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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

Reference
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.

References:
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 | https://doi.org/10.3389/fphar.2017.00265

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?

 

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

Jumping Improves Hip Bone Mineral Density

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.

 

Reference:

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.