A 55-year-old woman named Meaghan came in to see me last week in tears. She’s three years into menopause and had just returned from a review of her first bone density measurement. Meaghan was told she had moderate osteopenia of the hip and “near osteoporosis” of the spine. She was surprised and dismayed to hear that her bone density was “seriously low,” and without further discussion, was given an osteoporosis medication prescription and told to take calcium and vitamin D. Shocked, Meaghan came to my office asking what I thought about the proposed treatment plan.

When I hear a story like this, I can’t help but think of  the U.S. Surgeon General’s approach to osteoporosis prevention and treatment. And, I’ll give you a hint — it was not the approach her doctor used.

At the Center for Better Bones, we have long advocated a tiered approach to osteoporosis prevention and treatment, much like what the U.S. Surgeon General recommends. Rather than jump into pharmacological treatment based on a single measurement of bone density, the Surgeon General outlines a staged, three-step pyramid approach.

• Lifestyle choices. Nutritional and lifestyle modifications form the foundation for the recommended osteoporosis prevention and treatment program, as illustrated by the Surgeon General’s pyramid. This includes things like eating more fruits and vegetables, exercising, taking a quality multivitamin, and taking measures to prevent falls.
• Testing. The next layer of prevention and treatment moves into medical testing to uncover any causes of excessive bone loss. Here, the importance of testing for vitamin D springs to mind, but there are also many other important reasons for bone loss that need to be ruled  out.
• Prescription drugs. Finally, at the top and smallest portion of the treatment pyramid, you find drug treatment. After the individual case has been studied thoroughly (including an assessment of the individual’s real fracture risk), then comes drug therapy.

These days, as Meaghan found out, the Surgeon General’s Osteoporosis Pyramid has been turned in its head. From this upside down view, many doctors use bone drugs first, without a comprehensive lifestyle or nutritional evaluation, without multi-factorial fracture risk assessment, and without a thorough medical evaluation for possible causes of bone loss.

As Meaghan and I talked about righting the Surgeon General’s pyramid, Meaghan felt immediate relief. She quickly came to replace several bone-depleting lifestyle and nutrition patterns. Through a multi-factorial risk assessment, she learned that her real risk of fracture was actually very low at this time. She became empowered to go back to her doctor and request a full medical osteoporosis work-up. After all, if her bone situation was serious enough to qualify Meaghan for bone drug therapy, it was serious enough to warrant a medical work-up looking for the causes of her bone loss.

So, what’s the best way to treat bone loss? Turn the Surgeon General’s Osteoporosis Pyramid back on its broad base and step by step, regain bone health one day at a time.

If you're interested in learning more about this topic, take a look at these articles:

Do you really need a drug for your bones?
Who needs a medical osteoporosis workup?
20 Key bone-building nutrients

Reference:
Surgeon’s General Report on Osteoporosis, published in 2004.

We created the Osteo Blast blog as our forum to express opinions and educate the public about natural means of supporting and improving bone health and overall wellness. As part of this forum, we sometimes discuss medical issues and medications, and their effects on bone health in general. However, we cannot advise readers about specific medical issues in this forum. If you wish to obtain advice from Susan E. Brown, PhD, about your specific bone health and nutritional concerns, please visit our Consultations page. Other specific medical questions should be referred to your healthcare provider.