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Many women tend toward iron-deficiency anemia before menopause, but excess iron drives bone loss after menopause. Here are 10 things women and men need to know about the relationship between high iron levels and osteoporosis.

Iron overload causes bone mineral loss, osteopenia, and osteoporosis. If you grew up in the United States, and you are old enough to be concerned about osteoporosis that affects you or someone you love, chances are you remember a product called Geritol. Back when most television sets were black and white, Geritol was the sponsor of the original Lawrence Welk Show, a quiz show called Twenty-One, the original version of To Tell the Truth,  Bob Hope specials, and the original version of Star Trek. You couldn't watch any of the three networks that were on TV very long without seeing an ad for Geritol.

People took Geritol because it gave them a kick of alcohol, and because the Geritol logo was plastered all over their favorite TV shows. Sixty years ago there wasn't a problem with its tag line from an advertisement in which a husband discovers his wife has been taking the product, "My wife, I think I'll keep her." But the justification for this product taken by millions of women, many of whom went on to develop compressed spines and dowager humps, was that it was an iron supplement.

Iron supplements did and can continue to do enormous damage to women's bone health after menopause. They aren't healthy for most men, either. Here are five things everyone needs to know about iron overload and osteoporosis.

1. Excess iron 'rusts out" bones

Iron is used to make durable metals like steel. But iron and steel have a serious shortcoming. They rust. Something similar happens in bone.

Iron reacts with oxygen in the bloodstream and in bone. Excess, unbound iron generates toxic free radicals of oxygen. The chemical reaction of iron and oxygen in the human body doesn't really form "rust", but it creates reactive oxygen species (ROS) that in turn creates inflammatory cytokines such as tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6).

When these inflammatory substances are more abundant, the two-step process the bones use to stay healthy gets out of sync. The cells that break down bone to repair the inevitable tiny fractures that accumulate in bones are super-activated, and the cells that build new bone to replace the minerals they recycle can't keep up. As a result, the  hard cortex of bones gets thinner. The soft marrow of bones gets thicker. Bones become more fragile.

2. Just a little excess iron makes a difference after menopause

It is rare for women to have excess iron while they are still menstruating. It is rare for women to have so much iron in circulation after menopause that they get diagnosed with an "iron overload disease". But when estrogen levels go down, another hormone called hepcidin becomes more active. Before menopause, hepcidin keeps women from losing too much iron with menstrual blood. Estrogen turns off hepcidin after a woman's period is over. In menopause, hepcidin is active all the time, so iron levels gradually creep up. They may not become systemically toxic, but they get high enough to do damage to bone.

3. Three simple changes in lifestyle help protect bones after age 50

Women after menopause need to follow two simple rules to avoid excessive iron levels:

  • Don't take iron supplements after menopause unless a blood test confirms you have iron-deficiency anemia.
  • Don't eat excessive amounts of high-iron foods (liver, for example, and foods cooked in iron utensils). Avoid baked goods, flour, cereals, and rice that have been fortified with iron.
  • Don't eat fruit and iron-rich foods at the same meal.

Some fruits don't increase iron absorption from food. These include apples, grapes, peaches, and avocados. Some fruits and berries increase iron absorption a little. These include strawberries, plums, mangos, pineapple, and cantaloupe. And some foods increase the amount of iron you absorb from food a lot. These include guavas and papayas and citrus.

The more vitamin C there is in a food, the more iron your body will absorb from the foods you eat with it. Red grapes and red wine, however, block iron absorption.

4. Certain chronic health conditions in both men and women raise iron levels and damage bones

There are iron overload diseases that increase the amount of iron in bones and increase the risk of osteoporosis. These include hemochromatosis, beta-thalassemia, and sickle cell disease. Both women and men are prone to bone problems later in life if these conditions are not carefully treated throughout life. By age 50, many people with these conditions need a treatment specifically to remove excess iron.

5. Chelation therapy restores bone when iron overload disease damages it

Chelation is the process of removing a heavy metal from the body. The DMSO chelation therapy you might get at a naturopath's office by IV won't really work. You need something like ExJade (deferasirox, also marketed as Jadenu) to lower your iron levels. The upside of ExJade is that you can dissolve tablets in water and do your chelation at home. No intravenous drips are required. The downside of ExJade is that it is breathtakingly expensive in the USA; insurance companies typically get billed $19,200 a month for it. (In most of the United States the drug is covered by insurance, and outside the United States it is still expensive, but about $100 a week.) But Exjade/deferasirox restores bone mineral loss in the spine. It works whether or not women and men who have iron overload take calcium, vitamin D, bisphosphonates, or hormone replacement therapy. For these people, it is a stand-alone treatment that works. DMSO, unfortunately, will not do the same thing.

  • Ballot D, Baynes RD, Bothwell TH, Gillooly M, MacFarlane BJ, MacPhail AP, Lyons G, Derman DP, Bezwoda WR, Torrance JD, et al. The effects of fruit juices and fruits on the absorption of iron from a rice meal. Br J Nutr. 1987 May. 57(3):331-43. PMID: 3593665
  • Huang X, Xu Y, Partridge NC. Dancing with sex hormones, could iron contribute to the gender difference in osteoporosis? Bone. 2013.55:458–460. doi: 10.1016/j.bone.2013.03.008.
  • MacKenzie EL, Iwasaki K, Tsuji Y. Intracellular iron transport and storage: From molecular mechanisms to health implications. Antioxid Redox Signal. 2008. 10:997–1030. doi: 10.1089/ars.2007.1893.
  • Weinberg ED. Iron loading: A risk factor for osteoporosis. Biometals. 2006.19:633–635. doi: 10.1007/s10534-006-9000-8.
  • Photo courtesy of SteadyHealth

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