the “hard part” of your bones. It only “sees” how much calcium you have in your bones. It does not see the strength of your collagen. This is what concerns me. The DEXA test doesn’t tell you everything you need to know about your bone health.
SCURVY OF THE BONES? Let’s go back to vitamin C. Vitamin C does other things for bones. Vitamin C balances bone creation (osteoblasts) with bone breakdown (osteoclasts). This has been confirmed by research in mammals. If there is insufficient vitamin C in your bones there will be more bone breakdown (by osteoclasts) and less bone creation. To say it another way – if there is plenty of vitamin C there will be plenty of bone creation. And, the collagen matrix will be strong as discussed above.
Some doctors now think that osteoporosis is a focal SCURVY of the bones, not a lack of calcium. (Go here and here for more information). These doctors now believe that weak bones are mostly a result of not enough vitamin C.
This, my friends, is why I take a lot of vitamin C- to reverse a possible “scurvy” in my bones! And I think I can even prove that it is helping. Remember the DEXA bone density test I mentioned earlier? It cannot tell you what is happening with your collagen. The bone density test only tells you how much hardness or minerals are there. The only way to know if your bones are breaking down is to do a blood test that looks for a marker of bone break down. This test, called the CTX (C-terminal telopeptide), looks for pieces of collagen broken off by osteoclasts (mentioned above). The more active your osteoclasts are at breaking down your bone, the higher the CTX number will be. A CTX score in the range of 400 pg/mL to 550 pg/mL is considered “normal” for the osteoporosis population. A score higher than that might mean that your bone is breaking down faster than your body is creating new bone. I had this test done a few years ago and again recently.
Here are my results of this test–
2017 August – my CTX was 957 pg/mL (very high which means bones are breaking down!)
2020 January – my CTX was 544 pg/mL (“normal” for people with osteoporosis)
2020 December – my CTX was 779 (going back up, yikes!)
Notice that my CTX was extremely high in 2017. My endocrinologist told me this was a “disappointing” result. I immediately began a program of bone support (I started the Better Bones program) which included alkaline diet, weight bearing exercise and supplements including vitamin D, and some calcium.) I also started a very high dose of vitamin C (6000-7000 mg/day) during 2019.
My CTX marker for bone break down improved markedly after that! (Note the January 2020 result of 544 pg/mL.) I can’t say for sure if it was the vitamin C or some combination of vitamin C plus some other things I was doing (weights at the gym) but it is moving in the right direction.
However, I slipped again in December of this year, and the CTX test is now at 779 pg/mL. I think that the covid-19 lock down kept me out of the gym for close to 10 months. I am back to the gym now and hope to report better results in the year 2021. Note: the CTX test is a readily available blood test and does require you to fast for 12 hours before the test.
In conclusion, I think that bone health is more than just gulping down some calcium every day. I think it is more than just a number from a DEXA bone density machine. I think bones are more complicated than that. What I have learned is that bone density is only one small part of the bigger picture of bone health. Since vitamin C is inexpensive and has no upper toxic limit (you can just about take as much as you like) it is worth adding some to your diet. It is also worth doing other things such as weight training, an alkaline diet, and some of the things pictured in the photo below.
This is an informative and thought provoking article. I like the way you weave your own experiences into the article. Very interesting about the matrix of collagen and calcium/minerals. Seems conventional medical testing is often lacking. Perhaps we are more fluid than we think.
I originally started taking vitamin C to keep the collagen in my skin healthy, and to help my immunity. Makes sense that there would be collagen in the bones.
Since I’ve been taking higher doses of Vitamin C, my knees don’t hurt when I ride my stationary bike, which is really very ‘stationary’, in that it only has one speed, and is quite the work out!