# Osteoporosis

Category: Conditions

Also known as: bone loss, bone density

Osteoporosis is fundamentally a problem of deficient tissue renewal driven by impaired mitochondrial respiration, not simply a lack of calcium deposition. Peat argued that the lower collagen content of aged bone demonstrates that the core defect parallels sarcopenia, the…

10 passages · 2 authors · 2006–2024 · Most-cited: [Ray Peat](https://bioenergeticoracle.com/md/voices/ray-peat/index.md)

Canonical page: https://bioenergeticoracle.com/concepts/osteoporosis

## Synthesis

**Osteoporosis** is fundamentally a problem of *deficient tissue renewal* driven by impaired mitochondrial respiration, not simply a lack of calcium deposition. [Source 1, 5] Peat argued that the lower collagen content of aged bone demonstrates that the core defect parallels sarcopenia, the age-related loss of muscle mass, and is linked to other degenerative processes such as male baldness and Alzheimer's disease. [Source 1, 5] A high level of **respiratory energy production**, characteristic of youth and maintained by thyroid hormone, is required for proper bone maintenance. [Source 1] The accumulation of factors that impair mitochondrial respiration leads to a reliance on stress hormones, which progressively reshapes the organism and exacerbates the underlying energy deficit. [Source 1]

The hormonal environment governing bone health is dominated by the antagonism between protective, pro-metabolic substances and catabolic stress mediators. Peat identified **prolactin**, **serotonin**, **parathyroid hormone**, and **adrenaline** as central drivers of bone loss, all of which rise under conditions of stress, hypothyroidism, and estrogen dominance. [Source 1, 5, 7] Prolactin directly mobilizes calcium from bone, and estrogen promotes its secretion, creating a paradox where a hormone claimed to protect bone actually stimulates a potent bone-wasting factor. [Source 5, 7] Serotonin, whose intestinal synthesis is increased by irritation, was recognized as a basic cause of osteoporosis, making gut health a major consideration. [Source 1, 5] Adrenaline, which is elevated by stress, aging, and hypothyroidism, directly causes bone loss and powerfully increases parathyroid hormone, while its effects can be blocked by beta-blockers like propranolol. [Source 1] In contrast, **thyroid hormone** and **progesterone** are protective, improving magnesium retention and supporting oxidative metabolism. [Source 4, 6] Peat noted that the common medical practice of discontinuing thyroid supplementation upon an osteoporosis diagnosis is harmful, as untreated hypothyroidism leads to elevated prolactin and cortisol, two clearly established causes of bone loss. [Source 2]

The conventional diagnostic and therapeutic framework for osteoporosis is deeply flawed. Peat contended that dual-energy X-ray absorptiometry (DXA) scans are unreliable and harmful. The measurements are confounded by changes in tissue fat and water content, which estrogen alters, creating the false appearance of improved bone density. [Source 4, 6, 9] More critically, the **X-rays themselves poison bone metabolism**, accelerating the rate of bone loss, and their systemic inflammatory effects contribute to diseases like Alzheimer's and heart disease. [Source 3, 9] Peat advocated for **ultrasound** as a superior diagnostic tool because it can accurately evaluate both bone density and strength without radiation, and it actively stimulates bone repair. [Source 3, 9] Therapeutically, the claim that estrogen prevents osteoporosis is contradicted by the fact that bone loss begins around age 23 and progresses through the years when estrogen levels are rising, and that men, with lower lifetime estrogen, have heavier bones. [Source 6, 7] Estrogen causes calcium retention in soft tissues, contributing to pathological calcification, rather than building bone. [Source 6, 7]

Nutritional support for bone health requires a metabolic perspective that prioritizes protein, specific minerals, and vitamins while avoiding suppressive fats. Peat emphasized that a **protein deficiency** is a clear cause of osteoporosis, with milk protein being particularly protective, and that very high protein intakes are associated with less oxidative damage than merely "adequate" intakes. [Source 2] Dinkov and Mercola have extended this by highlighting that 30% of bone is **collagen**, making gelatin or collagen a fundamental nutrient for the bone matrix. [Source 8] **Calcium** itself activates mitochondrial respiration and lowers adrenaline, parathyroid hormone, and prolactin, with Peat noting that traditional diets like the Masai provided up to 5000 mg daily from milk. [Source 1, 10] **Copper**, the co-factor for cytochrome C oxidase, is essential for bone formation and consistently deficient in osteoporosis, and thyroid hormone increases its assimilation. [Source 1] Vitamins A, B6, K, and D are also critical, while **polyunsaturated fats** are toxic to bone, as they are converted to prostaglandins, suppress thyroid and progesterone formation, and their increased consumption has coincided with the rise in osteoporosis. [Source 2] Aspirin, with its thyroid-like actions including activation of mitochondrial respiration and reduction of serotonin, also stimulates bone formation. [Source 1]

## People also ask

### How does impaired energy metabolism cause osteoporosis?

Peat argued that bone loss results from deficient tissue renewal driven by impaired mitochondrial respiration, not just a lack of calcium. A high level of respiratory energy, supported by thyroid hormone, is required for proper bone maintenance, and its decline leads to reliance on catabolic stress hormones.

### Why did Peat consider estrogen harmful for bones?

Peat noted that bone loss begins when estrogen levels are rising and that men have heavier bones, contradicting claims of protection. He argued estrogen promotes prolactin secretion, which mobilizes calcium from bone, and causes calcium retention in soft tissues rather than building bone.

### What role does dietary protein play in bone health?

The corpus describes protein deficiency as a clear cause of osteoporosis, with milk protein being particularly protective. Since 30% of bone is collagen, gelatin or collagen is also considered a fundamental nutrient for the bone matrix.

## Related concepts

- [Alkalosis](https://bioenergeticoracle.com/md/concepts/alkalosis/index.md)
- [Arachidonic Acid](https://bioenergeticoracle.com/md/concepts/arachidonic-acid/index.md)
- [Calcium](https://bioenergeticoracle.com/md/concepts/calcium/index.md)
- [Carbon Dioxide (CO2)](https://bioenergeticoracle.com/md/concepts/carbon-dioxide-co2/index.md)
- [Dental Health](https://bioenergeticoracle.com/md/concepts/dental-health/index.md)
- [Estrogen dominance](https://bioenergeticoracle.com/md/concepts/estrogen-dominance/index.md)

## Cited passages

Passage numbers match the `[Source N]` markers in the synthesis above.

### Source 1 — Osteoporosis, aging, tissue renewal, and product science

Ray Peat · Article · 2012 · https://raypeat.com/articles/articles/osteoporosis-aging.shtml

> The fact that the collagen content of old bone is lower than in young bone (as a percentage of bone weight) shows that the problem in osteoporosis isn't a lack of calcification, it's a deficiency of tissue renewal, parallel to sarcopenia, the decrease of muscle mass with aging. Systemically decreased tissue renewal would account for the association of bone loss with other processes such as male baldness (Morton, et al., 2007) and Alzheimer's disease (Zhou, et al., 2011, Duthie, et al., 2011).
>
> A high level of respiratory energy production that characterizes young life is needed for tissue renewal. The accumulation of factors that impair mitochondrial respiration leads to increasing production of stress factors, that are needed for survival when the organism isn't able to simply produce energetic new tissue as needed. Continually resorting to these substances progressively reshapes the organism, but the investment in short-term survival, without eliminating the problematic factors, tends to exacerbate the basic energy problem. This seems to be the reason that Denckla's animals, deprived of their pituitary glands, but provided with thyroid hormone, lived so long: they weren't able to mobilize the multiple defenses that reduce the mitochondria's respiratory energy production.
>
> Several things that the geneticists would never be able to fit into their schemes of "bone regulatory molecules" such as OPG, growth hormone, parathyroid hormone, and estrogen, fit neatly with the idea that bone health is maintained by respiratory energy and tissue renewal, under the influence of thyroid hormone. For example, adrenaline, which is increased by stress, aging, and hypothyroidism (and in many cases by estrogen), causes bone loss. Even the bone loss caused by immobility can be blocked by an adrenaline blocker such as propranolol. (The stress of immobility also famously increases serotonin.) Adrenaline tends to decrease carbon dioxide and increase lactic acid, and it strongly increases parathyroid hormone (Ljunhgall S, et al., 1984).
>
> Calcium activates mitochondrial respiration, and lowers adrenaline (Luft, et al., 1988), parathyroid hormone (Ohgitani, et al., 1997), and prolactin (Kruse and Kracht, 1981).

### Source 2 — Bone Density: First Do No Harm

Ray Peat · Article · 2006 · https://raypeat.com/articles/aging/bonedensity.shtml

> Many women are told to stop taking a thyroid supplement when osteoporosis is diagnosed, but hypothyroidism often leads to hyperprolactinemia and hypercortisolemia, which are two of the most clearly established causes of osteoporosis. Calcitonin, vitamin D-active metabolite, and estrogen-”HRT” treatments can cause respiratory alkalosis (relative hyperventilation),[19-24] and hypothyroidism produces a predisposition to hyperventilation.[25] Hyperventilation tends to cause calcium loss. In respiratory alkalosis, CO2 (and sometimes bicarbonate) are decreased, impairing calcium retention, and in “metabolic alkalosis,” with increased bicarbonate, calcium is retained more efficiently and bone formation is stimulated, and its dissolution is suppressed.
>
> Other women are told to reduce their protein consumption, or to take fluoride or whatever drug has been most recently promoted. A protein deficiency is a clear cause of osteoporosis, and bone density corresponds to the amount of protein consumed. Milk protein, especially, protects against osteoporosis, independently of milk’s other important nutrients. Too much fluoride clearly increases the risk of bone fractures,[26] and the side effects of other drugs haven’t been properly studied in humans, while they often have dangerous effects in animals.
>
> Calcium, magnesium, vitamin A, vitamin B6, vitamin K, and vitamin D are important for the development and maintenance of bones. For example, a vitamin A deficiency limits the synthesis of progesterone and proteins. In calcium deficiency, parathyroid hormone is increased, and tends to cause the typical changes of aging, shifting calcium from hard tissues to soft, and decreasing the ratio of extracellular to intracellular (excitatory) calcium. Polyunsaturated fats are converted to prostaglandins (especially under the influence of estrogen), and several prostaglandins have toxic effects on bone. Those fats also suppress the formation of thyroid hormone and progesterone. The increased use of the unsaturated oils has coincided with the increase of osteoporosis. The oxidation of proteins caused by free radicals is increased with aging and by the use of unsaturated fats, and it contributes to tissue atrophy, including the age-related shrinkage of the bones.

### Source 3 — It’s Rainmaking Time — Energy-Protective Materials (June 2014)

Ray Peat · Interview · Jun 14, 2014 · http://l-i-g-h-t.com/files/rainmaking-time-energy-protective-materials.mp4

> **Ray Peat:** Yeah, x-­rays happen to poison bone metabolism, so the more bone scans you have, the more osteoporosis you are going to get. And the doctors have known for at least 15 years that looking at the bone with ultrasound is many times more valid than the x-­ray scans. And ultrasound stimulates bone strengthening, so it is totally crazy not to use ultrasound to test your bones.
>
> **Kim Greenhouse:** Do you think it is possible to order a test to have your bone density checked by ultrasound today?
>
> **Ray Peat:** Yeah, there are good machines and minimal machines. The good ones can tell you how strong the bones is, the minimal ones will just tell you where it rates on the scale of density, but it’s sort of hard to find them because the x-­ray people discourage competition.
>
> **Kim Greenhouse:** For sure. You don’t know of a single place in America that one could get their bone density tested via ultrasound?
>
> **Ray Peat:** I think someone found one in NYC but they are very hard to find around the country. I know the machines exist but they are probably mainly for research purposes.

### Source 4 — Estrogen and Osteoporosis

Ray Peat · Article · 2006 · https://raypeat.com/articles/articles/estrogen-osteoporosis.shtml

> Progeria, or premature aging, is a kind of wasting disease that causes a child's tissues (including bones) to atrophy, and to change in many of the ways that would normally occur in extreme old age. Recent studies have found that both men and women lose minerals from their bones at the rate of about 1% per year. Although men have lower estrogen in youth than women do, their bones are much heavier. During aging, as their bones get thinner, men's estrogen levels keep rising. Besides having weaker bones, old people have weaker muscles, and are more likely to injure themselves in a fall because their muscles don't react as well. Muscle loss occurs at about the rate of 1% per year. Women's muscles, like their bones, are normally smaller than men's, and estrogen contributes significantly to these differences. TNF can produce very rapid loss of tissue including bone, and in general, it rises with aging.
>
> Some of the people who like to say that "osteoporosis is caused by estrogen deficiency" know about the destructive actions of TNF, and argue that it rises at menopause "because of estrogen deficiency." There are very good reasons for rejecting that argument; the experiments sometimes seem to have been designed purely for propaganda purposes, using toxic levels of estrogen for a specific result. One researcher noted that the effects of estrogen on cells *in vitro* are biphasic: Low doses increased TNF, high doses decreased TNF. Everyone knows that unphysiologically high doses (50 or 100 or more times above the physiological level of around 0.25 micrograms per liter) of estrogen are toxic to cells, producing functional and structural changes, and even rapid death. So, when a researcher who wants to show estrogen's "bone protective" effect of lowering TNF adds a lethal dose of estrogen to his cell culture, he can conclude that "estrogen inhibits TNF production." But the result is no more interesting than the observation that a large dose of cyanide inhibits breathing. TNF is produced by endotoxin, and estrogen increases the amount of endotoxin in the blood. Even without endotoxin, though, estrogen can stimulate the production of TNF. Lactic acid and unsaturated fats and hypoxia can stimulate increased formation of TNF. Estrogen increases production of nitric oxide systemically, and nitric oxide can stimulate TNF formation.

### Source 5 — Osteoporosis, aging, tissue renewal, and product science

Ray Peat · Article · 2012 · https://raypeat.com/articles/articles/osteoporosis-aging.shtml

> In previous newsletters I have talked about the ability of intestinal irritation and the associated increase of serotonin to cause headaches, asthma, coughing, heart and blood vessel disease, muscular dystrophy, flu-like symptoms, arthritis, inflammation of muscles and nerves, depression, and inflammatory brain diseases. With the new recognition that serotonin is a basic cause of osteoporosis, intestinal health becomes a major issue in aging research.
>
> The protein that inhibits intestinal formation of serotonin is the low density lipoprotein receptor-related protein. This seems likely to have something to do with the fact that "low" HDL is associated with better bones. A low level of LDL is associated with increased vertebral fractures (Kaji, et al., 2010).
>
> Cartilage synthesis and turnover are highest at night. It is inhibited by metabolic acidosis (increased lactic acid), but not by respiratory acidosis (CO2) (Bushinsky, 1995). Since most calcium is lost from bone during the night (Eastell, et al., 1992; even in children: DeSanto, et al., 1988) in association with the nocturnal rise of the catabolic substances, such as free fatty acids, cortisol, prolactin, PTH, and adrenalin, things which minimize the nocturnal stress can decrease the bone turnover. These include calcium (Blumsohn, et al., 1994) and sugar. Catabolic substances and processes increase with aging, especially at night. Babies grow most during the night when bone turnover is high, and even a daytime nap accelerates collagen turnover (Lutchman, et al., 1998).
>
> Discussions about whether a certain person's osteoporosis is "menopausal osteoporosis" or "senile osteoporosis" have neglected the possibility that osteoporosis doesn't begin in either menopause or old age, but that it is the result of life-long developmental processes that interact with all the factors that are involved in aging. The fact that the collagen content of old bone is lower than in young bone (as a percentage of bone weight) shows that the problem in osteoporosis isn't a lack of calcification, it's a deficiency of tissue renewal, parallel to sarcopenia, the decrease of muscle mass with aging.

### Source 6 — Estrogen and Osteoporosis

Ray Peat · Article · 2006 · https://raypeat.com/articles/articles/estrogen-osteoporosis.shtml

> Both thyroid and progesterone improve magnesium retention. Estrogen dominance is often associated with magnesium deficiency, which can be an important factor in osteoporosis (Abraham and Grewal, 1990; Muneyyirci-Delale, et al., 1999).
>
> As part of the campaign to get women to use estrogen, an x-ray (bone density) test was devised which can supposedly measure changes in the mineral content of bone. However, it happens that fat and water interfere with the measurements. Estrogen changes the fat and water content of tissues. By chance, the distortions produced by fat and water happen to be such that estrogen could appear to be increasing the density of a bone, when it is really just altering the soft tissues. Ultrasound measurements can provide very accurate measurements of bone density, without the fat and water artifacts that can produce misleading results in the x-ray procedure, and don't expose the patient to radiation, but the ultrasound method is seldom used.
>
> In recent years, there has been quite a lot of research into the effects of the macrophage cytokines. Immune therapy for cancer was considered quackery when Lawrence Burton identified some substances in blood serum that could cause massive tumors in rodents to disappear in just a few hours. One of the serum factors was called Tumor Necrosis Factor, TNF. An official committee was formed to evaluate his work, but it reported that there was nothing to it. A member of the committee later became known as "the authority" on tumor necrosis factor, which was thought to have great potential as an anticancer drug. However, used by itself, TNF killed only a few cancers, but it damaged every organ of the body, usually causing the tissues to waste away. Other names, lymphotoxin and cachectin, reflected its toxic actions on healthy tissues. Aging involves many changes that tend to increase the inflammatory reaction, and generally the level of TNF increases with aging.
>
> Although cancer, heart failure, AIDS, and extreme hormone deficiency (from loss of the pituitary or thyroid gland, for example) can cause cachexia of an extreme and rapid sort, ordinary aging is itself a type of cachexia. Progeria, or premature aging, is a kind of wasting disease that causes a child's tissues (including bones) to atrophy, and to change in many of the ways that would normally occur in extreme old age.

### Source 7 — Estrogen and Osteoporosis

Ray Peat · Article · 2006 · https://raypeat.com/articles/articles/estrogen-osteoporosis.shtml

> Although I have spoken about progesterone and osteoporosis frequently in the last 25 years, I have only occasionally considered what estrogen does to bones; generally, I described estrogen as a stress-promoting and age-promoting hormone. In the 1970s, pointing out progesterone's protective antagonism to excessive amounts of other hormones, and that the catabolic glucocorticoids tend to increase with aging, I began referring to progesterone as the "anticatabolic" hormone that should be used to prevent stress-induced atrophy of skin, bones, brain, etc.
>
> A former editor of *Yearbook of Endocrinology* had reviewed a series of studies showing that excess prolactin can cause osteoporosis. Then, he presented a group of studies showing how estrogen promotes the secretion of prolactin, and can cause hyperprolactinemia. In that review, he wryly wondered how something that increases something that causes osteoporosis could prevent osteoporosis. Women have a higher incidence of osteoporosis than men do. Young women have thinner more delicate bones than young men. The women who break bones in old age are generally the women who had the thinnest bones in youth.
>
> Menstrual irregularities, and luteal defects, that involve relatively high estrogen and low progesterone, increase bone loss. Fatter women are less likely to break bones than thinner women. Insulin, which causes the formation of fat, also stimulates bone growth. Estrogen however, increases the level of free fatty acids in the blood, indicating that it antagonizes insulin (insulin decreases the level of free fatty acids), and the fatty acids themselves strongly oppose the effects of insulin. Estrogen dominance is widely thought to predispose women to diabetes. Between the ages of 20 and 40, there is a very considerable increase in the blood level of estrogen in women. However, bone loss begins around the age of 23, and progresses through the years when estrogen levels are rising.
>
> Osteoarthritis, which involves degeneration of the bones around joints, is strongly associated with high levels of estrogen, and can be produced in animals with estrogen treatment. Thirty years ago, when people were already claiming that estrogen would prevent or cure osteoporosis, endocrinologists pointed out that there was no x-ray evidence to support the claim.

### Source 8 — How Your Microbiome Influences Your Dietary Recommendations - Discussion between Georgi Dinkov and Dr. Mercola

Georgi Dinkov · Interview · Apr 28, 2024 · https://www.youtube.com/watch?v=Ie7TLgKicN0

> **Dr. Joseph Mercola:** And I've got a good dearest friend who we're hiring to work in my company. And his passion for the last at least dozen years or so has been osteoporosis and has been actively involved in screening programs, therapies to improve it. And I asked him what he thought was the single most important nutrient to build up bone density. He didn't know. It's collagen. Why wouldn't it be? 30% of your bone is collagen. 30%. Yeah. And it's interesting. If you look at the microarchitecture and muscles too, I mean, even your muscle fibers, your muscles pose lots of collagen. It's seamless. I mean, the tendons and the ligaments, they merge into the muscle. They're part of it. It's just the same structure. In fact, around every one of the sarcomeres is collagen. You can't have muscle without collagen. It doesn't work without collagen. It's the most fundamental protein in your body,
>
> **Georgi Dinkov:** I think.
>
> **Dr. Joseph Mercola:** And Ray understood that. He regularly encouraged. I mean, you hear him on his radio podcast. He was always telling people to take gelatin. He would say gelatin, but it's the same thing, collagen.

### Source 9 — Bone Density: First Do No Harm

Ray Peat · Article · 2006 · https://raypeat.com/articles/aging/bonedensity.shtml

> Breast cancer has not decreased despite the massive application of the technology, though the US government and others (using crudely deceptive statistics) claim that the War on Cancer is being won. Similarly, during the last decades when the “high technology” x-ray machines have been more widely used, the age-specific incidence of osteoporosis has increased tremendously. This apparently includes a higher rate of shortening of stature with aging than in earlier generations.[2]
>
> I think there are several reasons for avoiding x-ray tests of bone density, besides the simple one that everyone should eat a bone-protective diet, regardless of the present density of their bones. Even seemingly identical x-ray machines, or the same machine at a different time, can give very different estimates of bone density.[3-10] Radiologists evaluating the same images often reach very different conclusions.[11] Changes in the tissue water and fat content can make large differences in apparent bone density,[12] and estrogen, which affects those, could appear to cause improved bone density, when it is merely causing a generalized inflammatory condition, with edema. A machine that is accurate when measuring an aluminum model, won’t necessarily give meaningful results when the composition of the tissue, including the bone marrow, has changed. Calcification of soft tissues can create the impression of increased bone density.[13] Studies of large groups of people show such small annual losses of bone density (around 1%), especially in the neck of the femur (which is important in hip fractures) that the common technical errors of measurement in an individual seem very large.
>
> Ultrasound devices can do an extremely good job of evaluating both bone density and strength [14-16], rather than just density. Ultrasound stimulates bone repair. X-rays accelerate the rate of bone loss. X-rays do their harm at any dose; there is no threshold at which the harm begins. X-ray damage is not limited to the area being investigated. Deflected x-rays affect adjacent areas, and toxins produced by irradiated cells travel in the bloodstream, causing systemic effects. Dental x-rays cause thyroid cancer and eye cancer. Recent experiments have shown that low doses of radiation cause delayed death of brain cells. The action of x-rays produces tissue inflammation, and diseases as different as Alzheimer’s disease and heart disease result from prolonged inflammatory processes.
>
> I have never known a physician who knew, or cared, what dose of radiation his patients were receiving.

### Source 10 — KMUD Hair Loss Inflammation and Osteoporosis 2012

Ray Peat · Interview · 2012

> **Ray Peat:** My current interest in it is that it’s a good way to conceive the unified nature of the aging processes, because everyone’s bones get thinner with aging, and it corresponds pretty well to the loss of muscle tissue with aging. Generally it corresponds to the calcification of soft tissues that shouldn’t have calcium, and the excitatory processes of all the inflammatory and nervous activity — muscle cramping and so on — all of these things are associated with the misapplication of calcium, failing to put it in the bones. All of that is under the control of energy metabolism, so something going wrong with your thyroid and oxidative metabolism. The parathyroid, lactic acid producing kind of metabolism tends to replace it and causes stress, atrophy, shrinking of the tissues.
>
> **Andrew Murray and Sarah Johannesen-Murray:** It’s more of an error of calcium metabolism, so, in terms of correcting…because I know you’re very big on natural sources of calcium, and the calcium recommendations that you’ve mentioned in the past may to some people perhaps seem high, but have certainly proven very useful for people with conditions related to calcium decrease. So what kind of calcium intake do you think is reasonable for people, especially those people approaching an age where…you know, 50, or whatever they are…

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