estrogen therapy for osteoporosis

Why estrogen isn’t an option for osteoporosis anymore

When the American College of Physicians (ACP) recently updated its guidelines for treating osteoporosis (Qaseem et al, 2017), tucked in with the usual recommendations for drug therapy was something major: The ACP reversed its position on estrogen therapy for osteoporosis.

In 2008, ACP guidelines supported estrogen therapy based on “high-quality evidence that estrogen therapy was associated with reduced risk for … fractures in postmenopausal women.” In direct contrast to this, the new guidelines state that “[m]oderate-quality evidence showed no difference in reduced fracture with estrogen treatment in postmenopausal women with established osteoporosis.”

Why guidelines on estrogen therapy for osteoporosis have changed

How is it possible to have “high-quality evidence” that something works and a few years later, it somehow doesn’t? 

It’s all about how you look at the data. The 2008 guideline based its recommendation on studies showing estrogen decreased fracture risk—but, as the 2017 guideline points out, “many of these studies focused on postmenopausal women with low bone density, or on postmenopausal women in general rather than those with established osteoporosis.” In other words, the 2008 evidence came from women who did not have osteoporosis — the problem the guidelines are meant to address.

In the intervening years, a bunch of randomized clinical trials were done examining estrogen’s effects on women with osteoporosis to offer better information. Since estrogen offers little benefit and has known harms, like increased risk of stroke or breast cancer, the ACP’s decision to change their recommendation makes perfect sense. It also highlights two important points when it comes to science — one, it’s always changing with new information, and two, a lot depends on the assumptions of the people looking at the evidence.

It’s enlightening to look at the ACP osteoporosis guidelines side-by-side with the 2013 European Union osteoporosis guidelines (Kanis et al., 2013). The European recommendations start by discussing mobility, falls, and diet and nutrition before weighing the pros and cons of bone drugs. The ACP guideline starts with drug therapy and mentions nutrition only in passing (the usual suspects, calcium and vitamin D, nothing more) and devotes only three lines to exercise.

The ACP’s guideline assumes that drug therapy is the best approach. The Europeans look at it differently — and so do I. My Better Bones, Better Body approach has stayed pretty consistent over the years because it’s based on the understanding that the body knows how to heal itself if it has the resources it needs!


Kanis JA, McCLoskey EV, Johansson H, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis Int 24(1):23–57.

Qaseem A, Forceia MA, McLean RM, Denberg TD, for the Clinical Guidelines Committee of the American College of Physicians. Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update from the American College of Physicians. Ann Intern Med 2017;166(11):818-839.

prunes for bones

How many prunes do you need to eat to start building bone?

Six is officially the new magic number when it comes to how many prunes a day provide bone-building benefit. The recently published clinical trial confirms the preliminary results I reported earlier — and makes getting enough prunes in our daily diet a real possibility!

Here is more about the study findings along with two great Thanksgiving side dish recipes that include prunes:

Clear findings: prunes are good for bones

Researchers ran a 6-month trial comprising 48 women in their late 60s/early 70s who were identified as having osteopenia, in which 16 participants ate 50 g, or roughly 6 prunes, 16 others ate 100 g, or 9-10 prunes, and the remaining 16 was a control group and ate dried apples instead. (Watch an interview I conducted with researcher Dr. Shirin Hooshmand while the study was ongoing.)

The researchers measured the participants’ bone mineral density in the hip, lumbar spine, and ulna (forearm) and examined specific bone health indicators in the blood at the start of the study and again 3 months and 6 months later. They also analyzed participants’ nutrient intake to account for all other potential factors affecting bone health, like vitamin D status, calcium intake, exercise, and overall nutrition.

In the apple-eating control group, BMD stayed unchanged or decreased. But in both groups of women who ate prunes, spine bone density increased, while forearm and hip BMD remained the same. Those who ate 100 g of prunes had a slightly greater increase in vertebral BMD than the 50-g group, but the difference between the two groups wasn’t significant — and in both groups (but not the control), a specific marker of bone resorption called tartrate-resistant acid phosphatase (TRAP-5b) was significantly lower at both 3 months and 6 months into the study, indicating that eating either amount of prunes had a positive, long-lasting impact on bone turnover.

Based on these findings, the researchers concluded that the lower prune intake — 50 g or 6 prunes — was adequate for most women to get the benefits.

Two hearty prune recipes to be thankful for

If you’re losing bone and want a simple way to improve your bone health, the message here is quite simple: aim to include 2 prunes at each meal.
There are many interesting recipes out there that incorporate prunes alongside alkalizing vegetables. Here are two of my favorites — and both just happen to be perfect additions to your Thanksgiving menu. You can even share with your guests that besides being tasty, these side dishes are also helping them build stronger bones!

Shredded butternut squash with prunes and pistachios

1 medium butternut squash (1 ½ pounds)
2 medium shallots, finally chopped
1/3 cup shelled natural pistachios, coarsely chopped
3 large prunes, coarsely chopped
2 tbsp preferred cooking oil
2 tsp mint (finely shredded fresh or dried)
1 to 1 ½ tbsp fresh lemon juice
Kosher/coarse salt
Cayenne pepper

Peel and chop butternut squash (sized to fit in tube of food processor). Using the food processor shredding disc, shred squash (about 3 ½ cups). Heat cooking oil in a large skillet over medium heat until hot. Add shallots and cook for 1 minute, stirring. Add shredded squash, turn up the heat to medium high, and cook for 3 minutes, stirring, until the squash is tender, like a purée. Stir in the pistachios, prunes, mint, and lemon juice. Add salt and cayenne to taste. Serves 6.

– Recipe created by Sara Moulton, author, Home Cooking 101 via

Savory prune stuffing

2 tbsp olive oil
3 large leeks (white and pale green parts only), cut into 1-inch pieces (4 cups)
1 1/4 cups chopped celery
1 tablespoon minced garlic
2 Granny Smith apples, peeled and cut into 1/2-inch cubes
10 ounces pitted prunes, chopped into 1/2-inch pieces
1/2 cup sherry or vermouth (or warm water to avoid alcohol)
6 cups (1/2-inch) white bread cubes (soft Italian or French bread)
2 large eggs, beaten to blend
2 tsp crumbled dried sage
1 tsp chopped thyme
1/2 cup chopped flat-leaf parsley
Large pinch ground cloves
Large pinch grated nutmeg
1 cup (+/-) either beef, chicken or vegetable stock
Kosher salt to taste
Freshly ground black pepper to taste

Toast bread cubes at 350 degrees for 15 minutes (or just leave out uncovered overnight to dry). Soak prunes overnight (or at least 2 hours) in sherry (or vermouth). Sauté leeks and celery until softened (approx. 10 minutes). Add garlic, saute for 2 more minutes. Add apples and continue to cook until softened (approx. 10 more minutes). Add prunes and the soaking liquid to the mixture
In large bowl combine eggs, sage, thyme, parsley, cloves and nutmeg, whisk until evenly combined. Add egg mixture to the leek and prune mixture, gently combine with the toasted bread cubes. Use broth to moisten the mixture if needed. Place the stuffing mixture into a large baking dish and bake in oven for approximately 40 minutes to 1 hour at 350 degrees.

Stuffing variations:
To make a heartier stuffing cook off ¾ pound of either ground pork or sweet Italian sausage (casings removed) and add it  to the stuffing mixture before the final baking.

Roasted chestnuts also make a great addition to this recipe (whether you roast your own or use prepared ones). I would suggest using approximately 10 oz and either halve or quarter the nuts.

Substituting corn bread for the bread cubes will give an interesting texture and depth to this recipe.

Gluten free is easy enough with the substitution of gluten free bread cubes.

Hooshmand S, Kern M, Metti D, et al. The effect of two doses of dried plum on bone density and bone biomarkers in osteopenic postmenopausal women: a randomized, controlled trial. Osteoporos Int 2016;27:2271–2279.

Share these recipes with a friend! 

Are you eating these bone health superfoods?

7 superfoods that help decrease bone breakdown

Women with osteopenia may be able to reduce their bone breakdown by consuming a daily amount of 9 or more servings of vegetables and fruits. But not just any vegetables and fruits, as reported by a recent New Zealand study that highlighted which bone superfoods can make the biggest difference.

Here’s what these researchers found when they tested the effects of known bone super foods on women’s ability to build bone.

How the study tested bone superfoods

The study group of 142 postmenopausal women (mean age 60 years) was divided into three groups: a control group, which had no change to their existing diets, and two intervention groups of 50 women each, both of which were instructed to increase their consumption of vegetables and fruits to 9 or more servings (1/2 cup cooked or 1 cup raw) each day and to add some aromatic culinary herbs to each meal. Participants in one group chose from foods that emphasized specific vegetables/herbs/fruit known to reduce bone breakdown (aka bone superfoods). The other group was left to choose their 9 servings per day, but could not consume any of the bone superfoods.

Most of the women in the intervention groups (52%) had osteopenia; the rest mainly had normal bone density, although a few had osteoporosis.

No surprise: More plant foods lead to better bone health

The study found that:

  • Both intervention groups consuming the 9 servings of vegetables experienced significantly reduced loss of calcium and a rise in urinary pH compared to the control group.
  • Women in the group that ate the bone superfoods were the only ones to reach the daily internationally recommended level of 4700 mg of the key bone nutrient, potassium.
  • A significant reduction in bone breakdown was seen in women with osteopenia whose 9 or more servings of vegetables and fruits included the bone superfoods. This is a very positive marker, as excessive bone breakdown leads to further osteopenia and even osteoporosis.

Are you eating these superfoods?

Here are the foods that are so effective at building bone. Some of them may surprise you!

  • Green, leafy vegetables like kale, bok choy or red cabbage
  • Citrus fruits
  • Prunes
  • Onions
  • Broccoli
  • Tomatoes
  • Green beans

Here at the Center for Better Bones, we’ve long championed our Alkaline for Life Diet® — high in vegetables, fruits, nuts, seeds, pulses and spices — as the ideal bone-enhancing eating program. Our helpful graphic shows you what a bone-superfood Alkaline Diet looks like. How close is your current diet to this ideal?

superfoods for bones

Gunn CA, Weber JL, McGill A-T, Kruger MC. Increased intake of selected vegetables, herbs and fruit may reduce bone turnover in post-menopausal women. Nutrients 2015; 7(4): 2499–2517.

Bone Drugs: Are they worthwhile?

Conflicting advice on bone drugs — what does the evidence say?

It’s no secret that I’m no fan of bone drugs in general. I’ve found the arguments for their use deeply unconvincing for decades. And now, European researchers looking at the accumulated evidence about the various drugs’ long-term effects are starting to come to the same conclusion:

Except in extreme cases, bone drugs don’t offer enough benefit in reducing the risk of fractures to be worth the price paid in terms of both short- and long-term side effects.

A European/Canadian research group reviewed the evidence on bisphosphonates like:

  • alendronate (Fosamax),
  • ibandronate (Boniva) and zoledronic acid (Zometa or Reclast)
  • teriparatide (Forteo)
  • denosumab (Prolia)
  • two treatments not used in the U.S.: calcitonins and strontium ranelate

Their findings struck me as good general “lessons” for all of us to learn.

‘Denser’ bones are not always stronger bones

The review found that the majority of osteoporotic fractures happened in those who did not have “osteoporotic bone density.” This helps confirm: Bone density alone cannot predict fracture risk.

Other recent studies show a large percentage of people who fracture have only osteopenia or even normal bone density. Many people with an osteoporotic bone density never fracture.

Not all fractures are created equal

When it comes to assessing bone drugs’ effects, a painless vertebral fracture or a toe fracture (painful, but not life-altering) shouldn’t be considered as clinically important as a hip fracture, which is life-changing.

Yet many drug trials either focus on vertebral fractures or on “non-vertebral” fractures as an endpoint. The stubbed toe becomes equivalent to a hip fracture in determining how effective the drugs are in fracture prevention.

Not surprisingly, when hip fractures are looked at specifically as the endpoint of choice, the researchers discover something different. They found that the data on less serious fractures of toes, wrists and so forth obscure the fact that the drugs don’t do much to prevent the most serious and dangerous osteoporotic fractures.

Bone drugs’ benefits remain inconclusive

The benefits of taking a bone drug must outweigh the costs for it to be worth recommending. And even in high-risk older adults, such benefits have not been shown conclusively.

In weighing the risk-benefits of bone drugs, researchers took a hard line on the importance of evaluating all costs. “Clinical trials evaluating harm-benefit balance in osteoporosis or fracture prevention should be well-powered long-term studies that include hard endpoints,” they note. “Total mortality, total serious adverse events, hip fractures, and functional status are essential outcomes.”

New U.S. osteoporosis guidelines miss the mark

What’s frustrating to me is that experts in the U.S. still focus uncritically on the flawed studies that the review critiques. They glibly parrot the ideas that bone density is the same thing as fracture risk and that drugs offer protection from fractures.

Case in point: The American College of Physicians’ latest osteoporosis guidelines, which were published virtually simultaneously with the European review. They make a “strong recommendation” for the use of bisphosphonate drugs “to reduce the risk of hip and vertebral fractures.” Most galling to me, they openly equate bone mineral density with fracture risk: “most women with normal DXA scores” it notes, “do not progress to osteoporosis within 15 years.”

To which I respond with the European review’s first lesson: Denser bones ≠ stronger bones.

Erviti J, Gorricho J, Saiz LC, Perry T, Wright JA. Rethinking the Appraisal and Approval of Drugs for Fracture Prevention. Front Pharmacol. 15 May 2017 |

Qaseem A, Forciea MA, McLean RM, Denberg TD, for the Clinical Guidelines Committee of the American College of Physicians. Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update From the American College of Physicians. Ann Intern Med. 2017;166:818–839.

All you need to know about the latest bone drug

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

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’s 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 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 7180 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 benefited, 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 fracture. Among the 3,327 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 to 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 bones today?


Cosman, Felicia et al., Romosozumab treatment in postmenopausal women with osteoporosis. New England Journal of Medicine 2016;375:1532-1543.

should you take a drug for osteoporosis?

Osteoporosis risks vs. benefits of osteoporosis drugs — spinning the numbers

When it comes to osteoporosis, most patients and their practitioners are primarily concerned with fractures. The thinking behind bisphosphonates was that if we could halt the bone breakdown process and make bones denser, we could prevent them from breaking. Most of the ads you see will tell you this is the case. But on taking a closer look, the numbers don’t seem so hot.

What’s disappointing to me is the way numbers from studies can be manipulated to exaggerate treatment benefits. Allow me to give you an example. When the manufacturers of Fosamax say that the drug can reduce fractures by up to 50% in high-risk women, what they are referring to are results of a 2004 study showing relative risk reduction among women who, as a group, are already highly likely to fracture before they are even selected for the study. Most people don’t have time to analyze study results in detail, but these reveal that out of thousands of high-risk postmenopausal women (those with osteoporotic bone density and a history of previous fracture), about twice as many (2.2%) of the placebo group will fracture as those taking the drug (1.1%). Because 1.1% indeed is half of 2.2%, the drug’s manufacturer can advertise that the drug reduces hip fractures by 50% — which is the relative risk reduction (that is, a comparison of the number of people who fractured in both groups). But let’s not forget that both groups contained many more people who did not fracture at all, and if you include them in your comparison, you get what’s called the absolute risk reduction — a paltry 1.1% (2.2 minus 1.1) — in those taking Fosamax compared to those not taking anything.

A 2008 review of more than 40 years’ worth of data on more than 12,000 women using alendronate — that’s a lot of data — shows that overall, there was a mere 1-2% absolute risk reduction with its use. Co-opting this science, direct-to-consumer marketing continues to play up the 45-50% relative risk reduction figures. Yes, relative risk reduction can be a useful tool for researchers, and of value to a healthcare provider when determining absolute risk reduction. But any good biostatistician will tell you that it does not seem to be as useful a measure for patients or families when choosing a method of treatment!

Another detail we don’t hear from the drug companies is that fracture-reduction benefit of these drugs is largely for secondary prevention — that is, when bone density is already osteoporotic and/or there has been an existing fracture. There is much less benefit in primary prevention, where bone density is not osteoporotic and there have been no previous fractures. In women with osteopenia, some research even suggests increased rates of certain types of fracture with prolonged use! In fact, these drugs are not recommended at all for primary prevention, yet women who are not at elevated risk for fracture are among the largest target audience of direct-to-consumer advertising for bone drugs.

Possible adverse side effects associated with osteoporosis medications (bisphosphonates)

  • Ulcers of the esophagus
  • Upper GI irritation
  • Irregular heartbeat
  • Fractures of the femur
  • Low calcium in the blood
  • Skin rash
  • Joint, bone, and muscle pain
  • Jaw bone decay (osteonecrosis) (rare)
  • Increased parathyroid hormone (PTH)

If patients knew the reality of these numbers and the dangerous side effects that come with taking bisphosphonates (see chart at left), I’m sure they would reconsider the merits of taking a prescription for low bone density for the rest of their days. This information is hard to find, and many practitioners don’t have the time to analyze the statistics of each and every study that comes across their desk.

I would advise patients to ask their providers what the absolute risk reduction is for a drug before taking it. Or you can also ask about the number needed to treat (NNT). This figure gives you a sense of how many people would have to take the medication for one person to receive a benefit, and the lower the NNT, the better the chance that the drug will benefit you. For example, the above information tells us that Fosamax reduces fracture risk by about 1% (absolute risk reduction), so 100 people would have to be treated for one to benefit from fracture risk — the NNT is 100, in this case. In essence, the NNT is telling us that for every single person who is benefitting from these drugs, 99 more are getting no benefit at all!

The business behind bone density drugs

Unfortunately, the ads we see on television for various osteoporosis drugs don’t mention how small the benefits really are, or how serious the side effects can be. As the Baby Boomers begin to grow older, pharmaceutical companies have a market larger than ever before for bisphosphonates, and they aren’t stopping at much to capitalize on it. In fact, this large aging population is part of the reason it looks like osteoporosis has become an epidemic in this country. In reality, US hip fracture rates have gone down since the late 1960’s in women and since the early 1990’s in men, despite an aging population. Because of the large number of aging Baby Boomers, the actual number of fractures can seem overwhelming, even though the rate is decreasing.

It’s true that such a large group of people getting older, possibly fracturing, and taking up hospital beds will represent a burden to society. This is partially why drug companies want to find a solution, but the other part — as I’m sure you can imagine — has to do with profits. In 2006, at least $2 billion was spent on Fosamax alone. Drug companies are pushing hard for direct consumer advertising to encourage women to get bone density tests, in the hopes they’ll then be treated for low bone density.

In an article on leveraging the potential osteoporosis market, a contributing editor to Medical Marketing and Media writes, “In the United States, 95–100% of women who are screened and diagnosed with osteoporosis receive treatment.” He goes on to advise drug companies to “drive diagnosis rates” by sponsoring traveling DEXA scans in shopping malls, clubs for the elderly, and community events.

The DEXA scan was developed in the early 1980’s as a way to quantify bone density, but unfortunately it doesn’t reveal much about the actual strength of bone. Patients are given a T-score that compares their bone to that of a healthy 20- to 30-year-old, then told they have osteopenia or osteoporosis! The Z-score, which compares your bone density to that of other men or women in your age group, is more helpful for tracking your bone density over time, but still not great at predicting risk. The reality is there are many factors that go into predicting fracture risk, and bone density is just part of the whole picture. It clearly works in the interest of pharmaceutical companies to compare your T-score to a young person’s, but you should know that while a machine may categorize you as osteopenic or even osteoporotic, you may never fracture a bone in your life. And the odds are with you — most people don’t fracture their bones, even if they are at high risk.

The Surgeon General’s advice — work with nature

In one sense, I agree with pharmaceutical companies: prevention is best. But I don’t agree with their approach to prevention. Pharmaceutical medications, in my opinion, don’t work with your body. They work by suppressing or fooling it into doing something it wouldn’t do naturally. I know that in certain circumstances, bisphosphonates can be helpful, but for the most part they should remain a last resort.

In 2004, the Surgeon General studied osteoporosis in the United States and wrote a report over 330 pages long on the best ways to promote bone health and prevent osteoporosis and fracture. His advice, in essence, is to work with nature.

He provides an osteoporosis pyramid for prevention and treatment that starts with nutrition, physical activity, and fall prevention at the base. The second tier involves assessing and treating the underlying causes of compromised bone health. The very tip of the pyramid, and the last resort, is pharmacotherapy. The bottom line is that your bones are meant to last a lifetime. In most cases they don’t need drugs to keep them strong or prevent fracture. There are many, many natural ways to support your bones with proper bone nutrition and, many times, simple lifestyle changes to prevent osteopenia, osteoporosis, and needless fracture.

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

Jumping Improves Hip Bone Mineral Density

Become a Patron!

Here’s a great reason to jump for joy — new research shows that with only 20 jumps a day, premenopausal women can significantly build hip bone mineral density.  I always encourage women to remember that a small change to your daily routine lead to a big impact in your bone health, and this is a perfect example!

The study followed 60 women ages 25 to 50 who took part in the jumping program. One group of women jumped twice a day, six days a week, and as high as possible for 10 times.  Another group jumped 20 times, with the two groups each resting 30 seconds between jumps.  After 16 weeks, both groups had positive hip bone mineral density changes, while a group of women that did no jumping had a negative change in their hip bone mineral density.

What’s more, this study is important because it highlights that changes can be made in the hip, one of the most common and dangerous fracture areas. It’s estimated that the number of hip fractures could triple in the United States by the year 2040, according to the study authors.

I do want to note that the jumping in the study was jumping with a lot of force.  I call this power jumping, which is jumping as high as you can, swinging your arms up above your head.  You can land with your feet apart or together.

While jumping is simple, you may want to avoid it if you have severe osteoporosis, a history of fracture, balance problems or other health issues.  Also, keep in mind that this study looked at pre-menopausal women.  Other studies with postmenopausal women have not been so successful, even though they included more jumping.  I suspect that one hundred hops a day or jumps would benefit postmenopausal women, along with better nutrient intake and the alkaline diet, such as found in my Better Bones program.



Tucker, L.A., Strong, J.E., Lechemianant, J.D., Bailey, B.W. (2014) Effect of Two Jumping Programs on Hip Bone Mineral Density in Premenopausal Women: A Randomized Controlled Trial. Am J Health Promot.