The Truth About Osteoporosis and Osteopenia

Julian Whitaker, MD

Veronica, a healthy, active woman in her early 50s, recently had a DEXA bone density scan as part of a routine physical. When the results came back, she was told she had osteopenia and, if she didn’t do something about it, she was headed for osteoporosis.

When I spoke to Veronica she was in a panic. She was already exercising and taking calcium supplements, and she wanted nothing to do with any of the drugs that had been proposed. I reassured her that she didn’t have a disease and she certainly wasn’t on the fast track to osteoporosis.

Another Invented Illness

Osteopenia, defined as a “reduction in bone mass to below normal levels,” is just another invented illness. In fact, little more than a decade ago, it didn’t even exist. A diagnosis of osteoporosis used to be given only after fractures occurred. Today, anyone with thin enough bones is considered to have osteoporosis, and those whose bone density falls below a certain level—fully half of all postmenopausal women—are diagnosed with osteopenia.

This is nonsense. It’s another situation in which a bunch of experts got together, set some arbitrary guidelines, and bingo! Millions of people who were healthy the day before woke up with a disease. Like many other invented illnesses, this one was spurred by a diagnostic test, dual-energy x-ray absorptiometry (DEXA). It takes x-rays of the hip and spine, the most common fracture sites, and gives you a T-score, which tells you how many standard deviations your bone density is below or above the norm (the bone density of a healthy 25-year-old woman). According to the accepted guidelines, if your T-score is -1 to -2.5, you have osteopenia. If it is less than -2.5, you have osteoporosis.

Treat Patients, Not Test Scores

Now, I have no problem with the DEXA scan. In fact, we have a scanner at the clinic. But we use it to monitor the efficacy of our therapies, not to scare the dickens out of our patients.

Veronica’s only risk factors for osteoporosis are that she is petite, small-boned, and Caucasian. Aside from that, she is a lifelong exerciser, has never smoked, and rarely drinks alcohol. She has never taken steroids or had an eating disorder or a hysterectomy. Her diet is great, and she takes nutritional supplements. All of these factors are highly protective against osteoporosis. Under no stretch of the imagination does this woman have a disease.

Yet, when doctors focus on lab numbers, the patient gets lost in the process, which is exactly what happens to millions every year.

The Ups and Downs of Rx Drugs

Let’s look at the therapies offered for bone loss. The drug that has been around the longest is calcitonin (Calcimar, Miacalcin). It helps regulate calcium levels and slows the rate of bone resorption, or breakdown. However, according to a 2002 analysis of 30 years of clinical use, “there is no clear evidence that calcitonin reduces the risk of fracture…[It] should no longer be prescribed…”

The newest drug for osteoporosis is Forteo (teriparatide), which has effects similar to parathyroid hormone, a regulator of calcium and phosphorus in the bones. Although it has been shown to reduce risk of fracture, it is very expensive (more than $500 a month!), not to mention toxic. It requires a black box warning, stating that it increases risk of a type of bone cancer called osteosarcoma.

Estrogen used to be prescribed to prevent bone loss, but hormone replacement therapy (HRT) has recently fallen out of favor. Raloxifene (Evista), which has effects on bone similar to estrogen, has stepped into its place. It has been shown to reduce spinal fractures, but unlike conventional HRT, it does not increase risk of cancer or heart disease.

The most popular drugs for osteoporosis are the bisphosponates, Fosamax (alendronate) and Actonel (risedronate), which also interfere with bone resorption. A recent, much ballyhooed study of Fosamax, funded by its manufacturer, Merck, suggests that this drug improves bone density. Whether it reduces risk of fracture isn’t clear in this study.

I cannot argue that some patients at significant risk of fracture won’t benefit from drug therapy. However, there is absolutely no research to suggest that these drugs will help patients with osteopenia, who are at low risk to begin with. Creating osteopenia has simply given drug companies an excuse to push their pills on a new subset of “sick” people.

Dem Bones Gonna Rise Again

I am not minimizing the tremendous impact of osteoporosis. More than 1.5 million osteoporosis-related fractures occur every year in this country, costing us $47 million every single day! Hip fractures, in particular, cause much pain and suffering and often spell the end of independence and the beginning of a downward spiral in health.

Each and every one of us, women and men alike, needs to do everything in our power to maintain bone health, but that doesn’t mean you should take a drug. Instead, you need to get started on a bone maintenance and building program, and the earlier you start the better.

Recommendation

• To speak to a Patient Services Representative about treatment at the Whitaker Wellness Institute, call (866) 944-8253 or click here.

References

• Bone, HG et al. New Engl J Med. 2004; 350(12):1189-99.
• Heaney, RP et al. J Am Coll Nutr. 2003;22(2): 142-6.
• Macdonald, HM et al. Am J Clin Nutr. 2004;79: 155-65.
• Meunier, PJ et al. N Engl J Med. 2004;350(5): 459-68.
• Stone, KL et al. J Clin Endocrinol Metab. 2004 (3):1217-21.
• Wolfe, SM. Worst Pills, Best Pills. 2002;7(5):39-40; 2003April;9(4):25-7.

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