A look at osteoporosis

fosteoporosis-jpgNearly 45 million Americans are facing a major health threat. According to the National Osteoporosis Foundation, an estimated 10 million people living in the US today have osteoporosis, and an estimated 34 million are at risk due to low bone density. Further, while we think of osteoporosis as a “woman’s disease,” more than one quarter of the 45 million at risk are men.

Osteoporosis, characterized by low bone mass and structural deterioration of bone tissue, leads to bone fragility and an increased vulnerability to fractures, especially of the hip, spine, and wrist. Because there are few symptoms associated with bone loss, many are unaware that they have the disease.There are ways, however, to detect low bone density, but it is not always easy to predict who will actually suffer an osteoporotic fracture.

Bone density tests can measure bone concentration in various areas of the body, and markers of bone resorption can tell if you are likely losing bone at any given time. These tests can detect low bone density and high bone breakdown before a fracture occurs and thus help identify your chances of a future fracture. They cannot, however, predict who will fracture.

Given this, everyone, even those with good bone density, would do well to maintain a strong bone-building program. While there is no way to totally reverse osteoporosis, there are ways of preventing, halting, and treating it. Because the average woman has acquired 98 percent of her skeletal mass by age 20, building strong bones during childhood and teenage years is the first line of defense. Yet even into adulthood we can gain bone and as we age it is particularity important to consider prevention, causes, treatment, and possible risk factors of osteoporosis.

In contrast to osteopenia, osteoporosis indicates a higher degree of bone loss. You are said to be “osteoporotic” when your bone density is 2.5 standard deviations below that of the ideal young person of your same sex. This would mean that only a very small percentage of young people would have the same bone density as you. This also means that by the very nature of the statistical calculations, 1.5% of all healthy young women will have “osteoporosis.” The National Osteoporosis Foundation estimates that some 7.8 million American women are osteoporotic today, as well as some 2.3 million men.

 

 

 

The bone health hero: Mighty Mouse

albino rat isolated on white background

The L.A. Times has a feature that I just love. It’s called “Rodent of the Week” and it reports each week on new studies that come out featuring discoveries made by laboratory research on rats and mice.

Now, I know that animal experimentation is a touchy subject for some, but there’s no denying that mice play a big role in bone health research. NASA even sent some up on the last space shuttle mission so they could study — what else? — bone loss! The reason they’re so important is that mice go from infancy to old age in two years, giving scientists an excellent opportunity to see how the structure of their bones changes at different stages of life under different conditions. And what I’ve found when I look at mouse-based bone research is that a lot of the data that’s being collected supports many of the Better Bones perspectives. For instance, consider these three studies that were presented at the 2011 ASBMR Forum on Aging and Skeletal Health, held at the NIH:

Development of brittle bones in the aged is not just a matter of bone mineral loss, but is also caused by over-mineralization of, and loss of, the matrix of bone collagen and protein that forms the “living” part of bones. From the Better Bones perspective, this makes absolute sense. While researchers most often talk about the loss of bone mineral density as we age, by volume bone is half living protein collagen. When healthy and abundant, this living protein matrix gives flexibility to bone. When deficient or over-mineralized, it makes bone more fragile. Obtaining all the nutrients essential for healthy bone collagen is paramount to bone health as we age.

Adequate protein is essential for maintaining bone strength in the elderly.I’ve written about the need for balanced protein intake in articles and blog posts, and this study supports my contention that protein is an important nutrient for maintaining healthy bones. It’s a message that bears repeating, though because it’s estimated that up to 50% of elderly in the US have inadequate protein intake. Low protein directly worsens age-related loss of bone mass and bone strength, while these problems are positively influenced by supplementation with select amino acids (proteins). Adequate intake of protein should be a priority for all elderly persons, and amino acid supplementation used when the diet falls short of protein or when digestion is very weak.

Mechanical loading (exercise) builds bone strength, even in the aged. It has often been suggested that the skeleton lose its ability to respond to loading (exercise) with age. These authors’ mice studies have shown that the bones of mice across the lifespan, even in old age, are responsive to the effect of exercise. In other words, exercise will help to strengthen bone at any age. They did find, however, that the short-term response may be greater in younger mice, as observed by the rapid increase in bone volume upon loading in the youngest mice. To me, that means that while it’s possible to improve bone strength even into your 80s and 90s, it’s far better to start caring for your bones when you’re young and get greater “bang for your buck” — so it’s never too late or too early to think about bone health!

These are just three aspects of bone health toward which our small, furry friends have contributed data. There is undoubtedly a great deal more to follow — and not just from the mice sent up with Atlantis. I’m confident that much of what comes out of this research will confirm what I’ve been saying all along: the keys to strong bones are found in what we feed them (our bones, not the mice) and how we use them. Nutrition, exercise, and a mindful lifestyle make for strong, flexible bones even into extreme old age. (I wonder if anyone has ever taught a mouse how to meditate… hmmm…)

 

References:

Wynee, L et al., ASBMR, 2011 poster 4.

Isales, C., et al. The impact of dietary protein on bone mass and strength in the aging animal. ASBMR, 2011 poster 17.

Silva, M et al. Anabolic response of mice to mechanical loading during growth and maturation. ASBMR, 2011 poster 21.

 

How to work with your doctor to heal osteoporosis

When people come to me for a consult, one of the first steps I take is to get their medical history. As I’ve stated before, osteoporosis doesn’t happen in isolation — there’s always a reason for bone loss. If I see someone who’s losing bone at a rapid rate but doesn’t know why, I’ll encourage him or her to work with a physician to determine what’s causing the bone loss. In many instances, solving the hidden health issue puts an end to bone loss and helps to restore bone health more rapidly.

But working with a physician is challenging for some of my clients. Many of us grew up in an era where doctors were considered the unquestioned (and maybe unquestionable) authorities when it came to our health. And why not? It takes years of hard work and study to earn an MD or DO, and even once they have their degree, physicians keep studying and learning. Surely a doctor knows better how to handle a health issue than someone who doesn’t have that level of education… right?

While it’s true that medical professionals dedicate a great deal of time and energy to understanding how to treat diseases of the body, it defies common sense that any health professional, no matter how caring or dedicated, should be “in charge” of the decisions affecting a patient’s day-to-day health. Doctors aren’t mind readers; without a patient’s input, they can’t possibly know what their patients consider acceptable (or unacceptable) when it comes to health. I find that when clients work with their practitioners, the partnership between doctor and patient is often productive. But it’s important to realize that what the doctor does — treating the illness — is not the same as healing the patient. A doctor may suggest treatments, but is up to the patient to decide if the treatment is something they want to try as part of their healing process — and it’s also the patient’s responsibility to speak up if they don’t like what’s being offered.

I know this isn’t always easy. Not only are some people reluctant to speak up — physicians can be intimidating for those used to following “doctor’s orders” — but they may feel as though they lack sufficient information to make a decision. But what I tell my clients is, if you don’t feel you know enough to make an informed decision, then don’t make the decision until you do know enough.

Now, sometimes even well-informed patients encounter closed-minded resistance to their suggestions and input. I had one client who, after experiencing a nasty leg fracture, asked her doctor to perform some of the medical tests for osteoporosis that I commonly suggest, only to have her request dismissed. She was told, “You don’t need all these tests,” and when she tried to explain that she believed that they might uncover the reason for her weak bones, the doctor responded, “Who’s driving this bus, anyway?”

I see this sort of thing too often to be surprised by it, but the reality is that the patient, not the doctor, “drives the bus.” To her credit, my client was not happy with her doctor’s attitude, so she went and got a second opinion. When she told the new practitioner what the first had said, she got a much better answer. “Well, of course you’re the driver,” said the physician. “I’m really more like a tour guide.”

I always urge clients who encounter such obstacles to keep one thing firmly in mind: YOU are in the driver’s seat. If you have a “tour guide” who insists on taking the wheel from you, or who tries to guide you in a direction you believe to be wrong for your health, listen to your inner voice and put on the brakes! As the driver, you are responsible for what direction you take, and how fast you travel. It’s your journey — so don’t let anyone send you somewhere you don’t want to go.

 

 

My New Year’s wish list — 10 wishes for better bones in 2011

image[1]Last year I inaugurated my first annual Natural Bone Health Crystal Ball Reading, and I’m happy to say that some of my predictions came true in 2010. But this year when I sat down to write my predictions, I realized they were really more like wishes.

If all of my wishes could come true in 2011, the number of people diagnosed with osteoporosis and those suffering from debilitating fractures would certainly plummet. Even if two or three of my hopes for Better Bones in the new year could come to life, we’d all be much better off.

So, here we go. I’m sending them off into the universe with a few taps from my magic wand, in hopes that we’ll all see stronger bones and happier, healthier people in 2011. So send my bone health wish list around and share it with friends and family. Our Bone Health Revolution is only beginning.

My 2011 wish list

1. Women all over this country will gain increasing confidence in their bone health.
Not so easily frightened by a low bone density reading, women will ask two vital questions before taking bone drugs: (1) Am I really at high risk of fracture? and (2) What can I do to naturally increase the strength of my skeleton?

2. People in their 30s will begin osteoporosis prevention programs.
Can word trickle down to younger generations that bone loss begins much earlier than expected (in the 20’s and early 30’s), so that wise people can take note and take action?

3. This proverb will be scientifically validated:  A merry heart is like a medicine, but a broken spirit dryeth the bones.
Scientists will document with hard data that happiness and a general feeling of well-being are two of the most important factors influencing bone health.

4. Multi-nutrient therapy will become the rule rather than the exception.
Physicians and the general public at large will become aware of the role many nutrients (not just calcium and vitamin D) play in bone health.  Those looking to build bone strength naturally and even those given bone drugs will be told to supplement with the full 20 bone-building nutrients.

5. The 2010 RDA’s for Vitamin D will be found woefully deficient and readjusted upwards.
What if the new pertinent studies on vitamin D hadn’t been ignored and had been included in the current RDA calculation? Let’s hope for a congressional investigation and a change for the better because vitamin D is crucial on every level.

6. The link between osteoporosis and heart health will become clarified.
Noting that those with osteoporosis are at a higher risk for heart disease, researchers will stumble onto the fact that low levels of vitamin K link these two disorders.  The news will spread that vitamin K not only strengthens bone, but also helps protect those with osteoporosis from arterial calcification.

7. Testing for the causes of osteoporosis will become commonplace.
Wouldn’t it be wonderful if it was considered good medicine to test for the causes of bone loss before prescribing osteoporosis medications?  Canadian health officials now make this recommendation. Here’s hoping that the U.S. follows suit!

8. Exercise will be shown to be more effective than bone drug therapy.
I’m hoping for a comprehensive review of all existing research on exercise and bone health.  This analysis would reveal the long-overlooked power of exercise to naturally strengthen bone as well — or better — than any drug therapy without any negative side effects.

9. Bones are discovered to be “endocrine organs.”
The news will spread that our bones secrete powerful chemical messengers known as hormones, making them endocrine organs. These bone hormones will be found to play important roles in many parts of the body and, as such, natural bone health will take on even greater importance.

10. The use of bone drugs will be restricted to only those at high risk of fracture.
Realizing all the side effects of bone drugs, U.S. physicians will stop prescribing osteoporosis drugs for individuals at low or moderate risk of fracture and point to theU.S. Surgeon General’s recommendations of starting with nutrition and lifestyle modifications first.

I hope you find joy and good fortune in 2011 — and that all of your wishes come true.

 

Our neighbors to the north take the lead!

Recent changes to Osteoporosis Canada’s 2010 Clinical Practice Guidelines mean that deciding who needs a bone medication will now depend on a multi-factorial fracture risk assessment, rather than on simple bone density testing. Canadian doctors will be looking at previous fractures, family history, alcohol use, smoking, and other factors including a physical exam to assess who needs bone medication. And doesn’t this make good sense? It is well documented that having multiple risk factors is a much more powerful predictor of fracture than low bone density.

What this means is that fewer women in Canada are being classified as being at “high risk” of fracture and more are classified as being at “low” or “moderate” risk, as reported recently in the Annals of Internal Medicine. This is important because those at “high risk” of fracture are the most appropriate candidates for bone drugs. For lower risk patients, alternatives like exercise, fall prevention, and calcium and vitamin D supplementation are suggested. The end result is that fewer Canadian women will be told to take osteoporosis medications.

The move away from using bone drugs for low and moderate risk individuals is a progressive policy step I applaud. Over the years, I have noticed that Canadian osteoporosis agencies have taken a commendable science-based, public-interest approach to the burden of needless fragility fractures. Now, once again, our neighbors to the north take the lead — this time in the implementation of a more rational way to decide who should be given drugs for their bones.

I also congratulate Osteoporosis Canada for recommending physicians conduct biochemical testing on those at risk of fracture — the very similar medical osteoporosis work-up I have been recommending that doctors do for some time. This kind of testing allows us to get at the root of bone loss, rather than simply covering it up with a drug.

Hail Canada — thanks for leading the way, again!

 

References:

Leslie, WD, Morin, S, & Lix, LM. 2010. A before-and-after study of fracture risk reporting and osteoporosis treatment initiation. Ann Internal Med, 153(9):580-586.

Papaioannou, A, Morin, S, Cheung, AM, et al. 2010. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: Summary. CMAJ, early release online, Oct. 12, DOI:10.1503/cmaj.100771

 

Down to the bone injustice — not just for women

The “osteoporosis scare” is no longer just for women. Here at the Center for Better Bones, we are seeing an increasing number of men who are being directed to take osteoporosis drugs without any investigation to see if the person is actually at risk for fracture. Take the case of Frank, with whom I spoke today.

Frank’s case:

Frank describes himself as a man “going on 88″ who is very physically active. He is 5’6” tall and now weighs 140 pounds, having lost 20 pounds since his wife died eight months ago. A month ago, Frank’s doctor asked him to have a bone density test, even though he had no obvious fracture risk factors, aside from his age. He had never fractured anything, had no history of fracture in his family, is not particularly thin, and was not using medications that might damage bone.  All in all, Frank was at low risk for fracture.  In fact, he had excellent bones despite being well beyond the average age for a hip fracture (80 years of age).

Frank agreed to the bone density test and was told that his spine was at T -1.30 (barely in the osteopenia range), his wrist was T 0.57 (above the average for a young person), but his hip was osteoporotic at T -3.4.  Immediately, he was instructed to take Fosamax, without any attempt to look for the causes of Frank’s low hip bone density.

Although his doctor did not order any additional tests, Frank took it upon himself to test his vitamin D levels independently. As for the Fosamax, Frank — who already suffers from acid reflux, and who uses no drugs at all — simply refused to use the drug. Although he was thrown into the “osteoporosis scare,” he was sure enough of himself to know that he did not want bone medication.  Instead, he called The Center for Better Bones to ask for our input.

The Better Bones, Better Body Solution

Here are the action items I suggested for Frank:

1. Frank should get a copy of his bone density test to see exactly what the result of this single BMD test was.

2. Frank should ask the doctor for an opinion on why the hip bone density is osteoporotic, when Frank’s other bones are much denser.

3. It would be wise for Frank to remind the doctor of his acid reflux condition, and also to re-state his desire to follow natural treatment path rather than moving into pharmaceutical therapy.

4.  Finally, Frank should ask his doctor to conduct a complete medical workup for osteoporosis. Such medical testing would uncover (a)  if there is any hidden medical cause for Frank’s low hip bone density, and (b) whether the bone loss is ongoing or something that occurred many years ago that has now stabilized.

In the past, it seemed the push toward bone drugs was primarily focused on women. Because osteoporosis was rare in men, the cause of bone loss was investigated before drugs were prescribed. But now both women and men would do well to become informed and pro-active about their bones and seek out the cause of bone loss before filling a prescription. There are often more natural steps you can take to stop bone loss and even build bone. Follow Frank’s path and become your own best advocate!

Nothing comes from nothing—rethinking “primary osteoporosis”

When osteoporosis is diagnosed in men, a great effort is made to uncover the causes of the excessive bone loss. In fact, most male osteoporosis is considered to have a secondary cause, that is, to be caused by something, whether it’s a disorder like celiac disease, the use of various medications, or habits such as smoking, etc. Most osteoporosis in women, however, is simply considered a normal development due to menopause or advancing age. However, outside of the Western world, women don’t necessarily develop osteoporosis as a matter of course — and that says it’s not normal.

We at the Center for Better Bones have come to challenge this distinction between what scientists call “primary” and “secondary” osteoporosis. Our work leads us to suggest that all osteoporosis is indeed caused by something, and in this sense, all osteoporosis is secondary to something else. For example, the American College of Rheumatology has estimated that 20% of all osteoporosis in the US is due to use of steroid medications. Other researchers have suggested that 20% of all hip fractures are related to smoking. The use of acid-blocking drugs has been shown to double fracture rates. Some studies suggest that almost 20% of those with osteoporosis have the disorder caused or worsened by an excessive loss of calcium in the urine. Vitamin D inadequacy could be causing half or more of all osteoporosis, and so forth.

The reasons why someone may develop osteoporosis are many and varied, including undiagnosed medical problems or unhealthy lifestyle issues, such as smoking, acidic diet, etc. But if you can pinpoint out why you’re losing bone, there may be some way to halt your bone loss and perhaps even restore your bones to health. Lifestyle issues are easy to spot; undiagnosed medical issues take a bit more work.

I always tell my clients, “Take heart, and take action.” If you are losing bone but don’t know why (or if you’ve been told that your bone loss is “normal” or “expected” for someone of your age and gender), then it’s time to find some answers. I encourage you to review my article on secondary osteoporosis so that you understand — and maybe recognize — some of the hidden sources of bone loss that might be affecting you.

 

A needless osteoporosis scare

Occasionally I like to share some of the interesting bone health cases I see at the Center for Better Bones. As the one-liner goes, “We should learn from the mistakes of others because we don’t have time to make all of them ourselves.” We can also learn from the wise choices of others. In this case, Marie made wise choices worth emulating.

Many people come to me because they appear to have a high risk of fracture, and others see me because they have “established” osteoporosis (the term for those who have already experienced a low-trauma fracture). A significant number of the cases I see, however, are individuals who have fallen prey to what I call “the great osteoporosis scare.” These individuals have been told they have excess bone loss, that they are at great risk of fracture, and that they must begin taking osteoporosis drugs immediately. If they do not, it is implied — or even directly stated! — that they will suffer painful, debilitating bone fractures.

Marie came into my office recently with an obvious case of “osteoporosis scare.” In her 50s, Marie was a health-conscious, health-savvy individual who tended to seek and repair the cause of any health issue rather than turn to symptom-suppressing medications. A few weeks earlier, Marie was totally thrown off when her doctor emphatically insisted she begin osteoporosis medications — even though she only had osteopenia, had never fractured, and at age 54 had a higher bone density than she’d had at age 49. Stunned, she came to me for a second opinion. After reviewing her case, I saw that she was at very low risk of fracture and that she, like the vast majority of middle-aged women with osteopenia, did not need and would not benefit from osteoporosis medications.

After our consultation, Marie came out of my office amazed that she had fallen for the “osteoporosis scare,” yet pleased that she had had the wisdom to seek a second opinion. Also, she was appreciative that she now knew how to better nourish and monitor her bone health, beginning with the correction of her vitamin D inadequacy right on up to supplementation with all 20 key bone nutrients and the development of an Alkaline for Life® eating program.

So what is the take home message? For me, Marie’s case serves as a reminder that we should all follow our own instincts and become our own health advocates. As well-intended as your health professional may be, he or she generally does not have time to either fully assess your individual case or to critically “rethink” osteoporosis and your real fracture risk. Should your inner wisdom speak up, it’s up to you to become informed, seek that “second opinion,” and become an advocate for yourself.

 

Take heart and take action — that’s the take home message as I see it!

 

Those scary osteoporosis statistics – are they for real?

Many of the clients we see at the Center for Better Bones come to us because they’re scared — especially the women. They’ve been told that they’re at high risk for bone loss, and they fear that they will become “one out of every two women … over 50 [who] will have an osteoporosis-related fracture in their lifetime.” These women picture themselves with a broken hip, wheelchair-bound, or bed-ridden for weeks and months, unable to walk or drive or even care for themselves. I talk to women who are afraid to do even simple tasks like lifting groceries or walking down a flight of stairs for fear of fracture. I don’t blame them — who wouldn’t be frightened by the idea that debilitation and loss of independence are just a coin-toss away?

In fact, these statistics that sound so scary leave out a lot of information that we all need to know if we’re to get an accurate sense of how likely such an injury really is.

I took some time recently to look at the three statistics that are batted around most often:

1. One out of two women over 50 will suffer an osteoporosis-related fracture in her lifetime.

2. In women ages 50 to 59, 58% have low bone mass, and this percentage increases as we age.

3. Osteoporosis causes 1.5 million fractures every year in the US.

All of these figures are superficially true — but when you look at what the data really tell us, they’re pretty meaningless for determining what an individual person’s fracture risk might be. Does every second or even third woman in her 50’s land in the hospital with a broken hip or other serious osteoporotic fracture? Of course not. Do more than half of all women in their 50s have low bone mass? Well, that depends on what you consider to be “low,” doesn’t it? And does osteoporosis truly cause 1.5 million fractures? Possibly… but now ask whether those fractures are debilitating, or painful, or even noticeable to most people, and you’ll probably find that the majority are not.

I’ve spelled out the reality behind these statistics in a new article I hope to post on the site soon [update: the article is now posted here]. In the meantime, I hope that you take these (and other) scary statistics with a huge grain of salt and try to get a realistic sense of what your risk factors are, and then see what you can do to reduce your risk. We’ve been doing that at the Center for Better Bones without drugs for over 25 years. We take the position that statistics aren’t very useful when it comes to the health of an individual person — everyone is unique, and the risk factors that will (or won’t!) affect their bone health have to be taken case by case.

 

References:

National Institutes of Health. 2007. Fact sheet. Osteoporosis. URL (PDF): http://www.nih.gov/about/researchresultsforthepublic/Osteoporosis.pdf (accessed 10.12.2009).

International Osteoporosis Foundation. [No date of publication listed.] Facts and statistics about osteoporosis and its impact. URL: http://www.iofbonehealth.org/facts-and-statistics.html (accessed 10.12.2009).

 

Are Asians at higher risk for osteoporosis?

Does being Asian-American really increase your risk of fracture? Being “Asian or Asian-American” always figured high on the standard list of osteoporosis risk factors. So naturally, one is led to think that Asians and Asian-Americans are at high risk for osteoporotic fracture—particularly Asian-American women who are in or past menopause.

When we actually look at the fracture statistics, however, we find that postmenopausal Asian-American women have the lowest fracture rate of women in any US ethnic group. In a study of nearly 200,000 women, Asian-Americans were found to experience one-third the osteoporotic fractures of Caucasian and Hispanic women, and they even fractured much less than Native American and African-American women.

So, why is being Asian-American always listed as a big risk factor for osteoporosis? This is because Asian-Americans are generally thinner and have lower bone density than other ethnic groups. Yet the study shows that although they have lower bone density, they still fracture much, much less often.

This interesting paradox supports my long-standing position that bone mineral density is not a good predictor of fracture risk. As I have been saying for years now, many factors influence fracture risk, not just bone density. In fact, over half of all women who fracture do not have very low bone density.

To learn about the variety of risk factors contributing to osteoporotic fracture, take a look at my article, Rethinking the Causes of Osteoporosis.

 

Reference:

Barrett-Conner, E. et al. 2005. Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res, 20(2):185-194.