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Rethinking osteoporosis

Drug treatments for osteoporosis and osteopenia: Do you really need them?

by Dr. Susan E. Brown, PhD

• Effects of bone drugs on the body
• How do bone drugs work?
• Natural alternatives for healthy bones

If you’ve turned on the TV lately, leafed through a magazine, or surfed the internet, you’ve likely seen an advertisement warning you about bone loss and osteoporosis risk. And the ad most likely recommends a certain medication to prevent it. It’s true that more people are being diagnosed with osteoporosis today than in the past, but many people want to know if they really need to take Boniva, Forteo, Prolia, or some other prescription medication to strengthen their bones.

For the vast majority of people, my answer would be “no.” I don’t want to give the impression that I think these drugs should never be used, because there are circumstances where they’re appropriate — but for most osteoporosis cases, taking a prescription medication is not needed (and for most people with osteopenia, I don’t think medication is needed at all!). Osteoporosis and osteopenia medications are big business, but despite all the hype and marketing from drug companies, there is a safer, more effective and natural approach to bone health available to you.

How should osteoporosis be treated?

My basic philosophy is that we should work with Nature and with the body’s own healing capabilities. Osteoporosis happens for a reason, and it’s important for us to find that reason and correct it if we’re to stop bone loss. For a great many people, the first place to look for the culprit causing bone loss are these five factors:

• Inadequate nutrition, which can cause the body to tap into the bones to retrieve needed minerals, particularly calcium
• An acid-forming diet, which triggers the body to call for the release of buffering mineral compounds from the bones — mainly calcium again
• Chronic stress, which similarly increases the body’s acid load (and keep in mind, this can be physiologic stress — as occurs during the menopause transition for women — as well as emotional or mental stress)
• Lack of weight-bearing exercise, which the bones need to trigger activity in bone-building osteoblasts
• Low levels of specific nutrients, such as vitamin D, vitamin K2, magnesium and manganese, all of which are central to bone formation.

It’s also important to look for pathological causes, as a great many diseases and disorders can contribute to bone loss (my article on Rethinking “primary” osteoporosis discusses these causes in much greater detail.)

And I’m not alone in this thinking — the Surgeon General of the United States issued treatment guidelines in 2004 that stated that improvements to dietary and exercise habits, followed by investigation of potential causes of bone loss, were the first two steps a physician should recommend to any patient with osteoporosis and osteopenia. Unfortunately, these guidelines are infrequently followed — it’s simply a whole lot easier to prescribe a medication than to motivate a patient to change some very basic lifestyle factors. But in taking the easier path, physicians who bypass the Surgeon General’s recommendations (assuming they’re even aware of them) are offering patients a sledgehammer to pound in a screw — when a screwdriver would do the job better, and with less overall damage!

What are the effects of popular bone drugs?

Here’s the problem. Bone drugs, just like all drugs, have side effects. They aren’t targeted just at bone — they affect other tissues as well. And sometimes, they affect these other tissues in ways that are quite worrisome and harmful, particularly when taken for long periods of time. Here are just two examples:

• Bisphosphonate drugs, which have been prescribed for many years, halt bone breakdown in the short term, but after about a year they also halt bone building as well, leading to brittle bones that may be more susceptible to fracture, not less. We’ve learned that just because bones may look denser on a bone scan, it doesn’t necessarily mean they are stronger. At the same time, bisphosphonates promote acid reflux and related esophageal problems, possibly including esophageal cancer.
• Denosumab (Prolia), targets the RANK ligand, a protein that is crucial to the development of osteoclast cells. Without it, these cells don’t develop, so it reduces bone resorption — but RANKL is also expressed by cells in the gut epithelium and by T-cells, which are important immune system cells. Prolia can’t distinguish between RANKL in bone versus RANKL on a T-cell or epithelial cell — so what happens when it’s suppressed throughout the body? (Right now, no one knows the answer to that — the drug is still too new.)

My point in highlighting these examples is that if you’re trying to address an imbalance in bones, it seems sensible to do so without creating even greater imbalances in the body. (In the table below, I give a short summary of the best-known bone drugs on the market today.)

I understand that some people may need medication for serious bone disorders. What I often tell my clients is “You want to pull the parachute if you are falling out of the airplane, but it isn’t a great idea to pull the parachute if you are still inside the airplane.” My point is than you should only use bone drugs only when necessary. If you’re concerned about falling off a six-inch log, what makes sense is a pillow, not a parachute! So for those who are in otherwise good health but have experienced bone loss because of menopause, vitamin D deficiency, or for some other reason, it’s worth taking the time to figure out what you really need to cushion your fall before you decide to grab that parachute.

What you can do to promote natural bone health

I would also argue that it doesn’t hurt to have a pillow along with your parachute. So even if you make the decision to take medication for your bones, please try to incorporate my Better Bones Program along with your prescription.

Look closely at your risk. Have an honest discussion with your healthcare provider about what your risks truly are for fracturing. Check out our comprehensive Fracture Risk & Bone Health Profile tool to get a better sense of your 10-year fracture risk.

Eat an alkaline-forming diet. Acid-forming diets are one of the most significant problems in our culture when it comes to osteoporosis. This kind of diet can upset the biochemistry of our bodies and leads to a low-grade metabolic acidosis. A diet composed largely of fresh vegetables, nuts, seeds, fruits, and adequate (but not excessive) proteins helps to keep buffering minerals in the bones where they belong. Try to avoid processed foods, white flours, caffeine, and refined sugars. To learn more, read my article on pH balance and bone, or look for my book The Acid-Alkaline Food Guide for guidance.

Provide your body with specific bone-building nutrients. Even if you have a perfect diet, you may not be providing your bones with the full nutrition they need. There are many key bone-building nutrients with which we can supplement for improved bone health, not the least of which are vitamin D and vitamin K. Appropriate-dose vitamin D, in particular, has been shown to reduce fractures as much or even more than the drug therapies. You might consider a quality bone-building supplement, like the one we offer in the Women to Women Personal Program for Better Bones. See our article on the 20 key nutrients for more information on specific vitamins and minerals that aid in bone growth.

Generate stronger bone with exercise. Our bones respond to the demands we place on them. Any form of exercise can help halt bone loss through building muscle, and extensive strength training can build bone significantly as it builds muscle. Take more walks, enroll in a yoga class, or meet with a personal trainer at your local gym. There are loads of ways to include more exercise in your life. Remember that our bodies were meant to move and as we build muscle we build bone!

Prevent falls to live long. People may live for many decades with osteoporosis and never know it if they don’t fracture. One natural alternative to drug therapy is simply avoiding fracture by taking steps to prevent falls or diminishing their impact. You can enhance your balance markedly by practicing yoga, t’ai chi, or qi gong. Remove your throw rugs to avoid tripping, or possibly wear hip protection. There are virtually no side effects to these simple measures, and they have helped many avoid the complications associated with fracturing a bone.

Minimize your stress. Chronic stress takes a huge toll on our health. Not just the day-to-day stress of modern life, but issues from the past can also manifest themselves in new places in our lives. Cortisol, our major stress hormone, can be extremely detrimental to bone and other organs in the body if it remains at high levels ‘round-the-clock — more common than most realize! Be good to yourself, and seek help if you need it or simply give yourself more breaks — whether it’s a monthly massage or simply reading alone on the couch for an hour, do whatever you can to lower your cortisol.

You have choices about bone health

There is a lot of fear and anxiety around an osteoporosis or osteopenia diagnosis. Our instinct is to try and “fix” the problem immediately, and for many, this means taking a prescription bone drug. Know that your body is capable of building and strengthening bone on its own when given the needed support and time to do so. In the end, the choice is yours. Just remember that you have options when it comes to improving the health of your bones. The prescriptions advertised on television may sound and look enticing, but the benefits are often exaggerated. There is a better way to healthy bones — and we’re here to help you find it

To learn more on the topic of osteoporosis and bone loss, read our additional articles here:

• Top 10 myths about osteoporosis
• About the diagnosis of osteoporosis
• Causes of osteoporosis
• Risks versus benefits of osteoporosis drugs
• Natural approach to osteoporosis

Our Personal Program is a great place to start

At the Center for Better Bones we promote an all-natural approach to bone regeneration and repair that includes nutrition, diet, exercise, and lifestyle guidance. Our Personal Program is a convenient, at-home version of this approach.

• Visit the Women to Women website to learn more about the Personal Program for Better Bones, the at-home version of our natural approach to bone health.
• Take our free, on-line Fracture Risk and Bone Health Profile to assess your risk of fracture and learn about the health of your bones.
• Learn how to set up a personal consultation with Dr. Susan E. Brown, PhD, at the Center for Better Bones in East Syracuse, NY, or by telephone.

Questions about the Personal Program for Better Bones? Call toll-free at 1-877-200-1269.

Original Publication Date: 01/01/2009
Last Modified: 06/30/2011
Principal Author: Dr. Susan E. Brown, PhD