The fracture risk tool known as FRAX has come under fire from the World Health Organization (WHO) recently for several reasons. One key reason is that, although it’s often referred to as the “WHO FRAX tool” and was developed at a WHO “collaborating center” at Sheffield University, the FRAX fracture risk tool was not developed, evaluated, endorsed, or validated by WHO itself (Ford et al., 2016).
In fact, WHO’s health policy organization has no access to the algorithms, coefficients, or underlying data on which the FRAX tool was developed (nor does anyone else, for that matter!).
FRAX uses these risk factors
The only thing we know about how FRAX works are the risk factors they use in making the prediction:
- Personal history of fracture
- Family history of hip fracture
- Corticosteroid use
- Rheumatoid arthritis
- Secondary causes of osteoporosis
- Heavy alcohol use
What FRAX doesn’t do
All of these are factors that affect osteoporosis risk, but they’re far from a complete picture. Among the more glaring omissions: FRAX gathers no data on intake of bone-building nutrients like calcium, vitamin D, vitamin K, and magnesium — all widely known to be vital to bone health — and it does not ask women about their menopause status. Given the fact that menopause looms large in determining a woman’s bone density (which is part of the data they ask for), that’s a pretty serious oversight!
Even more telling is the fact that the FRAX risk assessments are used as a basis of a recommendation for bone drugs. Keeping in mind that the tool has not been evaluated or endorsed by the WHO, the world’s premier health policy-making body, you have to wonder what the basis of a recommendation might be that omits so many key risk factors.
It may become clearer once you know that the FRAX was developed by researchers with vested interests in drug therapies for osteoporosis — a bias that encourages overtreatment of women concerned about their bone health. In fact, well respected osteoporosis researchers determined that if the FRAX criteria, which are endorsed by the U.S. National Osteoporosis Foundation, were applied universally, almost 75% of U.S. Caucasian women 65 or over and a staggering 93% of those 75 or older would be candidates for osteoporosis drug treatment.
For these reasons, I tell my clients and readers, “consider the source” of the information coming from this tool. You may want to try my simple but reliable Bone Health Profile to assess the health of your bones and your potential risk of fracture.
Ford N., Norris S.L., Hill S.R. Clarifying WHO’s position on the FRAX® tool for fracture prediction. Bull World Health Organ 2016;94:862 | doi: http://dx.doi.org/10.2471/BLT.16.188532
I fondly recall my grandmother’s homemade blackstrap molasses cookies and her molasses sweetened, old fashioned, baked beans. If you feel like indulging your sweet tooth, you can skip the refined sugar, sucrose, dextrose, corn syrup and fructose.
A better way to add a little sweetness — along with the big nutrient benefits — is to use blackstrap molasses. See some of my favorite ideas below.
What is blackstrap molasses?
Blackstrap molasses is the thick dark syrup — full of alkalizing, bone-building trace minerals — left after the third boiling in the sugar refining process.
Nutrients in blackstrap molasses
Blackstrap molasses is rich in many key bone nutrients such as calcium, magnesium, potassium, iron, and even the hard to get trace mineral manganese. Some reports suggest you only need two teaspoons of blackstrap molasses to get 18% of the recommended daily value for manganese.
Manganese plays a special role in bone cartilage and bone collagen formation and is required for bone mineralization. In one study, women with osteoporosis were found to have ¼ the manganese levels of the women who didn’t have osteoporosis.
Compare the nutrients in blackstrap molasses to table sugar
|Nutrient Content per 1 Tablespoon|
|Nutrient||Blackstrap Molasses (organic unsulfured)||Table Sugar|
|Manganese, Zinc, Copper, Selenium, Chromium||Trace amounts||none|
Table Reference: U.S. Dept of Agriculture, USDA Branded Food Products Database, Jan. 2017
Molasses spice cookie recipe
(Makes 24 cookies)
3 Tbsp water
1 Tbsp ground flaxseed
2 C light spelt flour (or gluten-free baking mix)
2 tsp baking soda
1 tsp ground cinnamon
1 tsp ground ginger
½ tsp ground cloves
1/8 tsp sea salt
2/3 C Sucanat sugar
½ C clarified butter
¼ C blackstrap molasses (originally regular molasses in the recipe)
Sucanat sugar for coating
- Preheat the oven to 375 degrees F. Lightly coat two 9-x-13-inch baking sheets with clarified butter, or line them with parchment paper and set aside.
- In a small bowl, combine the water and flaxseed. Stir well and let sit for 10 minutes.
- In a medium-sized bowl, whisk together the flour, baking soda, cinnamon, ginger, cloves, and salt. Set aside.
- In a large mixing bowl, combine the flaxseed mixture, sugar, butter, and the blackstrap molasses. Mix well with a spoon until blended.
- Add the dry ingredients to the wet ingredients and mix well with a spoon until blended.
- Lightly coat a plate or pan with sugar. Using your hands, shape the dough into 1½-inch balls and roll each ball over the sugared surface. Arrange the balls on the prepared baking sheets, leaving about 2 inches between the balls to allow for spreading.
- Bake for 8 to 10 minutes or until the edges are set but the middle of the cookie is still soft. Let cool for 10 minutes and serve.
More ways to use blackstrap molasses
Molasses apple cider tea
This warming drink involves two of my alkalizing favorites. I simply put 1 Tbsp of blackstrap molasses and 1 Tbsp apple cider vinegar in a cup of hot water and enjoy.
Wholesome alternative sweetener
As a simple sweetener, I like the flavor of blackstrap in yogurt, oatmeal, homemade granola, and even tea. It also works to replace some of the honey or maple syrup in your recipes with blackstrap.
Barbecue sauce or veggie glaze
If you prepare homemade barbecue sauce try mixing a bit of blackstrap to secret BBQ sauce. Or, if you like to spice up things by glazing your root crops, try mixing a bit of blackstrap with butter for a flavorful glaze.
Source for nutrition information: Whole Foods
Chromium is an old friend of mine! I first used it to help women tame their sweet tooth in my days as a nutritionist. And now, chromium is one of the key essential nutrients I recommend to women for their bone health. I’m also excited to see that researchers are learning more about how chromium plays a role in the truly amazing way the skeleton helps regulate energy metabolism.
Key benefits of chromium
- Preserves bone mineral by reducing the loss of calcium in the urine, promoting collagen production, increasing adrenal DHEA levels and improving insulin regulation.
- Stabilizes blood sugar
- Reduces craving for sweets
- Helps the skeleton regulate energy metabolism — the complicated process includes osteocalcin (a hormone secreted by the bone-building osteoblast cells) acting on the pancreas to enhance insulin production and in peripheral tissues to increase glucose utilization, as well as to increase insulin sensitivity and reduce visceral fat (like abdominal fat accumulation).
Are you getting enough chromium?
Unfortunately, probably not.
That’s because not many foods have chromium. Plus, chromium is a nutrient easily lost in food processing and soil mineral depletion. But — as you’ll see below in the list of chromium-rich foods — there is some good news. Red wine can have a fair amount of chromium!
How to get enough chromium (red wine is on the list!)
Most everyone in this country could benefit from chromium supplementation. While there is no RDA established for chromium, I recommend 200 mcg per day. Here’s a great list of foods with chromium from the National Institutes of Health. As you’ll see, getting a daily dose of 200 mcg from food alone is difficult!
What foods have chromium?
|Broccoli, ½ cup||11|
|Grape juice, 1 cup||8|
|English muffin, whole wheat, 1||4|
|Potatoes, mashed, 1 cup||3|
|Garlic, dried, 1 teaspoon||3|
|Basil, dried, 1 tablespoon||2|
|Beef cubes, 3 ounces||2|
|Orange juice, 1 cup||2|
|Turkey breast, 3 ounces||2|
|Whole wheat bread, 2 slices||2|
|Red wine, 5 ounces||1–13|
|Apple, unpeeled, 1 medium||1|
|Banana, 1 medium||1|
|Green beans, ½ cup||1|
Source: National Institutes of Health
Adding to the difficulty of getting enough chromium is that our levels also tend to diminish with age. Stress, a high sugar diet, an infection or vigorous exercise can diminish chromium levels in the blood.
You can help your body absorb chromium by getting enough with vitamin C and the B vitamins through foods and/or supplementation.
To get the most beneficial effects of chromium, I suggest you supplement with a chelated form of chromium such as chromium picolinate or chromium polynicotinate. My Better Bones Builder includes 300 mcg of chromium (as chromium polynicotinate) so you can be sure you’re getting the optimal amount of chromium.
Clemens, TL, and G Karsenty. 2011. The osteoblast: An insulin target cell controlling glucose homeostasis. J Bone Miner Res 26(4):677–680.
Evans, GW et al. 1995. Chromium picolinate decreases calcium excretion and increases dehydroepiandrosterone (DHEA) in postmenopausal women. FASEB J 9:A449.
National Institutes of Health. 2013. Chromium. https://ods.od.nih.gov/factsheets/Chromium-HealthProfessional/