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.
Barrett-Conner, E. et al. 2005. Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res, 20(2):185-194.
My recent blog on the bone-building action of prunes drew a lot of attention and generated several interesting follow-up questions. Let me answer your questions as best I can.
Q. Wouldn’t eating 9-10 prunes a day cause diarrhea and/or gas?
A. As we well know, prunes have a laxative effect. The studies using 9-10 prunes a day, however, found that if people introduce the prunes slowly, taking a few to start and adding more over time, they do not experience excessively loose stools. Also, at the Center for Better Bones we find that soaking or lightly cooking the prunes also helps improve their digestibility, as does eating them warmed a bit, if necessary. Another tip is to spread your prunes out over at least 2 meals. Incidentally, prunes make a tasty dessert or sweet addition to hot cereal.
Q. Will eating all these prunes each day cause me to gain weight?
A. As it appears, consuming prunes did not cause weight gain and, in fact, prune researcher, Dr. Bahram Arjmandi specifically addresses this question, suggesting that prunes are so satisfying that they can actually aid in weight control. Also, recent work at the San Diego State University found snacking on prunes twice a day curbed the appetite while improving blood lipids, which actually aids weight management.
Q. I try to keep my blood sugar under control. Wouldn’t eating these prunes harm my blood sugar?
A. As Dr. Arjmandi reports, “Because prunes are low on the glycemic scale, they should not be a problem for people with diabetes.”
Q. Does drinking prune juice have the same effect as eating prunes?
A. All of the research I have found uses whole prunes, so I have to say that we simply do not know if prune juice would have the same bone-building impact.
Q. You list prunes as being an “acid-forming food.” So how can they help bones?
A. We have to remember that foods have many qualities, and not all acid-forming foods are bad for bones. In fact, protein is acid forming and yet adequate protein is essential for optimum bone health. Although prunes are slightly acid-forming, they contain phenolic and flavonoid plant compounds, which increase bone growth factors, so overall their impact on bone is very positive.
In April 2008 the U.S. National Osteoporosis Foundation published its new criteria for osteoporosis treatment, “Clinician’s Guide to Prevention and Treatment of Osteoporosis.” This handbook sets forth their official suggestions for treatment, which basically boil down to two sets of criteria for determining if a person should be given osteoporosis drugs. One criterion is based on bone density alone; the other concerns the assessment of fracture risk based on multiple risk factors other than bone density.
The guidelines were designed to help doctors determine who to treat and were well intended, but I can’t help but ask, “What do they mean?” What do these new NOF guidelines mean for women (the majority of osteoporosis patients), and just how many women would be treated with osteoporosis drugs if these guidelines were followed by doctors around the country?
Interestingly enough these same questions were asked by researchers from the noted U.S. Study of Osteoporotic Fractures. The answer they came up with is quite astounding. Applying these new criteria to women in the large, representative Study of Osteoporotic Fractures these researchers calculate that at least 72% of white women aged 65 and older, and 93% of women aged 75 and over, would be told to take osteoporosis drugs.
To me this is startling and rather frightening. First, as reported by the U.S. Surgeon General, only 17% of white women aged 50 older will experience a hip fracture in their life; 15% a vertebral fracture, and 16% a forearm fracture. Second, the side effects of these drugs are well noted and substantial — and they would be recommend to the vast majority of older Caucasian women. Third, I am perplexed at such a strong focus on drug therapy these days when science is now documenting the many life-supporting ways we can both prevent osteoporotic fracture and at the same time build better overall health. For example, many researchers, myself included, estimate that nearly half of all osteoporotic fractures could be prevented with adequate vitamin D supplementation with even greater results possible if all the key 20 bone-building nutrients were consumed in adequate amounts.
If you are interested in avoiding the risks of osteoporosis drug therapy, know that there are science-based, natural alternatives, and I am happy to share these with you. You can start by assessing your fracture risk through our simple fracture risk and bone health profile.
Wishing you all Better Bones and a Better Body.
Donaldson, MG et al. Estimates of the proportion of older white women who would be recommended for pharmacological treatment by the new U. S. National Osteoporosis Foundation Guidelines. J Bone Mineral Res 2009; 24 (4): 675-674.
U.S. Surgeon General. Bone Health and Osteoporosis: A Report of the Surgeon General. U.S. Dept of Health and Human Services, Rockville, MD, 2004.