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Osteoporosis: What You Need to Know The National Osteoporosis Foundation says one in two females and one in four males over 50 years old will have an osteoporosis-related fracture in their remaining lifetimes. Osteoporosis is defined as a decrease in bone density causing skeletal weakness. Ten million people in the U.S. (80 percent of them female) are said to have this condition, with 34 million at risk. Screening for bone density has become routine and a large percentage of women over the age of 50 are on medications for this condition. Is this really a disease that warrants its present amount of media coverage and requires current levels of medical intervention? Although osteoporosis can be crippling and certain people at risk definitely need treatment, prior to the 1970s, osteoporosis was considered rare and was only diagnosed after a fracture, usually in the elderly. This soon changed when sales of the estrogen drug Premarin began to decline in 1975. According to Dr. Sherrill Sellman, author of Hormone Heresy: What Women Must Know About Their Hormones, Ayerst, the manufacturer of Premarin, remarketed the drug to target osteoporosis. A media campaign started in 1982. Sales of estrogen began to increase. In 1988, the first dual-energy X-ray absorptiometry (DEXA) machine was developed to measure bone mineral density (BMD). It was designed as a screening tool for osteoporosis. In 1992, the World Health Organization called for a conference to determine whether osteoporosis could be identified before a patient broke a bone. The conference was sponsored by two drug companies and a drug-company foundation. It was determined at the conference that a 70-year-old female would be compared to a 30-year-old female, the age at which bone mass peaks for most people. A measurement called a "T score" was used. If a women had a score of -2.5 T or worse, she was diagnosed with osteoporosis. They also set a new guideline stating that anyone with a score between -1 and -2.5 had osteopenia, or low bone mass. Under these new guidelines, 70 percent of all females over 50 years old in the U.S. fall into one of these two categories, thus qualifying for bone-strengthening drugs and numerous DEXA tests. That's about 44 million Americans, meaning millions of DEXA tests each year. The main treatment for these conditions, in addition to estrogen, is the administration of drugs called bisphosphonates (such as Fosamax and Actonel). The side effects of these medications include heartburn, indigestion, nausea, inflammation of the esophagus and, in some cases, death of the jaw bone. Fifty percent of women who start the medication stop within one year due to the side effects. To better understand how these drugs work, it is helpful to know how bone is remodeled. One type of cell, called an osteoclast, removes old bone. In response to the release of certain minerals when osteoclasts break down bone, a second type of cell, called an osteoblast, forms new bone. The balance between these two types of cells is necessary to make healthy bones. Bisphosphonates suppress the activity of osteoclasts, stopping the breakdown of bone. The problem with this, says Susan Brown, Ph.D., director of the Osteoporosis Education Project, is that "they halt the breakdown of bone by 90% but they also halt bone formation by that much." These drugs do help increase bone density and decrease the incidence of fractures in the first year of use, but their longterm effects have not been identified yet. Christine Northrup, M.D., points out that BMD does not measure bone strength or quality, an argument often cited against the use of DEXA measurements as the sole criteria for determining bone health. Peak bone mass varies with ethnicity, country (even regions within countries) and season. For example, in Japan, hip-bone density is markedly lower than in the U.S., and yet their fracture rate is less than 40 percent of ours. Northrup adds that one has to look at weight, ethnicity and cigarette use to get a real picture of bone health. According to Gillian Sanson, author of The Osteoporosis Myth, a 1995 study called the National Health and Nutrition Examination Survey determined a different peak bone mass that was much lower than the one used by manufacturers such as Merck. Sanson states that the use of this finding would have "cut the prevalence of osteoporosis, as defined by BMD, by more than half." In addition, the Canadian Multicentre Osteoporosis Study in 2000 showed the "prevalence of osteoporosis as defined by BMD to be 16% in women and 5% in men, as opposed to the official Canadian estimates of 50% and 12%," Sanson says. This is not to say that the DEXA test or medications are all bad or that they don't have a place in the health care system. In 2002, a federal committee chaired by Al Berg, M.D., head of the University of Washington's Department of Family Medicine, developed guidelines for osteoporosis testing. These guidelines, among others, were set independent of any drug companies. The committee concluded that testing should be targeted to women 65 or older and that DEXA testing should be limited to the hip. This recommendation validated some of the allegations that millions of women were getting unnecessary tests and taking medications without evidence that the drugs were safe or even effective. Rather than thinking of osteoporosis as a disease of aging, I prefer to think of it as a degenerative process, much like cardiovascular disease, hypertension and diabetes. These processes are reflections of our lifestyle. According to Dr. Susan Brown, hip-fracture rates vary worldwide by as much as 40-fold, with the highest in the U.S. and Europe and the lowest in underdeveloped countries and Asia. While there may be many reasons for osteoporosis, some of the biggest contributing factors are: Smoking: Those who smoke have a significant decrease in bone density and are much more likely to suffer fractures. Alcohol consumption: Alcohol suppresses osteoblast activity. More than two drinks a day can increase your risk of osteoporosis. Caffeine: As few as 2 - 4 cups of coffee or black tea a day can double the risk of hip fracture. Stress: High levels of sustained stress produce increased levels of cortisol. This hormone suppresses the immune system, causes calcium to be released from the bones into the bloodstream and suppresses hormones that facilitate bone remodeling. Lack of exercise: Bone is dynamic and responds to the stress put on muscles, tendons and bone itself by becoming stronger. A sedentary lifestyle decreases bone strength. Acidosis: Our blood maintains a pH of approximately 7.25. A diet rich in sugar, refined carbohydrates and grain-fed animal meat lowers the pH and makes us more acidic. Our bodies respond by pulling calcium and other minerals from our bones to help us become more alkaline. This process increases our risk of bone loss (see The Balancing Act: Acid and Alkaline," Issue #12). Antacids: The use of Nexium, Prilosec or Prevacid blocks our ability to absorb calcium and other nutrients (see Kicking the Antacid Habit: Healing Heartburn Naturally, Issue #7). My recommendations are the following: Decrease your intake of alcohol and caffeine and quit smoking: Make managing your stress through meditation, yoga, walking or whatever works for you a primary goal. Exercise: Research shows that even moderate weight-bearing exercise can dramatically increase bone density. Doing an activity like lifting light weights, jogging or power-walking 2 - 3 times per week for 30 - 40 minutes can help a lot. Choose healthy food: Increasing your intake of dark green vegetables could be one of the best things to help prevent bone loss. Kale, dark green lettuce, chard and broccoli are just a few of these vegetables. When eating carbohydrates, eat whole grains if possible. Try switching to meats and dairy products from pasture-fed animals. They are much higher in calcium and other nutrients and do not create as much acidity as the same products from grain-fed animals. The elimination or reduction of refined carbohydrates is absolutely necessary. Increase nutrients: The use of vitamin D (see Vitamin D Delivers, Issue #8.) is extremely important. Some studies have demonstrated that vitamin D is just as effective as some bisphosphonates in improving bone density. I recommend about 2,000 mg per day, but you may want to get tested to accurately assess your vitamin D levels. I also suggest 500 mg of magnesium per day. As far as calcium, I prefer a form that contains bone marrow and plant enzymes and is checked for impurities and heavy metals. I suggest Standard Process Calcifood (available in natural pharmacies or online), two per day. I also recommend 2,000 mg a day of fish oil, as it helps mobilize calcium into the bone and tissues. Discuss the pros and cons of the DEXA tests and medications with your health care practitioner and don't be afraid to get a second opinion. In some cases, pharmaceuticals may be indicated — but they should always be a last resort, not the first line of therapy. I have seen numerous patients come back showing improvement on their DEXA tests after a year of modified lifestyle and nutrient intake. The Acid Alkaline Food Guide: Nourishing Traditions, 2nd ed. The Myth of Osteoporosis Hormone Heresy: What Women Must Know About Their Hormones by Sherrill Sellman, N.D. (Sherrill Sellman, 2000) James Keough, "Bones of Contention" Alternative Medicine, April 2007 Christine Northrup, M.D.
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