The next big bone drug: big bang or little whimper? 5 questions to ask

istock_000013020173xsmall

The next big new bone drug is about to hit your doctor’s office. Impressive claims that the drug reduces fractures by 73% are being tossed around. But bisphosphonates were once touted in similar terms and are falling out of favor due to side effects and limited efficacy.

Do the stats in these studies mean anything real?

Whenever I hear about a new bone drug, I look at the research and ask a set of key questions to see whether there is any good news. I’m sharing them with you so you have tools to help you assess what you hear.

Question #1: What is the nature and action of the drug? What will its long-term effects be?

The experimental bone drug I mentioned is a monoclonal antibody called romosozumab that inhibits action of a protein in the body known as sclerostin. Some time ago, it was discovered that sclerostin deficiency causes a rare genetic disorder characterized by high bone mass and resistance to fracture, so the pharmaceutical industry decided to make a drug to block this protein and see if it could reduce bone breakdown and enhance bone buildup.

Now Romosozumab is a drug that tinkers that with both bone breakdown and bone formation in a whole new way, and its discoverers claim that “the risk of new vertebral fracture was 73% lower in those who took the drug.” Pretty impressive, if it’s true. So let’s take a closer look and continue asking questions.

To begin with, an important unanswered question is, “What are the many roles that sclerostin plays in the body, and what will be the long-term impact of suppressing this protein?” The current study does not address the issue of long-term impact or safety, and it often takes 10+ years to see the full effects of such tinkering with human physiology. For now, we know roughly how the drug acts, but we do not know what its long-term effects are.

Question #2: How many people participated in the study, and how were they selected?

This study looked at 6600 postmenopausal women ages 55 to 90 with a hip bone density T score between -2.5 and -3.5. The group was divided into two subgroups — 3325 who took the drug, 3327 who were given a placebo. So on the surface, this is a strong study — it includes a large sample of individuals who are similar in age, gender, and baseline bone density, and the groups are equivalent in size.

But a closer look shows that those at higher risk of fracture were excluded from the study. That includes women with a hip T score worse than -3.5, a history of hip fracture, or even one severe or more than two moderate vertebral fractures; those with a vitamin D below 20 ng; women with high or low blood or calcium as well as those with bone diseases or conditions affecting bone metabolism.
In other words, they chose participants based on low bone density rather than fracture risk (and if you’ve read my blogs, you know that the two aren’t necessarily the same).

Question #3: How long was the study?

Study subjects were only given the new drug, romosozumab, for 12 months and then switched to another monoclonal antibody bone drug, denosumab (Prolia®), in the second year. While researchers do not explain why they switched to another drug, I suspect they feared extended use of this new drug would result in serious longer-term adverse effects. This is not unlike the case with the drug teriparatide (Forteo®), the use of which is limited to two years due to potential life-threatening impacts.

Question #4: What is the real-life fracture-reduction benefit?

The length of the study is important because the short-term fracture reduction benefits may be very different from the long-term ones. In this case, all we have is a 1-year study with romosozumab and then another year-long study switching all study subjects (those on placebo and those on romosozumab) to the denosumab (Prolia®) bone drug. This makes the study a little confusing, but I’ll try to clarify the findings:

  • Only a few vertebral fractures were prevented by using either of the two drugs. The study had a total of 6,652 women, all of whom had a pretty low fracture risk to begin with. In the first year of the study using romosozumab versus placebo more than twice as many women (59) in the placebo group experienced vertebral fractures than the women in the romosozumab group (16). So when you look at how many women were spared from a vertebral fracture by taking the new drug (that is, 59 – 16 = 43 women), you realize that for every 1 woman who benefitted, there were 76 others in the drug group who took the medication and got nothing out of it. If your doctor told you he had to treat 3,327 women to prevent just 43 vertebral fractures, you might look into other ways to strengthen your spine.
  • Both drugs put together had very little benefit on vertebral facture. Among the 3327 women who received placebo the first year and then were put on denosumab in the second year, there were 84 new vertebral fractures, whereas the women who took romosozumab the first year had only 21. Overall, then, 63 women out of 6652 were saved from having a fracture by taking bone drugs for both years. That’s not even 1% of the total number of participants.
  • The new drug had almost no impact on non-vertebral fractures. Vertebral fractures often cause no symptoms in those who have them, but others — like fractures in the wrist, collar, arm or hip — can be more serious and painful. Such fractures occurred in 56 patients on the new drug and 75 in the placebo group. That means the drug helped prevent only 19 of the 3,327 women avoid non-vertebral fractures with over 1 year of treatment. So you’d have to treat 175 women to save just 1 woman from fracturing a hip. And when you take the second year into account, when all the participants took bone drugs, you find no significant difference in risk between the romosozumab group and the placebo group. So if you were looking prevent fractures of the hip, wrist, collarbone, arm, or other non-vertebral fracture, the new drug was no help at all.

Question #5: What are the reported and potential adverse effects of the drugs?

In this 1-year trial of romosozumab, adverse effects included the following: hypersensitivity to the injection; 2 cases of osteonecrosis of the jaw; 1 atypical femur fracture; a high incidence of anti-romosozumab antibodies (the impact of this on the immune system is yet unknown); and lowered serum calcium levels in those using romosozumab. These are all fairly serious problems.

Is there a better way to reduce needless fractures?

From my nearly 3 decades of clinical practice and bone health research, I confidently say yes, there is a better way! And that better way is one that builds Better Bones and a Better Body naturally, without the many risks of bone drugs.

Approaches like my Better Bones Program enhance health, vitality, and fitness while reducing fracture risk. Why not take a few minutes to review the steps to the Better Bones, Better Body Program and get started strengthening your bone today?

 

Reference:
Cosman, Felicia et al., Romosozumab Treatment in Postmenopausal Women with Osteoporosis. New England Journal of Medicine
October 20, 016:375.532-1543.

6 ways standard osteoporosis treatment is dead wrong: Part 2

woman-thinking-about-her-health

I’ve written recently about two of my top six concerns about the standard approach to bone health.  And now, here are two more that emphasize how women are often being misled about how to best protect their bones:

3. Contemporary osteoporosis management treats bone as if it were separate and isolated from the rest of the body.

It’s tempting to look at the body the way we look at cars — as a collection of independent parts, each with a specific job. But that’s not what the body is! It’s a set of dynamic, interconnected systems that are constantly changing in response to what goes on around us and inside us.

While most people lose some bone as they age, bones don’t just “wear out” over time, the way a car’s parts do. If bones are weak or rapidly become thin, it’s nearly always because of a larger systemic problem in the body. The most effective approach in this situation is a big-picture perspective that looks at bone health as an indicator of overall health — it’s been shown that older adults who experience a hip fracture have lower baseline health-related quality of life than those who don’t.

But the standard approach is to focus on the mechanics of bone breakdown and interfere with them. Most bone drugs work by targeting the cells that break bone down and stopping them from doing their job. Doing this doesn’t actually solve the problem — it just masks the effects.

Enduring bone health requires rebuilding strength and vitality. That’s why it makes sense to look at the complete body system — circulation, bone, acid-base balance — to find the places where something isn’t working right to cause bone loss, rather than focus in on halting bone loss itself, which is most often an effect of a larger problem.

4. High-dose calcium is still considered the first-line treatment, yet it does not prevent fracture, and may be harmful.

Speaking of “larger problems,” let’s take a look at what happens when you try to address fracture risk with calcium supplements. There is tremendous controversy about calcium and bones, but now it’s becoming clear that high-dose calcium supplementation is not the solution.

Multiple studies show that calcium does not decrease fracture risk except in those with a very low calcium intake — and some studies suggest that taking high-dose calcium supplements can lead to an increase in arterial calcification, stroke, kidney stones.  In my own research, it’s quite clear that while adequate calcium is needed for healthy bones, using high doses is counterproductive.

It seems wise to obtain the total 1,200 milligrams of calcium daily from diet and supplements as recommended by the National Institute of Health. At the same time, we recommend you also learn about the other key bone nutrients and make sure you obtain adequate doses of all these essential bone builders.

Stay tuned for next week’s blog for my final two reasons the standard approach to bone health doesn’t make sense. And as you’ll see, are far less effective and far more risky than commonly thought!

See Part 1 here.

 

References:

Randall, AG et al., Deterioration in quality of life following hip fracture; a prospective study osteoporosis international 2000, 11(5);460-6.

Bischoff-Ferrari HA, et al., Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr. 2007
Dec;86(6):1780-90.

Bolland MJ, Leung W, Tai V, Bastin S, Gamble GD, Grey A, Reid IR. Calcium intake and risk of fracture: systematic review. BMJ. 2015;351:h4580. doi: 10.1136/bmj.h4580.
Bolland MJ, Grey A, Reid IR. Calcium supplements and cardiovascular risk: 5 years on. Ther Adv Drug Saf. 2013 Oct;4(5):199-210. doi: 10.1177/2042098613499790
https://ods.od.nih.gov/factsheets/Calcium-Consumer/

* Information presented here is not intended to cure, diagnose, prevent or treat any health concerns or condition, nor is it to serve as a substitute professional medical care.

6 ways standard osteoporosis treatment is dead wrong: Part 3

iStock_000010779625XSmallIn my previous two blogs, I’ve given you 4 important reasons why I don’t believe standard osteoporosis treatment is effective. In this final blog of the series, I want to emphasize that there is no magic bullet for optimal bone health – despite what you may have heard about calcium or bone drugs.  Here’s why:

5.    The calcium-centered focus has distracted us from the fact that at least 20 nutrients are essential for bone health.

I’ve pointed out that calcium doesn’t reduce fracture risk and excessive calcium intake holds increased risk of cardiac problems. But if calcium isn’t the “magic bullet” for bones, what is? Well for one thing, adequate vitamin D levels are essential, and  a lot of doctors are finally realizing how important vitamin D is for bone health.

Yet too little attention is still paid to other essential bone nutrients — especially vitamin K, which makes a major contribution to bone health and supports many other systems as well, but also zinc, magnesium copper, boron, folate, manganese and vitamin C.

6.    Bone drugs are far less effective and far more risky than commonly thought.

Here’s where it really becomes frustrating. Our health system pushes high-dose calcium (which doesn’t work) as the solution to low bone density (which is not necessarily the problem). Then when there’s no improvement in bone density from overloading the body with calcium, the typical next step is to prescribe a bone drug.

I’ve always maintained that such medications should be used only as a last resort, for very severe cases where drastic measures are needed — for instance, a person experiencing low-impact fractures or excessive, uncontrollable bone loss. This is not the situation for most people who have relatively low bone density .

With that in mind, it shouldn’t be surprising that the results of bone drug therapy are often  very disappointing. Even worse, the evidence suggests no benefit from bisphosphonate bone drugs on real-world hip fracture incidence. Nor do these drugs benefit people 80 years old and older — which is, of course, the group most likely to fracture a hip!

What it all boils down to is this: If we’re to really help people to live long, healthy lives free from the fear of bone fractures, we don’t need more bone drugs.  Instead, we need to change our approach by:

  • Carefully assessing each individual case to identify whether excessive bone loss or weakness exists;
  • Detecting and correcting both obvious and hidden causes of excessive bone weakening;
  • Broad-spectrum, whole-body support with nutrition, exercise, neuroendocrine and hormonal balance, stress reduction, and resilience enhancement.

Such an approach would limit bone drugs to the few specific situations where obvious bone weakness cannot be offset by natural means and requires heavy-duty intervention.

Missed the previous blogs?  Read more.

Part 1

Part 2

* Information presented here is not intended to cure, diagnose, prevent or treat any health concerns or condition, nor is it to serve as a substitute professional medical care.

6 ways standard osteoporosis treatment is dead wrong: Part 1

Wrong in right , full frame

It’s no secret that I’m not a fan of the way bone drugs like Prolia® and Fosamax® are used these days. But people sometimes misinterpret my thinking as being “anti-drug” — yet it’s not just the drugs I object to. It’s how medicine in general approaches bone health and fracture risk.

I have at least 6 major objections to the standard approach, but for the sake of brevity, we’ll look at them two at a time over the next three weeks.

1.    Treatment is based on bone mineral density — but bone mineral density does not predict fracture.

Having a low-side bone density isn’t actually a health problem. It doesn’t hurt or limit mobility — it doesn’t even necessarily mean the bones aren’t strong! It’s only when you fracture a bone that you have a health problem — and more, you cannot predict fracture by bone density alone. In fact, the majority of people whose bones are so fragile they experience a low-trauma fracture do not have an “osteoporotic” bone density.

That’s why treating low bone density bones as a “disorder” that “needs to be addressed” with heavy-duty medications makes no sense. Weak bones, on the other hand, need intervention. And, as far as weak bones go, there’s almost always an underlying problem causing the depletion of bone strength — whether it be nutritional, hormonal, bone-damaging medications, or some other hidden health condition or lifestyle factor. Properly detected and corrected these underlying causes can greatly reduce the risk of fracture. This is why a real fracture risk assessment and an assessment of underlying causes are so critical to developing a comprehensive bone-building program.


2.    The standard medical approach to osteoporosis is fear-based — and fear actually damages bone.

Given that a low-side bone density does not necessarily indicate weak bones, why do you suppose doctors are so adamant that people with a low-side bone density need treatment? They’re afraid their patient will have a serious fracture.

But fear of fractures is itself bone damaging and can be a self-fulfilling prophecy — literally, as studies have linked higher levels of stress and the stress hormone cortisol with osteoporosis and increased fracture risk. A recent Danish study, for example, showed that just the perception of stress — seeing yourself as stressed — increases risk of osteoporotic fracture by 68%. It is bad enough that we have so many reasons to fall into stress and worry, we really do not need our health professional piling on more stress with unfounded fears of fracture. Again, what’s needed is a fracture risk assessment leading to a comprehensive bone building program — one that includes stress reduction and hope.

It’s interesting to note that Traditional Chinese Medicine holds that bone health is determined by the “kidney energy” and that fear is the emotion that disrupts the kidney energetic system. (And even Western medicine links osteoporosis with renal disease because the kidneys play such a central role in vitamin D metabolism, mineral reabsorption, and acid-base balance. (As I have discussed before, when kidneys can’t adequately buffer metabolic acids, calcium from bones is called upon to rescue essential pH homeostasis.) The ancient Chinese wisdom tradition suggests that the kidneys control bone and fear damages the kidneys — and I have found this to be true. All in all, we need less fear and more hope and bone-building solutions.

This isn’t all of course. Look for my post next week giving two more problems with the standard approach to bone health!

 

References:

Adeva, M. M., and G. Souto. 2011. Diet-induced metabolic acidosis. Clinical Nutrition 30(4):416–421.

Azuma, K., Y. Adachi, H. Hayashi, and K. Y. Kubo. 2015. Chronic psychological stress as a risk factor of osteoporosis. Journal of UOEH 37(4):245–253.

Häussler, B., H. Gothe, D. Göl, G. Glaeske, L. Pientka, and D. Felsenberg. 2007. Epidemiology, treatment and costs of osteoporosis in Germany: The BoneEVA Study. Osteoporosis International 18(1):77–84.

Lu, Nan. 2010. Traditional Chinese medicine: A woman’s guide to a hormone-free menopause. TCMWF Publishing, New York.

Seeman, E., J. P. Devogelaer, R. Lorenc, T. Spector, K. Brixen, A. Balogh, G. Stucki, and J. Y. Reginster. 2008. Strontium ranelate reduces the risk of vertebral fractures in patients with osteopenia. Journal of Bone and Mineral Research 23(3):433–438.

Stone, K. L., D. G. Seeley, L. Y. Lui, J. A. Cauley, K. Ensrud, W. S. Browner, M. C. Nevitt, S. R. Cummings, and Osteoporosis Fractures Research Group. 2003. BMD at multiple sites and risk of fracture of multiple types: Long-term results from the Study of Osteoporotic Fractures. Journal of Bone and Mineral Research 18(11):1947–1954.

Fosamax® is a registered trademark of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

Prolia® is a registered trademark of Amgen Inc.

New analysis looks at bone drug risks vs. benefits

risk-and-benefits-analysisWouldn’t it be valuable if there was one study to answer the important questions about bone drugs, including:

•    How effective are bisphosphonates?
•    How well do they actually work to prevent hip fractures?
•    What’s the possibility of harm from these bone drugs?

Now, there is one — thanks to researchers who conducted a detailed systematic analysis of clinical trials using bisphosphonate drugs to treat osteoporosis and prevent hip fractures.

Benefits vs. risks of bisphosphonates

Here are two striking numbers researchers discovered when looking at how bisphosphonates help or hurt the women who take them:

•   175 postmenopausal women with bone fragility had to be treated for three years to prevent one single hip fracture.
•    Treating 300 people with bisphosphonate drugs for three years will result in one person being harmed from serious side effects.

What’s more, researchers noted that hip fracture rates in developed countries are declining, yet sales of bisphosphonate drugs tripled between 2001 in 2008 and are forecast to exceed $11 billion in 2015. Also, while 80 is the average age at hip fracture, the evidence suggests no benefit from bisphosphonate bone drugs for this age group.

“Pharmacotherapy (for hip fracture prevention) can achieve at best a marginal reduction of hip fractures at the cost of unnecessary psychological harms, serious medical adverse events, and forgone opportunities to have greater impacts on the health of older people,” said Dr. Barbara Mintzes, one of the study authors.
I really appreciate that they took into account the psychological impacts of osteoporosis overdiagnosis, which is something I see often in my work.

Listen: The trouble with bisphosphonates

You can listen to Dr. Mintzes detail more about the research findings in the first 13 minutes of this interview that aired on Australian national radio titled “The trouble with bisphosphonates” here.

 

Reference:
Jarvinen, T.L., et al, Overdiagnosis of bone fragility in the quest to prevent hip fractures. BMJ 2015;350:h2088, 2015 May 26 (http://www.bmj.com/content/350/bmj.h2088)

Bisphosphonate bone drugs caught in compromising position

While you may not think to turn to The Journal of Clinical Endocrinology & Metabolismfor breaking scandals, I recently saw troubling news about bisphosphonate bone drugs that I believe deserves some big headlines.

JCEMA new study shows that the popular bone drug therapy — Fosamax, Actonel, Boniva and Reclast — actually blocks the effectiveness of two natural bone builders.

Specifically, a team of international researchers showed there’s a vicious circle effect when it comes to the relationship between nitrogen – bisphosphonates and the levels of coenzyme Q10 (CoQ10) and vitamin E. In the case of CoQ10, the drugs compromise the metabolic pathways essential for its synthesis, resulting in lower levels in those using drugs. Plus, researchers suggested that the lack of the needed CoQ10 places additional demands on vitamin E, resulting in significantly reduced levels of that key antioxidant too!

Vitamin E and CoQ10 are essential for bone health

If you don’t have the proper levels of CoQ10 and vitamin E in your body, here’s what your body is missing:

Benefits of vitamin E:

• Protects essential lipids from oxidative damage body-wide.
• Works synergistically with vitamin C for halting spinal bone loss in elderly women.
• Low levels are associated with osteoporosis and low spinal bone density in early postmenopausal women.
Benefits of CoQ10:
• Enhances immunity, and protects the heart and skeletal muscles.
• Known to play a key role in cellular energy production and is found in nearly all cell membranes.
• Works in conjunction with vitamin E to protect against free radical damage.
• Inhibits the development of osteoclast bone-breakdown cells.

Remember that my intention #4 for 2014 is Sharing the truth about bone drugs. The more you know about bone drugs, the more you are empowered to make the right decision for your individual situation.

 

References:

Kalyan, S, et al. Nitrogen – bisphosphonate therapy is linked to compromise coenzyme Q 10 and vitamin E status in postmenopausal women. Jr Clin Endocrin, Jan 13, 2014 me

Xu. Et al. Vitamin E Stimulates trabecular bone formation and alters epiphyseal cartilage morphometry. Calcif Tissue Int. 1995 Oct; 54(4):293-300.

Chuin A, et al., Effect of antioxidants combined resistance training on BMD in elderly women: A pilot study.Osteoporosis Int., 2009, Jul; (20 (7):1253-8

Mata-Granados JM, et al. Lower vitamin E serum levels are associated with osteoporosis in early postmenopausal women: a cross-sectional study, J Bone Miner Metab 2013, Mar 28

Moon, H-J, et al., Coenzyme Q10 regulates osteoclast and osteoblast differentiation. Jr of Food Science, Vol. 78, issue 5, May 2013: H785-H791. DOI:http://dx.dol.org/10.1210/jc.2013-3648 Moon, H-j et al. Antioxidants, like CQ 10, selenite and curcumin inhibit osteoclast differentiation by suppressing reactive oxygen species generation. Biochem and Biophys Res. Comm. Vol 418, issue 2, Feb 10, 2012:247-253.

 

You can try Dr. Brown’s comprehensive supplements in her at-home bone health program, developed with Women’s Health Network. Get her exclusive formulations along with her detailed lifestyle and diet guidance, plus telephone support whenever you need it. Learn more about the Better Bones programs.

We created the Better Bones 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.

New warning reminds us bone drugs aren’t “magic pills”

It’s no secret that I encourage each of you to look for life-supporting ways to enhance bone health — using bone drugs only when absolutely necessary. Bone drugs are not the broad solution that advertisements claim and I believe our bodies are capable of building and maintaining adequate bone strength without them. This is a key point of my Better Bones Manifesto which also holds that these medications disrupt the fabric of life and may lead to unwanted and even dangerous side effects.

These truths were recently reaffirmed when a physician friend forwarded a new safety warning sent to doctors by Genentech, USA, the manufacturer of Boniva, a popular bisphosphonate bone drug.

Labeled “IMPORTANT DRUG WARNING” in a large red box, doctors are advised that there have been “…cases of anaphylaxis, including fatal events” as a result of an immediate allergic reaction to the Boniva injection. Doctors are told that, when giving the Boniva injection, they should “…have available appropriate medical support and monitoring measures.” The warning goes on to note that while reactions are rare, physicians should be prepared.

Considering all side effects

While this particular warning concerns a rare case event, it underscores that bone drugs — given as an injection or in pill form — are certainly not wonder drugs. For example, as part of its communication to doctors, Genentech reminds doctors about other adverse reactions, which include atypical femur fractures, osteonecrosis of the jaw (ONJ), abdominal pain, hypertension, dyspepsia, arthralgia, nausea and diarrhea. Quite a list!

From a patient point of view, I believe that women with a history of severe allergy might do well to take note of the Boniva warning and discuss this matter with their physician. In regards to ANY medications, I strongly encourage you to be aware of their potential side effects and discuss them with your physician. Often — especially in the case of bone health — you have natural, life-supporting options. I am committed to helping you find them!

 

You can try Dr. Brown’s comprehensive supplements in her at-home bone health program, developed with Women’s Health Network. Get her exclusive formulations along with her detailed lifestyle and diet guidance, plus telephone support whenever you need it. Learn more about the Better Bones Package.

We created the Better Bones 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.

How big is the bang from osteoporosis drugs?

Answering the question “how big is the bang from osteoporosis drugs?” can be quite challenging.

One reason is that the statistical calculations are complex and highly manipulated making them difficult to understand. Another is that the subjects included in the drug studies are generally highly-selected and may not represent “real-world” populations.

Recently scientists took an important step to help us separate hype from reality in regard to the benefits of bone drugs.

Researchers asked if “real-world” patients taking bone drugs received the same fracture-reduction benefits seen in the clinical trials. After analysis of hundreds of studies, they found that highly compliant, “real world” patients on osteoporosis drugs experienced a 21% reduction in all clinical fractures. This compares to the 24% overall clinical fracture reduction experienced by subjects in osteoporosis drug clinical trials.

What a different messages than we often hear — such as how bone drugs reduce your chance of fracture by 50%! Or have you ever been told that the fracture reduction on bone drugs is really more like 21-24%? That is — if you use the drug faithfully.

Now compare this 21-24% fracture-reduction benefit from bone drugs to the studies documenting that those taking vitamin D in any dose (much less a therapeutic dose) experience a 23-26% reduction in fractures. It seems to me that the bang from osteoporosis drugs isn’t quite as big as we’ve been led to believe.

As your bone health advocate, I congratulate these researchers on the enormous effort to analyze and synthesize data from hundreds of studies. I also congratulate the drug company which funded this study for clarifying the real fracture/reduction benefit of today’s bone drugs.

 

References:

Wilkes, et al. 2010. “Bisphosphonates and osteoporotic fractures: a cross-design synthesis of results among compliant/persistent postmenopausal women in clinical practice versus randomized controlled trials.” Osteoporosis International 21:679-688

Bischoff-Ferrari, HA et al. 2005. Fracture prevention with vitamin D supplementation: A meta-analysis of randomized controlled trials. JAMA, 293(18): 2257-2264

 

You can try Dr. Brown’s comprehensive supplements in her at-home bone health program, developed with Women’s Health Network. Get her exclusive formulations along with her detailed lifestyle and diet guidance, plus telephone support whenever you need it. Learn more about the Better Bones Health Package.

We created the Better Bones 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.

A common-sense finding: vitamin D levels predict response to bone drugs

Over the last few weeks, two of my golfing buddies incidentally mentioned to me that their doctors took them off their bisphosphonate bone drugs because the drugs were not helping stabilize bone. No surprise there — if the drugs weren’t working, of course their doctors were right to stop the treatment. The interesting part was that right after going off the drugs, both of my friends had gained bone density.

Of course, my first question to both women was, “What changes did you make that could have helped you to build bone?” As I probably should have expected, both women reported that after being taken off the drugs, each of them had had their vitamin D levels tested for the very first time. Both women were found to be vitamin D deficient and had begun taking supplemental vitamin D on a regular basis… and that’s most likely the reason they built new bone.

It seems to defy common sense that vitamin D testing should come several years aftertreatment with bone drugs, but unfortunately my friends’ experience is typical. And it has a profound impact on how well the drugs work. New research by Carmel et al., released at the 2011 annual ASBMR meeting, reported that “[w]omen whose mean level of serum 25 hydroxy vitamin D (25[OH]D) was at least 33 ng/mL were almost five times more likely to benefit from bisphosphonates than those whose levels fell below that cutoff.” In other words, a sub-adequate level of vitamin D, defined as any level below 33 ng/mL, was directly correlated with failure of the drugs to provide a benefit.

Now, many doctors still consider vitamin D readings in the high 20’s or low 30’s to be adequate. Even more troubling, recent Institute of Medicine findings declared vitamin D levels of 20 ng/mL or greater to be adequate. But this research shows that at such low levels, bone has little or no ability to renew itself — even in the presence of powerful drugs that put a halt to osteoclast activity.

Ultimately, this study shows that everyone — even those on bone drugs! — needs trulyadequate vitamin D — that is, a level greater than 33 ng/mL — in order to absorb calcium and protect bone. It’s frustrating to realize just how long it has taken medical science to recognize this basic fact. Indeed, I would take this further and state that everyone also needs the full complement of all 20 key bone nutrients. How long it will take researchers to finally grasp the idea that our skeleton needs a full array of nutrients, just as does the entire body?

While we’re waiting for that day, you can find a world of knowledge on these 20 key bone nutrients on my BetterBones.com website. I encourage you to nourish your skeleton — it’s your foundation!

 

References:

Carmel, A., et al. 2011. The 25(OH)D level associated with a favorable response is >33 ng/mL. ASBMR Abstract 1137. Institute of Medicine (IOM) Dietary Reference Intakes for Calcium and Vitamin D. November 20, 2010. http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx

 

You can try Dr. Brown’s comprehensive supplements in her at-home bone health program, developed with Women’s Health Network. Get her exclusive formulations along with her detailed lifestyle and diet guidance, plus telephone support whenever you need it. Learn more about the Better Bones Health Package.

We created the Better Bones 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.

FDA looking into bisphosphonate safety? Well it’s about time!

As I was heading to Maine for the weekend last Friday, two advisory panels of the Food and Drug Administration (FDA) were looking at whether or not it’s safe to take bisphosphonates (such as Fosamax) for more than five years.

Just a mere 15 years after the drugs became common.

If you sense more than a little frustration in the statement above, you are right.  Here’s why:

• While I obviously believe it is important for the FDA to tell consumers about the very real dangers of these drugs, I have to ask what took them so long — so long that there are many women who have been taking a drug for more than 10 years without any study of the safety or the risk! In fact, one drug manufacturer is facing more than 1,500 lawsuits regarding jaw damage or unusual femur fractures and other bone injuries.

• What’s more, there’s a lot of confusion around the effectiveness of these drugs. Research data reported by bone specialists such as Dr. Susan M. Ott has shown the benefits of bisphosphonate drugs are far less than people have been told. Gillian Sanson, in her wonderful book The Myth of Osteoporosis, spells out all of the statistics that show how ineffective these drugs really are, but I want to quote her on just one: “If a woman has low bone density (osteopenia), but no previous fractures, her risk for fracture is low. Any treatment is at best going to marginally reduce an already low risk.It is estimated that up to 270 such women would need to be treated for three years to prevent one vertebral fracture in one of them.” (Sanson, 2011, p. 81-2).

• I also have to wonder where we’re going with this.  Does this mean that we’re going to wake the “sleeping monster” of even stronger drugs such as Prolia? Meaning — will doctors and the pharmaceutical industry cast it as a “new, safer drug” and just switch people to a new drug?

Now, there’s also very good news about the FDA investigation.  In particular, I want to celebrate:

• The news is getting out to more people than ever that bone drugs can cause serious side effects and weaken bone. This story is being reported in depth by ABC News, The New York Times, and other major news outlets.  The ABC News coverage, in particular, features stories of real women who have suffered serious consequences — including one who experienced a traumatic leg fracture after simply stepping off a curb.

• I believe the news is going to help women to become more empowered to return to a bone health strategy that makes sense — such as that of the Surgeon General’s “pyramid approach.” This approach says working with nature is the best way to promote bone health, followed by assessing and treating underlying causes affecting bone health. The last option recommended is the use of bone drugs.

I was hoping I would come back from my travels to put up a post that said that the FDA had see the light and was going to recommend limiting the length of time that any individual could take these drugs. But contrary to expectations, they didn’t do so — even though FDA’s own staffers, in a report issued Wednesday, stated that there appeared to be no benefit to continuing the use of bisphosphonates for more than five years.

It’s a shame the FDA finds itself unable to act in the best interests of both doctors and patients alike. What I had hoped was that the FDA would set this limit and help everyone give more serious thought to using bisphosphonates the way they should be used — as a temporary measure in cases of rapid and severe bone loss — and look to natural alternatives for healthy bone as a long-term solution for osteoporosis.

Of course, at the Center for Better Bones, we’ve been talking about the dangers of bone drugs and the better alternatives for years.  You can read more of my thoughts in my article What do I really think of bone drugs, anyway?

 

References:

Sanson, G. 2011. The Myth of Osteoporosis. Santa Barbara, CA: MCD Century Publications, LLC.

Wilson, D. 2011. F.D.A. to review safety of popular bone drugs. The New York Times, September 5, 2011. URL:http://www.nytimes.com/2011/09/06/health/06bone.html. (Accessed 09.09.2011)

Wilson, D. 2011. Stronger cautions backed on bone drugs for women. The New York Times, September 9, 2011. URL: http://www.nytimes.com/2011/09/10/business/fda-panels-back-sterner-language-on-bone-drugs.html. (Accessed 09.09.2011)

CDER. 2011. Background Document for Meeting of Advisory Committee for Reproductive Health Drugs and Drug Safety and Risk Management Advisory Committee. [Downloadable PDF] (Accessed 09.09.2011)