Stronger Bones—Without Drugs
Julian Whitaker, MD
After making a splash in Gidget and The Flying Nun, Sally Field went on to a distinguished film career. Now the two-time Oscar winner has taken on another role: Sally is the public face of osteoporosis. She’s appeared on countless magazine covers, schmoozed with talk show hosts, and addressed members of Congress—all in the name of increasing awareness of osteoporosis.
She’s also a mouthpiece for Big Pharma. Just listen to her story from the Rally With Sally for Bone Health website: “Osteoporosis was the furthest thing from my mind, because I’ve always tried to eat right, exercise, and be active. But a test showed I was rapidly losing bone density…. My doctor said that I could take a medication to strengthen my bones…. If you have osteoporosis, you need to talk to your doctor. The truth is medicine can help, but most women with osteoporosis don’t take it long enough or they skip doses. This puts them at greater risk for breaking a bone….”
This may be a public awareness campaign, but it’s a sales pitch as well. Sally Field’s face also graces ads for Boniva, an osteoporosis drug, and Rally With Sallyis sponsored by none other than the pharmaceutical companies that market this drug.
I’m not denying that osteoporosis increases risk of fracture, or that fractures can have serious consequences. But you need to know the real risks and benefits of the prescription medications used to treat osteoporosis, as well as safe, non-drug therapies for strengthening your bones.
Some Bone Loss Is Inevitable
Bone, like other tissue, is in a constant state of turnover, or remodeling. Cells called osteoblasts form new bone while other cells, osteoclasts, break down and clear out the old. It’s a delicate but perfect balance—until we reach our mid-thirties, when bone loss begins to outpace bone building. Over time, the result is weaker, more fragile bones.
To quantify bone loss, bone mineral density (BMD) is tested with X-rays, ultrasounds, or CT scans that measure the amount of calcium and other minerals in your bones. It gives you a T-score, which compares your BMD to that of a healthy 30-year-old. The lower the T-score, the less dense the bone. So what do most doctors do to increase BMD and presumably reduce risk of fractures? They prescribe drugs, of course.
Boniva, the drug Sally Field promotes, is a biphosphonate, which works by preventing osteoclasts from breaking down and resorbing bone. Drugs of this class also include Fosamax (a bestseller at $1.7 billion in 2009 alone), Actonel, and Reclast. Boniva’s claim to fame—besides Sally’s endorsement—is that you only need to take it once a month.
Biphosphonates have quite a few adverse effects. They cause esophageal irritation and ulceration, bone and muscle pain, and rare but serious eye inflammation. Intravenous Fosamax is linked with a horrendous condition called osteonecrosis of the jaw that results in deterioration and death of the jawbone. Fosamax also increases risk of atrial fibrillation by 86 percent, and a one study revealed that long-term use actually raises risk of stress fractures in the bones of the legs!
You’re probably thinking these drugs must be exceptionally effective for doctors to overlook this dirty laundry list. Truth is, docs are so focused on BMD—just as they are on other lab numbers, such as cholesterol and blood pressure—that they forget the real goal, which is to reduce fractures.
Dangerous and Ineffective
John Abramson, MD, Harvard professor and author of Overdosed America, delved into the clinical studies supporting these drugs and came up with some disturbing findings. Here’s an example: A study published in JAMA found that women with osteoporosis who took Fosamax had dramatic reductions in the relative risk of hip fracture. High-risk women who took the drug for four years had a 56 percent reduction in risk compared to those in the control group who took no drugs.
But a closer look at the data reveals that even the untreated women had a very low risk of fracture, just 0.5 percent per year. Odds that low are hard to improve upon. The women taking Fosamax had a 0.2 percent risk—technically a 56 percent reduction in relative risk. But all it really means is that their yearly odds of not having a hip fracture improved from 99.5 percent to 99.8 percent. Dr. Abramson concluded, “The bottom line is that 81 women with osteoporosis have to take Fosamax for 4.2 years, at a cost of more than $300,000, to prevent one hip fracture.”
Outcomes were even worse for the women in the study who had osteopenia (pre-osteoporosis). The drug actually increased their risk of hip fractures by 84 percent and their risk of wrist fractures by 50 percent!
Dr. Abramson explains that osteoporosis drugs increase density in the hard outer layer called cortical bone. But they do little to beef up the internal structure of trabecular bone in the hips, wrists, and spine. Trabecular bone is more metabolically active than cortical bone and is the first to go when bone is lost. Once this supporting internal architecture is compromised, the new bone growth stimulated by these drugs is primarily on the outer cortical bone. So although bone density improves, fracture risk may not.
Hormones Can Help…
The good news is that you have options besides drugs. And rather than trying to one-up Mother Nature, natural therapies simply give your body the raw materials needed to maintain bone on its own terms.
One of the most powerful is bioidentical hormone replacement therapy (HRT). Bone loss accelerates after menopause, thanks to drops in estrogen and other hormones, and HRT has been clearly shown to slow bone loss—especially when used during the decade after menopause. Unfortunately, many women are so freaked out by the side effects of conventional HRT that they won’t go near hormones of any type.
Some of them turn to Evista, a selective estrogen receptor modulator (SERM) that works in the bones in a manner similar to estrogen except that it blocks the effects of estrogen in the breasts. As a result, it increases BMD and protects against invasive breast cancer. Unfortunately, Evista also raises risk of serious blood clots and stroke, and causes hot flashes and other side effects.
…But Make Them Bioidentical
That’s why I only recommend bioidentical estrogen and progesterone. Chemically identical to hormones made in the human body, bioidentical hormones help preserve bone as effectively as conventional hormones, but they’re considerably safer and much better tolerated.
I also suggest giving dehydroepiandrosterone (DHEA) a try. DHEA is a natural precursor to testosterone, progesterone, and other steroidal hormones. When taken in supplement form, it has a broad range of benefits. In a recent study, researchers gave 50 mg of DHEA daily to healthy men and women, age 55 and older, for one year. Although this supplement had little effect on men, it raised the women’s blood levels of bone-building hormones and improved markers of bone turnover and BMD of the lumbar spine.
Men can benefit from hormones as well. Although they tend to lose less bone mass later in life, about a third of hip fractures occur in men. Fosamax, Actonel, and Forteo (an injected form of parathyroid hormone) are all approved for men with osteoporosis, but I prescribe testosterone for my patients. In addition to increasing BMD, it also improves muscle mass, energy, libido, and heart function.
Calcium and Vitamin D: Dynamic Duo
Everybody knows that calcium and vitamin D protect against bone loss. Calcium is the most abundant mineral in your bones—it’s what gives them their strength. Vitamin D is required for proper absorption of calcium in the gut and for bone mineralization and remodeling. Scores of studies show that calcium and vitamin D together improve BMD and fracture risk.
Some people are nervous about taking calcium, believing it may increase risk of calcification in the arteries and prostate cancer. Let me emphasize that the bulk of the research does not support these fears. I stand by my daily calcium recommendation of 1,000–1,500 mg from food and supplements. Most of us get just 600 mg per day from food, so supplements aren’t just an option—they’re a must.
Calcium comes in several forms. Calcium malate and citrate are better absorbed than calcium carbonate, but the latter isn’t as bad as some would have you believe. For optimal absorption, take in divided doses with meals along with vitamin D3 (cholecalciferol), the preferred supplemental form.
The government’s suggested daily intake of vitamin D is only 600 IU, but most experts agree that this is woefully inadequate given the high prevalence of vitamin D deficiency in our country. I recommend a range of 2,000-5,000 IU daily. To make sure you’re getting enough of this crucial vitamin, have your vitamin D blood level tested and adjust your dosage accordingly.
The Full Gamut of Nutrients
Calcium and vitamin D are by no means a two-man band. Magnesium has a hand in calcium regulation, and studies have shown that this mineral also reduces bone turnover. Vitamin C is a key player in the formation of collagen, another important constituent of bone. And trace minerals such as silicon, boron, and manganese are also essential for bone health.
Another bone-boosting supplement is ipriflavone. Similar to the protective isoflavones in soy, ipriflavone has been shown to increase bone density and inhibit bone resorption in men and women alike. Also consider taking vitamin K. This long-overlooked vitamin ushers calcium into the bones and steers it away from the arteries—making it an up-and-coming therapy for heart disease as well.
Finally, there’s strontium. This supplement does more than improve BMD—it dramatically decreases fracture risk. Belgian researchers recently published the results of a study of more than 5,000 women with osteoporosis who took either strontium ranelate or a placebo for 5 years. Fracture risk for women taking strontium decreased by 43 percent in the hip and 24 percent in the vertebrae.
Don’t Forget Diet and Exercise
Of course, diet also matters. Eat lots of leafy greens and broccoli, which are rich in vitamin K, calcium, and magnesium. Include a little low-fat dairy in your diet, and avoid sodas, which contain phosphoric acid that leaches calcium from the bones. And get plenty of lean protein. Protein used to be considered a culprit in bone loss. However, more recent studies suggest that it actually promotes bone health. Good sources include chicken, turkey, fish, and tofu.
Exercise is also of paramount importance. Walking is great exercise that helps stave off bone loss, but if you want to reverse it, you’ll also need to lift weights. Bones respond to the stress of heavy weights by building new bone. That’s why heavy people are at decreased risk of osteoporosis—they’re weightlifting every time they get out of a chair or move around. Get a trainer at a local health club or buy a fitness video for instructions on proper strength-training techniques.
Remember that childhood is a time of rapid bone growth, so make sure your children and grandchildren are getting the appropriate nutrients. Also, encourage them to exercise. More than half of an adult woman’s bone mass accumulates during adolescence, and strenuous exercise during this time protects against osteoporosis later in life.
- With the exception of DHEA, which is available in health food stores, bioidentical hormones require a prescription. They should not be used by men with prostate cancer or women with breast cancer.
Suggested daily doses of bone-building nutrients are: calcium 1,000–1,500 mg, vitamin D at least 1,000 IU, magnesium 500–1,000 mg, vitamin C 1,000 mg, ipriflavone 600 mg, vitamin K 45–300 mcg. Make sure your multi and/or supplement also contains a broad range of trace minerals. If you’re taking Coumadin (warfarin), talk to your doctor before taking vitamin K.
- Strontium ranelate (the form used in the study) is not available in the US, so I recommend strontium citrate. The recommended dose is 680 mg of elemental strontium. It is important to take it at least two hours before or after eating or taking other supplements, especially calcium. These supplements are available by calling(800) 810-6655.
- Osteoporosis prevention and treatment require a comprehensive program of nutritional interventions, lifestyle changes, and bioidentical hormone replacement. To talk to a Patient Services Representative about becoming a patient at the Whitaker Wellness Institute, call (866) 944-8253.
- Abramson, J. Overdosed America. HarperCollins, New York, NY, 2004.
- Rally With Sally For Bone Health Web site. www.bonehealth.com.
- Reginster JY, et al. Effects of long-term strontium ranelate treatment on the risk of nonvertebral and vertebral fractures in postmenopausal osteoporosis. Arthritis Rheum. 2008 Jun;58(6):1687–1695.
- Von Mühlen D, et al. Effect of dehydroepiandrosterone supplementation on bone mineral density, bone markers, and body composition in older adults. Osteoporos Int. 2008 May;19(5):699–707.
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