I read this article before deciding on a Reclast infusion. After the infusion by 6 pm I was hurting. By 9 the pain was as severe as my original hip fracture. An ambulance took me to the hospital. By then I was incoherent from pain at the 10 level and the ER doctor leaned over me and said, "There is no cure but we do have pain medications." By the next morning my leg was frozen in one position due to mussel spasms. I was bedridden and in pain. Long story short: it took 3 days to get me out of bed and into a chair and finally home where I still hurt. The insurance company did not approve therapy and I was admitted as an "observation" patient so I expect a bill of $10,000. Ms. Brody, I am glad you can get 3 infusions a year. But I can see why most people pass based on what just happened to me personally.
2
I am sorry to hear about President Carter’s hip fracture and hope he recovers fully. The prognosis can be worse for a man suffering a fragility fracture. Am happy however that he was about to be doing something that he loved - go turkey hunting.Hope he reads the advice in this column and takes heed. And I would add for all older adults - avoid or declutter the many of the medications that can increase risk of falls - and declutter rugs, furniture, anything that can get in the way.
“First you have a drug, and then you create the perception of need. The diagnosis of osteoporosis determined by bone density testing was promoted in 1995, simultaneously, and not coincidentally, with the FDA approval of the first major drug indicated for osteoporosis treatment. The use of bone density criteria greatly expanded the number of people who might be "diagnosed" to have osteoporosis or low bone density (commonly called "osteopenia") and therefore "eligible" for, or even requiring, medication to treat or prevent osteoporosis.
Osteoporosis is a true medical syndrome, but does this make low bone mineral density measurement (BMD) the equivalent? BMD is a surrogate for fracture risk, but it does not have as good a predictive value as other indicators, especially previous fracture or even advanced age. BMD improvement became a standard measure of drug efficacy in many clinical trials rather than the prevention of fracture, the true important outcome. Marketing to and by the medical community, as well as to prospective "patients", has created a huge medical market for a disease that followed the creation of new drugs.
.... While helpful in establishing understanding and awareness of osteoporosis as a common disease, this marketing served to identify additional patients for pharmacologic prevention and treatment of osteoporosis, with questionable results.”
Ethics in Osteoporosis and Osteopenia: The Bare Bones of a Surrogate Marker
7
While all of the osteoporosis medications do have drawbacks, some serious, the drugs have to be weighed against fractures. I was diagnosed w/osteoporosis at 50 after a wrist fracture (and have a fracture history dating back to age 5). I am also a thin/blond, blue-eyed female. Always very active, ie lift/carry heavy items, chop wood, etc. Not able to take fosamax, i was put on forteo for 18 mo, with remarkable results, and now inject prolia 2 x year. I no longer fear opening a window, tripping on a hike, or falling on ice, though i continue to use caution. The drugs have allowed me to have an active life rather than a sedentary one, which to me is no life at all.
12
I appreciate Jane Brody taking the personal risk to write about and to guide us through the complexities of practice involved with modern medicine, physical fitness and nutrition. My, oh, my, how often Jane is mocked and otherwise made fun of for trying to write, with some clarity and simplicity, about health problems and doctors’ possible cures for them (see her recent piece on statins and the ridicule it brought her) It is not right for us to expect her to be the goddess of medicine knowing medicine’s absolute truths. She, like us, is only too human. Thanks, Miss Brody, for taking the immense risk to write on these complex medical topics.
11
I don’t understand why Jane Brody is so often viciously attacked for trying to guide common readers through the complexities of modern medicine. A month or so ago she was ridiculed for an astute article on statins and today she is mocked for writing a piece on bone weakness and fractures and the drugs that might prevent these illnesses. Do the Armchair Physicians, homeopaths who wouldn’t accept any medicine unless it was picked from a wilderness field, and the Snake-oil Doctors and other Medical Quacks, all trained at Internet Search University, expect anonymous Google authors in their not-peer-reviewed articles to do better?
14
@Dave Thomas
No, conventional medicine often uses outdated dogmas to justify usage of medicines of less effectiveness for causal solution and with side effects. Readers with experience using such medicines find out ineffectiveness and side effects of such medicines, and will become antagonistic to doctors or Jane as proxy of conventional medicine that continue to recommend usage of such medicines.
2
@Dave Thomas
You must have in your family some of the True Believers who will believe anybody rather than science-based, Western medicine. Every week or so, being told by them some new, exciting revelation, that "blows the lid" off, exposing the "greed and conspiracies" of doctors.
Hard to live with these people, and, by the way, all of them are in bad shape and have bad health.
1
Many people take anti-acid over-the-counter medicines without knowing that long-term usage will cause chronic degenerative diseases including osteoporosis. "Many people take over-the-counter and prescription acid reducers to soothe reflux pain and lesions. New studies show, however, that long-term use of strong acid-lowering medications (cimetidine, ranitidine, omeprazole) may cause a host of problems including osteoporosis and higher chances of hip and thigh fractures, even when taking medications to reduce bone loss called bisphosphonates (Fosamax, Boniva, Actonel, Reclast, etc.). Although antacids produce an alkaline environment in the stomach, they ironically contribute to metabolic acidosis. Antacids contain aluminum that increases calcium excretion in the urine and lead to mineral deficiencies. In order to maintain pH in the blood, the bones respond by releasing calcium into the blood to balance the loss of calcium through the urine. Over time, the bones thin and weaken. In this study, those who used antacids regularly but less than once a day had a 12% higher fracture risk, a pill a day caused a 30% increased chance of fracture and most significantly, those who took more than one antacid per day had an increased risk of fracture of 41% over those who do not take any antacids."
Source: High Alkaline Diet and Body pH
https://www.invitehealth.com/article-body-ph-acid-base-balance-and-alkaline-diet.html
It is not just density. Dense bones can also be brittle and prone to fracture. Some of the osteoporosis treatments increase brittleness. Buyer beware!!!!!!!
3
The risk is minute compared to the benefit of the drugs.
1
Another Jane Brody column that’s “meh” @ best, & where I learned much more from the comments section.
2
@Mme. Flaneuse Why read it?
2
@DI
As medical professional, always try to keep up on what is “out there” for the public. I should be able to learn something, too, if well researched & well written. In this case - once again - not so.
1
Incorrect. Ms Brody once again has written an excellent article. My only criticism is that the orthopedic surgeon should recommend consultation for medical therapy once the repair is done. They are doctors not mechanics and they know the risks of this insidious disease. I am a primary care physician who cares only for women.
7
The principle problem with anti resorptive (bisphonate )therapy for OP is that bone formation and bone resorption are tightly coupled. Turn off resorption and you turn off bone formation.
3
I have osteoporosis too, not taking anything. I belong to several FB groups on osteoporosis. Many report doctors say exactly the same thing “You are at risk of breaking a hip and you will die in a year. Side effects are minimal, and there’s rarely any case of necrosis.” M oral surgeon told me he had seen jaw necrosis in patients taking the drugs and wouldn’t work on anyone taking them. This was a very small practice in a small community. What the doctors don’t do is talk about the vitamins and minerals that you need and possible exercise or therapy programs. I’m may eventually find the need to take the drugs, but not yet. They keep discovering problems with them and some medications you can only be taken for a certain number of years and then what do you do? I don’t think doctors are listening to patients and hearing their concerns. I know I would feel better if the doctor told me about a good program in my area for osteoporosis exercise and support, a good nutritionist for diet and supplements. I would appreciate if she talked about the side effects more and how the risk factors are affected by heredity. In my family a large number of women, all small, lived into their 90s. Only one broke her hip. She was 90 years old at the time and she lived until 99.
6
@NYQueens
Would you mind sharing the Facebook groups you mentioned? I took Actonel for two months and had so many side effects that I'm going to stop. Looking for some support which is hard to find. Thanks!
Vitamin D and Calcium alone don’t do much good. Vitamin K-2 is essential to move the minerals into the bones, and out of the blood, the artery walls, the kidneys, and the prostate.
8
After diagnoses for osteoporosis in some spots and osteopenia in others and a hairline fracture in my spine in my late 50s, I discovered Phd. nutritionist Dr. Susan Brown (Better Bones, Better Body) and started her recommended alkaline diet, took bone supplements with the full range of minerals needed to build bones and exercised with weights regularly in addition to walking. Years later I had a bad fall after my foot hit a piece of metal embedded in the roadway in Golden Gate Park. Very painful (black and blue) but luckily no broken bones after my whole body and head slammed down on the concrete.
9
@Rosemarye
Your comment is precious among over 100 comments here. Alkaline diet rich in minerals is the best way to prevent osteoporosis and other chronic degenerative diseases. This is the reason why your bone was okay even after the bad fall. You probably eat leafy green vegetable rich in vitamin K, folate, magnesium and other minerals. Because of alkaline diet, you have probably never experienced secretion of Parathyroid hormone (PTH), a hormone secreted by the parathyroid glands that regulates the serum calcium by taking away calcium from on bone, kidney, and intestine. I have been practicing alkaline diet by checking morning urine to go up close to 7 by adjusting protein intake ( because of my age, always 20% above RDA, 0.8 grams per kilo of weight).
5
Vitamin D is good, but studies have shown that supplementation with calcium does not help.
Some of us have extra reason to avoid a drug that has osteonecrosis of the jaw as a potential side effect. I had radiation for throat cancer, and that means I already am at risk for osteoradionecrosis of the jaw, due to the damage to the vascular system that radiation causes in the jaw. I am reluctant to take anything that may increase this.
So I take raloxifene (Evista), which has less research behind its effectiveness but does not have osteonecrosis as a side effect. I have met a number of folks online who have suffered this after radiation to the jaw, and it's truly horrible.
3
Just wish to add that my wife has serious osteoporosis she has taken all the bone density deficit medicines including Reclast infusions for several decades.
My wife also has a brain disease that makes her fall often Parkinson's ,when she needed a left hip replacement her excellent surgeons decided to place in her left side a dual-mobility hip which has a very good record if a patient has a falling history post op ,this specially designed"hip" moves when one falls which reduces breakage or displacements from falling which not only brain injured people suffer from but so do the elderly .
4
to repeat an important comment from below
"In China and areas of Southeast Asia, where dairy consumption is minimal, arthritis and bone deterioration are not the major health problems that they are in the wealthy countries of the West. Evidence points to certain cofactors of calcium metabolism as the problem: calcium absorption requires adequate dietary magnesium, phosphorus, and vitamins A, C, and D. In fact, without certain of these nutrients, it appears that calcium cannot be absorbed at all." -Paul Pitchford, Healing with Whole Foods
It is your total diet!! and weight/stress exercise for the bones and muscle health.
i.e Fosemax and its ilk are not the answer and they have side effects.
11
Medicare apparently only pays for bi-annual bone density tests.
If one wants to have tooth implants, one must NOT start Fosamax etc. until the procedures are done.
I had osteoporosis from age 59 -- now 74. Osteo-P where ever they test.... and I have fallen (but not breaks)-- however,
There is already a test for brittle versus subtle bones -- what this might mean in terms of bone health is a ??
PS Oriental women have a less severe type of osteo-P than do whites.
2
"In China and areas of Southeast Asia, where dairy consumption is minimal, arthritis and bone deterioration are not the major health problems that they are in the wealthy countries of the West. Evidence points to certain cofactors of calcium metabolism as the problem: calcium absorption requires adequate dietary magnesium, phosphorus, and vitamins A, C, and D. In fact, without certain of these nutrients, it appears that calcium cannot be absorbed at all." -Paul Pitchford, Healing with Whole Foods
I scanned the comments and could not find a single mention of magnesium, which, as I understand it, many people are deficient in, or vitamin C, or other nutrients that are known to be necessary for strong bones. Calcium supplementation, however, is rampant and contributes to calcification of tissues, which is implicated in breast cancer and even kidney disease. (See the article "Osteoporosis is Scurvy of the Bone" for an interesting perspective from a nephrologist - http://drsuzanne.net/2012/08/osteoporisis-is-scurvy-of-the-bone-not-calcium-deficiency-suzanne-humphries-md/.)
I watched a video presentation from Dr Loren Fishman on yoga and bone health a few months ago. It was quite helpful, as I hadn't known anything about the medications used for osteoporosis and how they compare to yoga. A friend has opted for Fosamax and looks more frail, but prefers to trust her medical advice.
It all makes me both sad a little angry that public discourse about health has become so compromised.
6
Osteoporosis is a terrible disease. My mother had it and her spine was bent over so she was always looking at the floor. Very painful, and she suffered spontaneous fractures just sitting in a chair. There does seem to be a hereditary component to the disease--both my sisters have it, and my most recent bone scan revealed I am on the cusp, with my numbers just beginning to go over the edge from osteopenia to osteoporosis. I've taken calcium and vitamin D for years, but have upped the dosage and started on one of the bone building drugs. I am aware of the side effects, but I have also witnessed the suffering and decline of my mother. I walk, I take the supplements and now the drug. I will do anything to prevent ending up like mom. Anyone who has witness the awful effects of the disease will have no qualms about taking the drugs that may help prevent it. Mother's doctor remarked that because of the new bone building drugs, she may be among the last patients that will have to suffer with the pain and disfigurement of osteoporosis. How wonderful that will be!
12
If you are just beginning to read these comments, find the comment by Diane in Colorado Springs and read it if you are considering any of these drugs. Also, I haven't seen any mention of the website of the National Osteoporosis Foundation called Inspire. You might want to read postings on their site. This is a very complex subject and the article is too optimistic about drug usage.
6
All these drugs frighten me. My gyn recommended them to me 3 years ago because my bone density test was in the yellow area. I said no. Than she recommended I add calcium )which I did, plant base) and hopping on one foot (something she got from a study mentioned in the Berkeley Wellness Letter).
Currently my bone issue is my lower spine, and I cannot get a real treatment plan or go to PT for 6 weeks and come back and we will give you a shot!!
This society is too quick to prescribe drugs. We need to remember that often the best medicine takes time, and includes a good diet, exercise, and no smoking.
8
The "Number Needed to Treat" for alendronate (Fosamax) is about 50 (higher or lower depending on the type of fracture.) This means that to prevent one fracture, fifty people have to take the drug. To put it another way, if you take the drug, the likelihood that it will benefit you is 1 in 50. Many physicians see this as an outstanding benefit that everyone should take advantage of. Many patients do not see it this way.
14
A hip fracture is a deviating injury with 1 and five year death rates similar to breast cancer. Would we be having this discussion about rare side effects if we were talking about medicines that could decrease those rates? Vitamin D and calcium pills have been a disappointment to reduce fractures in large studies. Physical activity and hormone status are important, but attention to slightly built white post menopausal women who can be at increased risk is potentially life saving.
8
I was diagnosed with osteoporosis soon after turning 50. Very young for that. I resisted taking Fosamax because there was so much conflicting information on the drug. An orthopedic surgeon advised against it, while my rheumatologist pushed it. Intense yoga practice was said to build bone, years ago, and then that was proved wrong and the new thing was impact exercises that broke down bone a bit so it that your body would rebuild it. But then experts said older folks couldn't build new bone, only stabilize. And oh, by the way, calcium supplements do nothing to help because older folks can’t absorb the calcium. I did eventually try Fosamax, but had some unacceptable side effects from it. I did a short course of Forteo, too. But I took nothing for several years. After multiple bone breaks and worsening DEXA numbers, I finally relented to my doc’s “encouragement” and agreed to get Prolia injections. We’ll see how that goes. It’s crazy expensive and I resent that a drug used mostly for women is not well covered by insurance. But men are fully covered for ED drugs. Priorities, man.
37
@Passion for Peaches
Your story sounds exactly like mine. I finally succumbed to taking Prolia for the past 18 months. Prior to Prolia, I had 11 fractures in 10 years, two that required surgery. My spine at age 54 was the average density of a 92-year-old woman Since prolia, I have had no fractures. I wished I had started some sort of treatment sooner. By the way, I eat an extraordinary healthy diet and exercise every day.
Many of my friends were critical of my choices which was not helpful.
6
Three years ago my GYN wanted me to get on Fosamax ASAP. I did not yet have osteoporosis, but my numbers were close enough that she wanted me to get on it as a “preventative.“ I balked and saw a bone specialist who told me that I would probably need to take it someday, but that no one should be on it until they absolutely had to be. He also told me that photos and Max was a one time deal to be taken for no more than five years.He told me to “step up my game“ with exercise. I have been going to Zumba classes irregularly and have gotten the recommended amount of calcium through diet and supplements and have taken more than the recommended amount of vitamin D. My latest bone density showed an increase in density. My GYN was quite surprised and said “keep doing whatever you’re doing.“ Lesson: Always get a second or third opinion from a bone specialist. And, Zumba, bounce, weight-bearing fun exercise etc.
17
@KT
Bounce should do it -- build bones. Esp. before age 40.
EVERYONE -- needs to know dental implants cannot be done or do not take on people using the anti-osteoporosis drugs.
Get sunshine -- Vit. D is not necessarily the answer. We don't know... exactly but good nutrition seems to help. (Supplements may or may not be a waste of $$$.)
1
Forgot to add that I’m 60 yo.
There are several large (500+) studies of post-menopausal women who develop osteoporosis as a result of treatment for breast cancer which knock their already small estrogen down to almost zero. One half were treated for osteoporosis from the start; the other half had their bone density monitored and began treatment only after it went below a critical level. Although the first group had higher bone density, the fracture risk was the same. After 5 years, 10% of BOTH groups had fractures.
Most of these treatments increase bone density by slowing the breakdown of bone. But this does not necessarily lead to stronger bones. Other factors, e.g., estrogen level, probably play an important role in bone quality and strength.
3
@MBR, my doctors did discuss the role of estrogen when I was diagnosed with osteoporosis (in my early 50s, and I was already post-menopause at that point). They said one course of action for someone like me would be to prescribe HRT long-term. My late mother (who had osteoporosis) had been prescribed birth control pills well into her 80s — that is how her HRT was managed. However, I’d done HRT for five years during menopause, and the hormones worsened my migraines and caused my (inoperable) fibroids to grow. Because of the fibroids, I was told that I’d have to get a hysterectomy if I wanted to go the estrogen route. No way I am having my organs removed by choice. And then there is the complicating fact that I will not take equine-origin estrogen (Premarin), and the non-equine bio-identical that I took earlier were not covered by my insurance (and my primary care doctor said the whole bio-identical concept was nothing but “wand waving” anyway). I got all of this conflicting information and was told to sort it out myself.
BYW, anyone who takes Premarin is participating in the horrific torture of mares. Full stop. You take the drug, you support the industry. You are complicit.
7
There is hazard in blindly taking calcium and Vitamin D supplements, as is often recommended by Dexascan technicians. These supplements can be harmful if hyperparathyroidism is present but not yet diagnosed.
Blood calcium that is even slightly elevated in consecutive test results needs to be further investigated. It may indicate hyperparathyroidism due to one or more adenomas on the parathyroid.
The fairly common adenomas cause elevated parathyroid hormone which triggers calcium to be drawn out of the bones and into the blood. This then leads to many physiological complications even aside from the calcium loss from the bones. It is sometimes referred to as "stones, bones, groans" because of the physical discomfort patients suffer yet this condition is frequently overlooked by doctors.
Two women in my family had primary hyperparathyroidism. One sister was diagnosed after her primary care doctor looked further into her elevated calcium and referred her to an endocrinologist. Unfortunately, she was briefly treated with bisphosphonates to see if it brought the blood calcium down. It did not and a sestamibi scan and PTH blood test revealed the adenoma.
The other sister self-diagnosed after her primary care doctor had ignored her elevated calcium readings for several years. Her hyperparathoidism was confirmed by blood test and sestamibi scan.
The only cure is surgical removal of the adenoma but it may help save the bones.
3
@Lynn
I recently had a parathyroid adenoma removed and feel very much better. But it did damage my bone density and now I am being told to take supplemental calcium and Vitamin D. Prior to the diagnosis I had also been told to take both. No one indicated to me that this exacerbated the disease. I would assume that it was actually somewhat protective. Just prior to the surgery my foot broke in 3 places. This was the ticket to get the endocrinologist to move me from the one year waiting list for an appointment and referral to surgery to the 4 month waiting list ! Then the surgeon treated me about 6 weeks later.
To those who insist that exercise and diet will prevent these bone changes : I've never smoked, I have exercised daily all my life, much of it weight bearing and I eat reasonably well. The real problem is menopause.
3
The author neglected to point out the benefits of Occupational & Physical Therapy, not only after hip surgery but before. Before sustaining a fractured hip therapy can help with improving muscle strength, improve balance, safety issues,work simplification & energy conservation techniques (I could go on...)to help prevent fractures in the first place. After hip surgery therapy is a must to teach the above mentioned but also hip precautions to heal properly to decrease the chance of another fracture. Therapy is an integral part of any Rehab team treating post surgical patients.
16
@dakota49 YES! As a PT Assistant, I couldn't agree more with your comment. I'm very surprised that PT/OT were not mentioned at all in this article.
11
@dakota49
Great idea but most insurance has very limited P/T coverage. And of course no insurance at all for vitamin supplements, chiropractic, acupuncture, massage, exercise in the form of yoga or tai chi, or any other form of sneeringly so-called alternative treatment.
6
@Cloudy
Get another insurance company - mine pays for many of the preventive/alternative treatments. And for seniors there is the Silver Sneaker program which even pays for gym membership (and online classes during the pandemic). You can also set up a medical flex spending account which will pay for them.
1
In the same position / condition as several responders here: small-boned, caucasian post-menopausal woman who worked very hard over the last 4 decades to avoid bone-loss through weight-bearing exercise and good nutrition. Very healthy in every way except for osteoporosis (-2.5 to -3 in scores) with no medical explanation except "heredity."
Would very, very much appreciate any feedback from endocrinologists (who I have visited, of course) with information on parathyroid issues. My labs are normal/high, but in the "acceptable" range.
Thank you.
1
@Mayda
You need to be seen by a specialist in PTH. "Normal" blood levels depend on the definition of normal, and that varies with the lab and doctor. Google mini-parathyroid surgery and educate yourself on PT adenomas. There is a graph that shows the probability of having an adenoma given your levels of serum calcium and PTH. I had surgery, had a huge adenoma removed, and felt better within 3 weeks. My DEXA scores have improved but I was told that my adenoma had probably started 10 years earlier and it would take several years for my bones to strengthen.
2
@Mayda
I have already written a lengthy comment going into the parathyroid issue so won't go on too long here.
Our bones are a storehouse for calcium that is tapped by our endocrine system so the blood can send calcium throughout the body as it is needed. There is a very NARROW range of "normal" for the blood calcium. It will spike and drop with physiological changes but it needs to stay within that range. There is a level that is more ideal than "slightly high" (e.g. 9.7 is better than 10 even if 10 is "normal". I won't give actual numbers here because different labs might give different readings and I am NOT an endocrinologist).
The parathyroid is constantly bathed in blood and is "sampling/responding" to the blood chemistry. The gland sends out parathyroid hormone to "tell" the endocrine system to release calcium from the bones if the blood calcium is low. If your blood calcium has been consistently on the normal/high side, even by mere "points", you may have a parathyroid adenoma. It is an often ignored signal of these insidious benign growths.
Please do as BioNerd suggests and look into this. At the minimum, you can get a PTH blood test and it will indicate if the parathyroid is operating "out of whack". I have personal experience with two family members on this and can tell you that the calcium in the blood can be at the high/normal level for years as the calcium is being leached needlessly from the bones and damaging other organs.
2
@Lynn
PTH changes because of our homeostasis, a sophisticated multi-tasking system whereby the body’s chemical and hormonal interactions work to maintain a balance, above all else, by continually correcting for and returning functioning within a normal range. Therefore you are chasing a wrong target, a constantly moving target based upon acid-base(alkaline) balance of our blood system. Instead you had better focusing on morning urine pH. Urinary pH has been shown to be a good indicator of nutritional mineral status both in population studies as well as clinical trials. Epidemiological studies showed an alkaline-generating diet with higher fruit and vegetable and lower meat intake are related to more alkaline urine.
https://www.invitehealth.com/article-body-ph-acid-base-balance-and-alkaline-diet.html
2
As a healthcare provider who does evaluation for secondary causes of osteoporosis as well as prescribe treatment, I would also note that we have previously thought that people fall and then break their hips. We now think that it is more likely that they break their hip and then fall. I have had quite a few patients spontaneously fracture - a vertebrae that fractured turning over in bed, for instance. Also, I don't know that I agree about the statement that treatment is for those "with a reasonable life expectancy". I have an 85 year old female with mild dementia - I am treating her because she has already experienced a vertebral fracture that required surgery and is in moderate amount of pain all the time. If I can prevent further fracture so that the remainder of her life, short or long, does not have more pain, that is worthwhile. Interestingly, she came to my practice for something else unrelated - her primary MD has not done a bone density nor recommended treatment options. Her daughter, who came with her, said he didn't even mention it!
20
The "atypical" femur fracture that Ms. Brody is far more common than the literature would suggest. As an orthopedic surgeon I can attest to how difficult it is to treat.
Certainly osteoporosis is aging patients is a problem, but beware of the push of drug companies. Calcium and vitamin D for older patients may be an option, but more important are lifestyle changes such as resistance training, balance programs and the use of canes or walkers, something my patients are reluctant to admit they need. Most hip fractures happen at home and removing rugs, cords, using shower chairs etc should be one of the first changes made for aging parents. I was struck by the comment that Dr. Khan's parents both fell in the same spot at home.
45
@TW My 80+ mother recently fell and broke her femur. We aren't sure of how it happened, because she was alone and I think the trauma has clouded her memory of it. She is getting physical therapy now, but what are the questions the family should be asking her caregivers (bone density assessment is probably a big one)? She is alone for periods throughout the week, and she lives in a remote area, both of which are probably going to have to come to an end.
2
As yet another orthopedic surgeon, I heartily agree with your emphasis on everything other than drugs. Two other thoughts: this begins in one’s 20’s, requiring Calcium and resistance and impact exercises, just like brushing your teeth. And that large number of folks who are dead within a year of a hip fracture- for many the fracture is just a symptom of the multiple system failure which signals the end of life. Sort of apoptosis on an organismal scale.
18
@TW and @Albert — I wish doctors would take into consideration the psychological hit a major fall and hip break can have on on an older person. I saw my once-active and vivacious mother quickly morph into a bent-over, hobbling old lady after her hip break (and replacement). So of course she had a couple more falls after that. She received the usual post-operative physical rehab after her hip procedure, but there was no prescription for counseling or other monitoring of her mental health. You can treat bones and monitor the blood and organs, but it’s imperative that the mind be maintained as well, as we age.
12
The article you cite and all pharmacologic treatments of osteoporosis are written by internists and pharmacologists.
Their focus is on disrupting the normal process of bone turnover; either turning off the the breakdown of bone or stimulating the build up of bone. This may result in more bone material, but not structurally normal bone tissue.
Bone in any person at any age will strengthen and repair itself when it is exposed to the right amount or resistance for the right amount of time.
This is the ideal strategy to prevent and treat osteoporosis. However because there is no billion dollar drug involved this well established treatment is never researched or given clinical credibility.
32
Yes I'm the outlier here - I plan to begin taking Reclast, because I value the recommendations of my endocrinologist, my gynecologist, my internist, my physiatrist, and my physician relatives, all of whom have seen patients with osteoporosis - related fractures. Moreover, I have yet to read one of Ms Brody's articles that I felt delivered mistaken or wrong-headed advice.
9
@Khars I can't agree with you. After 2 years on Forteo which changed my bone density readings from osteoporosis to osteopenia I was told to take the drug Prolia to maintain my gain. The specialist told me it was "so safe he would have his mother use it". It wasn't for me. Prolia caused me several bad side effects including fractures of the right hip and pelvis. I feel Ms. Brody hasn't done her research in the right places. The National Osteoporosis Foundation has a website called Inspire. There you can read other stories of members harmed by these drugs.
14
The side effects of these drugs are claimed to be rare. But, I spoke with my dentist about taking Fosamax, and her office will not perform extractions on people taking it. She said they refer such patients to an oral surgeon, but some oral surgeons won’t do it, either. Is the necrosis is of the jaw is so rare, why won’t a local dentist perform an extraction? And what do you do if you need one and can’t get it done?
30
@Susan My endodontist vigorously warned me against taking bisphosphonates due to the risks inherent if you have to have a tooth extracted. She said the bone may not heal and this rules out implants. She said she "has seen it" and "it is awful" for the patient. She said the drug's half life is 12 years, so even when you stop taking it, the drug remains in your system for decades.
7
@Susan--I am a throat cancer survivor, and I had radiation to my lower jaw, which puts me and others like me at risk for osteoradionecrosis, which is just osteonecrosis caused by radiation. So I don't take the regular drugs for osteoporosis, and due to poor gum condition had all my teeth extracted before treatment.
But people like me who retain their teeth and are told to undergo hyperbaric oxygen dives both before and after any invasive dental work. It delivers more oxygen, thus better healing, to the jawbone. Its effects have been so well documented that insurance pays for these dives, even though it won't for many other purposes. The typical "prescription" is for 20 dives before a dental procedure and 10 after. This might work for osteonecrosis caused by medication as well.
3
@Susan
Hi, Susan -
Thank you for your comment. My father had oral cancer, with surgery and radiation treatment, and had the hyperbaric oxygen treatment when he had to have some dental work done a number of years later. That worked for him. Having seen all that he went through, plus after speaking with my dentist, I cannot bring myself to take a medication that can have the potential side effects on the jaw that bisphosphonates can have. Best wishes to you.
3
The article doesn't mention yoga, which has been shown in peer-reviewed, published research to reverse osteoporosis and osteopenia in 83% of those who practice certain poses for 12 minutes a day,. Yoga is practically free, can be done throughout the life it generally extends, and has "side effects" like better posture, improved balance, greater range of motion, enhanced strength and refined coordination, all factors that make fracturing falls signficantly less likely. See https://journals.lww.com/topicsingeriatricrehabilitation/Fulltext/2016/04000/Twelve_Minute_Daily_Yoga_Regimen_Reverses.3.aspx?WT.mc_id=HPxADx20100319xMP.
21
@Loren Fishman, MD
Just took a look at the 12 poses suggested in the study. Poses #8 thru 11 might be contraindicated for someone who has had a hip replacement, so anyone who wants to pursue yoga as a strengthening exercise post-surgery might want to check with their physicians first.
5
@Chicagogirrl13 Many yoga poses and pilates exercises are contraindicated for those with osteoporsis. Exercise and diet did not help me. If you have osteoporosis or even osteopenia please educate yourself about the moves in these programs that can hurt you. In all my years of taking classes I never heard one instructor mention this.
4
It is frustrating that BHRT is not mentioned as a proven intervention. ;(
1
In most cases, Medicare will only cover a bone density test every 2 years. Also what is rarely mentioned is that iron supplements interfer with calcium absorption. Knowing that, I take one of my two daily 600 mg calcium supplements at breakfast and lunch and take my multivitamin w. iron at dinner. I think the side effects of bone-protecting medication are too risky and will not consider them. I exercise (dog walking several miles a day). Indeed, breaking a hip would be devastating but not as much as jaw necropsy or a stroke which I can prevent by avoiding the optional meds.
8
Bisphosphenates are harmful. They work by stopping the osteoclasts from removing old bone. Therefore the old bone material remains and shows up as "bone" in the DEXA scan. But it is not functional bone material. The crystalline structure is more like saltines than functional bone. So of course -- you crash and fall even without trauma.
Wait, there's more: the osteoblasts, which build new bone, only work well when they get signals from the osteoclasts. Remove the osteoclasts and the osteoblasts stop working too.
If that weren't bad enough -- this drug stays in the body and keeps working for years after you stop taking it.
This is the drug that was prescribed to millions, before the method of operation was truly understood. I took it myself for years.
47
I have had bone density measured every two years (the most that is allowed by most health insurance plans). My doctor ordered it. I'm surprised that Jane Brody skipped this for long period. It was done when I went for a mammogram. I never even thought to refuse it.
3
The assumption is that this is an old age issue, but the reality is the military takes very high non-combat low-trauma injury rates.
Lappe et al found roughly 20% of young women at entry to the Army had osteopenia/osteoporosis. Lappe also decreased Navy basic training stress fracture rates by 20% with extra vit D and calcium.
The AF found roughly 25% of women and 9.5% of men had iron anemia at entry. Treating the anemia significantly decreased injuries and attrition.
Multiple studies (Westphal et al for one) found malnutrition increased post-entry.
Rivero found 60-80% of Navy basic trainee stress fractures had osteopenia/osteoporosis.
Meanwhile the Army re-injury rate can be as high as 350% (USARIEM).
The Institute of Medicine suggests that the RDA/DRI are not normed on an athletic population, and, therefore, may not account for athlete's increased sweat losses and tissue damage.
The point being that an inadequate diet, poor exercise hx, smoking, etc. at any age can lead to low trauma injuries with poor treatment outcomes..... especially if the HCP doesn't look at the patient comprehensively. Just casting doesn't address etiology.
Eat a healthy diet? How? The USDA says nutrient content of food has declined significantly. Or look at NHANES data re population deficiencies. Even assuming folks are eating real food anymore.
You can buy comprehensive blood chemistries online. Hard data is the only way to go.
7
"After a hip fracture is repaired, people often fall through the cracks." Ha!
24
Bones are a living protein (50%)-mineral-fat matrix that respond to loading stress....bones are metaphorically stiff muscles.
It is true that normalizing calcium and vitamin D (to a 50 ng/ml serum level) will help, but bones need 20+ nutrients and osteogenic loading to be optimally strong.
Therefore, you want to do a comprehensive blood chemistry and normalize all nutrient values. As you know, the USDA documents declining nutrients in food and the avg American diet is 60% process food. BMD (as measured in NHANES) is declining.
BMD is not strongly predictive; the better measurement is pQCT.
You should read the NASA studies on bone health.
Therefore, to prevent a second break, you want to optimize all nutrient levels (especially protein), consider vibration therapy, begin weight bearing exercise, and add plums/prunes to your diet.
Elderly folks face a number of issues... declining vision, decreasing balance, loss of appetite, etc.,,,,therefore multiple interventions are needed in terms of re-engineering the home environment, balance training, better nutrition, etc.
Obviously stopping smoking is important because smoking interferes with bone re-modeling. Plus adds heavy metal poisoning.
See www.slideshare.net/James8981/fracture-healing-141129888 or www.betterbones.com
We have created a research system that creates misleading conclusions with its focus on single variables. Organic chemistry is really the interaction of many variables, not just one or two.
30
Kudos to florida, Diane, and Molly, among others. When my right femur snapped in May, 2011, after 12 years on Fosamax (recommended by a board-certified, female internist and also a board-certified, female rheumatologist as well), two different orthopedic surgeons told me, "Bisphosphonates are evil drugs. Do weight bearing exercise." I have not had a bone density test since that time. A bone density test cannot "see" how bisphosphonates make the insides of your bones brittle. I walk two miles daily as well as 20 minutes of yoga. To all of you out there, please find a physician not brain-washed by the enticement of bisphosphonates.
61
@PR
Yes, I agree. I read somewhere these drugs result in strong scafolding surrounding a weak building.
6
Oh my gosh, I can't believe I'm reading some of this garbage you are writing.
My mother in law was put on Fosamax because...who knows? She did not have osteoporosis. I guess because of her age, and that she is of slight build. After 6 years, her femur broke as she was getting out of a car. The surgeon said it looked like she was in a bad car accident. 4 more years of Fosamax and the other femur broke as she started to walk up a flight of stairs. So she is in that "teeny tiny minority" of atypical femur fractures. Well let me tell you, it totally changed her life. And how do we know that those broken hips are from people hitting the floor? How about their hip breaks FIRST and they fall? We have no way to measure that.
You have no mention of diet and exercise to prevent bone loss.
I hope, Ms. Brody, that you are will not join that group of AFF patients who have suffered so much with the use of these drugs.
44
I think doctors should give women hormone replacement therapy during and after menopause. I had a very intelligent doctor who put me on hormone replacement therapy after I had to have a hysterectomy at age 40 (but that’s another story). Anyway, I stayed on it till I moved to another town and had to have a new doctor who wouldn’t give me HRT. She FINALLY agreed to let me have estradiol but only at 50mg. So now in my 80’s with the estradiol and taking vitamin D, calcium, LEF’s ArthroMax and Bone Restore, my bones are still fairly strong. Plus exercise.
Why are doctors so reluctant to give women HRT, when they’ll give men testosterone at the drop of a hat?
22
@April Kane
Read the book "Estrogen Matter". It talks about the flaws within the biggest research of HRT, The Womens Health Initiative. It is an eyeopener. HRT helps women and conventional doctors are relying on flawed data.
5
@April Kane
I too am on Estradiol (patch) and promethium. Started around age 40 as I went through early menopause. Am 70 now and still taking these. My one regret is that I ever took Fosamax. Wish I had dodged that bullet as you did. Am convinced that HRT forever is the way to go, if you have a risk profile that suggests you are more likely to fall and break a hip, than you are to get cancer.
12
@April Kane I agree with you because of my personal experience. From about age 50 to age 65 I used HRT. Then the Women's Health Initiative made us feel that HRT was dangerous so I quit. A few years I started using Fosamax until (after 5 years use) I learned it could cause atypical femur fractures. I've told the rest of my story that Prolia caused fractures.
1
I am very surprised that there is no mention of the parathyroids in this article. Any person who breaks a bone in a less than traumatic situation should, at the very least, have their calcium, parathyroid hormone (PTH) and vitamin D checked in the same blood draw. They should insist.
Primary hyperparathyroidism occurs when PTH elevates. PTH's job is to call for calcium, which it takes from the bones. It almost always results in osteopenia or osteoporosis, and it causes a slew of there symptoms, such as kidney stones, bone pain, and exhaustion. It is cured by a rather simple surgery.
The parathyroid glands are located on the back side of the thyroid, hence their name, but they are entirely separate from the thyroid. And, for some unknown reason, they are hardly ever on a physician's radar. The should be on every physician's radar, as part of the annual check-up.
Fun facts: It is the third most common endocrine disease, after diabetes and thyroid. The occurrence is estimated at 1-7 per 1000 adults. The chances of having it increase as one ages and it it 3 times more common in women than men.
This article is really remiss by not mentioning primary hyperparathyroidism. In fact, all the bone building drugs in the world won't work if a patient has this disease.
28
@mbm My mother at age 80 told her pcp that she was feeling much more tired than usual. Her pcp's first response was "You're 80. what do you expect?" but my mother insisted "this isn't me" and the pcp referred her to an endocrinologist who tested her and diagnosed hyperparathroidism. After the surgery, my mother was back to swimming 45 minutes a day. Know thy body!
11
@mbm
You offer very important, critical information! Hyperparathyroidism can cause lots of bone pain and aches due to the calcium drain. It is known as "stones, bones, groans".
Two members of my family developed parathyroid adenomas that were indicated by high blood calcium. One sister had a doctor who was alert and sent her on to an endocrinologist. The other self-diagnosed (her doctor had ignored it for several years) after learning of our sister's test result and sent herself to the same endocrinologist.
Elevated PTH can be caused by one or more adenomas which can develop on the parathyroid gland. There is a narrow range for normal blood calcium. It will naturally have spikes and lows however the calcium level should stay within that narrow normal range. If the calcium level is even SLIGHTLY high, even within that "normal" range, it is an excellent reason to, at minimum, have another calcium test and compare results. A PTH test and sestamibi scan of the parathyroid can help confirm the adenoma. If there, surgery will follow.
Hyperparathyroidism can be completely (and only) cured by removal of the adenoma(s) and the blood level of PTH and calcium return to normal. Calcium that was being drawn out of the bones will correct itself. It is a life changing procedure.
Also, blindly supplementing with Vitamin D and calcium after a poor Dexascan can be dangerous if hyperparathyroidism is the actual problem. See a doctor and DON'T brush off a "slightly elevated" calcium level.
4
So disappointed to see no mention of physical therapy or exercise in here. The science is clear that it helps, is safe for nearly every patient, and is without major side effect or drug interaction. Try these safe and fun interventions as part of your treatment plan!
48
@Jennifer Norris
Agree. As well as, perhaps, occupational therapy for fall avoidance techniques.
4
Not once is exercise, particularly weight bearing, mentioned here, for example, tai chi which has been proven in clinical trials to increase bone density and strengthen muscles, tendons, ligaments which support bone. Osteoporosis drugs are contraindicated for many who have risks for those side effects ! Most of what we hear about supplements is negative; that is, they don't work (re: D and Ca).
Exercise, to whatever capacity one has, and diet are crucial to mitigating this serious condition.
50
not to mention all the other psychological, social and physical benefits from exercising. a pool you take alone, Tai Chi you do in a group. better yet, start early, not only after your first fracture.
2
@florida And tai chi is lots of fun. Taking dangerous drugs isn't.
2
Well, all very well having an annual bone density test but my insurance will only pay every three years, and this after I broke a toe and a wrist in quick succession.
10
Tragedy and irony of the modern conventional medicine is that doctors rely too much on symptoms-based and pharmacological solution without much learning on nutrition, particularly micronutrients such as vitamins, minerals, antioxidants etc. even though we encounter chronic degenerative diseases mostly or partly caused by decades of deficiencies in micronutrients as Dr. Bruce Ames hypothizes in his "triage" theory. It seems that these diseases including osteoporosis are multi-factorial ones to involve multi-gene expressions and multi-epigenetic factors, and ,because of this, one miracle medicine targeting one symptom can't solve the problem. How many doctors are taught on genetics and epigenetics? How many doctors know the fact that the vitamin D receptor complex regulates 3% of the human genome, and about 10% of human genes are directly or indirectly responsive to vitamin D? (Ref. Clark, A., & Mach, N. (2016). Role of vitamin D in the hygiene hypothesis: the interplay between vitamin D, vitamin D receptors, gut microbiota, and immune response. Frontiers in Immunology, 7, 627.)
Researchers and doctors engaged in conventional medicine had better realize the fact that single miracle medicine targeting elimination of "amyloid plaques" for Alzheimer's treatment has never succeeded in spite of investment of billions of dollars and thousands of researchers. Osteoporosis, autoimmune diseases, type 2 diabetes, fatty liver and many other chronic diseases are in similar situation.
19
@Wind Surfer
Awesome comment.
3
How about Magnesium?
17
Falling a second time and sustaining a second fracture may very likely be because balance and sufficient strength of the first broken leg were never properly achieved. This is not mentioned. Surgery and drugs cannot fix all. The hard but successful work of a good rehab program can help prevent additional falls. A thorough physical therapy program should include this. Don’t quit PT after you can walk 50 feet. Strength and balance!
43
And yes, a home care PT can do a thorough fall risk assessment in the home. So helpful after a first fall and fracture. Don’t wear slip on slippers, move cords, add grab bars, don’t use wheeled and swivel seats, add a raised toilet seat etc...recommendations are individualized by a person’s size, home setting, assistive device used , balance and strength etc...
25
I am a retired Orthopaedic Surgeon. The controversy of management for Osteoporosis is real and unsettled, but an important part of management is diagnosis. Women, particularly fair skinned white women, who smoke or smoked, breast fed a child, or have a family history of osteoporosis should have a bone density evaluation early, probably before age 30, but certainly before menopause. If her bone density is low there is time for intervention without medication. Waiting until she sustains her first hip fracture is too late.
28
@Dempsey Springfield, MD
Would the esteemed Dr. Springfield care to comment on his medication recommendations for older patients?
7
It is really disappointing to see yet another article promoting the use of bisphosphonates (Fosamax, Reclast, Boniva, Actonel, etc.). According to the author, the doctors prescribing these drugs still seem to regard the risks as insignificant when compared to the benefits. The risks are likely much higher than has been publicized because the reporting is often spotty and/or inaccurate. More research is needed, and not by Big Pharma, but by independent researchers not looking to cash in.
I experienced an atypical femur fracture after 5 years on alendronate. I did not have osteoporosis and still don't. Bisphosphonates make bones brittle. I did not fall and break my leg. My leg broke upon standing and then I fell. Those of us who have lived through the experience and the aftermath of trying to resume a normal life regret that we were ever convinced to take these drugs. Healthy diet, exercise, the right supplements (which may vary from one person to another) should always be the first line of defense. Routinely using these drugs is a mistake. Each person with doubts about the best treatment for them should have a careful, complete evaluation and should not just swallow such a dangerous pill without understanding the risk of truly life-changing consequences.
87
@Diane I agree with the not-so-fast-prescribing advice. My doctor said I had osteopenia and prescribed Fosamax. After four months on the drug, I had such extreme bone pain I could barely walk My doctor didn't believe me that the drug could be causing the pain, but did offer me pain drugs. I discontinued the Fosamax but it took almost a year before the pain eased. Further testing by an endocrinologist showed that I didn't have the spinal osteopenia my primary care doctor had said. I had some arthritis in my spine. While this article makes side effects seem minimal and rare, I would never want to go through that experience again.
4
Triage theory for vitamin D (Source: Vitamin D Council)
"The triage theory: Does vitamin D fit?"
https://www.vitamindcouncil.org/the-traige-theory-does-vitamin-d-fit/#.XLYZIehKiM8
"Vitamin D’s main role is to maintain serum calcium, making sure the blood has enough calcium to keep the body alive in the short term. But what about long-term? Research is still far from conclusive, but it appears that vitamin D is implicated in a multitude of long term health conditions, like cancers, cardiovascular diseases and autoimmune diseases. Drs Ames and McAnn have special interest in mental health, and vitamin D’s potential role in delaying the onset of mental health disorders, like dementia.
The implication here is that maybe the body only needs a vitamin D level (25OHD) of 10-15 ng/ml to maintain serum calcium. But then when the body has a level of 20-30 ng/ml of vitamin D, it can better maintain bone health. And then when the body has a level of 30-40 ng/ml, it can start to protect against things like cancer, and so on. These figures arbitrary and theoretical, but you can see the suggestion."
5
Reading all the advice given here and after other such articles, I have one more comment. Young women need to begin considering how their life style will contribute to their bone condition. I wish someone had told me when I was younger that my greatest bone density would be achieved before age 30. Then I would have been more careful. I see young people drinking sodas instead of milk. Also, there are many other habits that will cause poor bone quality later. If you really want to have good bones, start early.
34
@Lallie Wetzig
Actually, age 40 -- get out there and pound the pavement.
1
Time for Ms. Brody to retire and get someone with medical education. I fell from an upper living room onto solid Italian tile lower living room. Fractured my femur. Underlying cause Meningioma of Pons that destroyed vestibular information connection to brain by pressure on 8th cranial nerve. There are many reasons for falling in older people.
18
I'm not sure osteonecrosis of the jaw is so rare a side effect of the meds for osteoporosis. My DH was recently hospitalized for an infection of the jaw from this and the OMS doctor said they have been seeing more and more cases of ONJ with these meds. My DH had to have IV antibiotics, surgery, was in a medically induced coma for 18 hours then ICU for 4 days. It was harrowing. Of course we are stopping the Prolia and now we are told he will be at an increased risk of a fracture of a spine in stopping it. I question the idea that ONJ is so rare with these meds, how does anyone know? I have a background in statistics myself.
37
@Anonymous Yes, I agree, how does anyone know. It is possible to report these side effects, but I know that very few people do this. The only way I found out was from another member of Inspire. I've never read anywhere that someone collected and published this information.
9
First, I am not a kook. OK? I have a degree in Chemistry and I did research for a pharmaceutical company. I took Fosamax for five years, but still had osteopenia in some parts of my back and osteoporosis in others. On advice from I friend I respect, I started drinking 1 tsp of baking soda in a cup of water every night. My recent bone scan shows no osteoporosis at all, and only osteopenia is several others. I was skeptical, but the proof is in the pudding. Not only that, I not longer have acid reflux. Try it, it can't hurt you!
23
@Bet Interesting; I'll give it a try. I too used Fosamax, for over 5 years until I read an article in the New York Times about atypical femur fractures associated with use of the drug. And, about 6 months after I stopped I had a spinal fracture lying in bed one night. Originally I said the drug didn't prevent the fracture, but now I suspected that using Fosamax for more than 5 years caused the fracture.
23
As a retired Nurse Practitioner , I am very aware if the side effects of drugs like Fosamx- now pharmacists will tell yo how rare how rate they are -but if you are one in say 100.000 people to get one of these side effects like Jaw necrosis- then you will have a more sever issue
have early osteoporosis in my left hip. I have - 1- more more emphasis on exercises like alking - weight bearing ones , losing weight , and have started a very low dose Estrogen patch. Studies done in Europe and the US show Estrogen helps the body build new bonbe cells- with very very few side effects- no increase in Cardio Vascular issues or Breast Cancer- I am not sure what an alternative would be for men- but I am not a fan of any of these drugs and even if I wanted frequent bone density tests Kaiser would not offer them- there is not need - unless you have had serious side effcts from Osteoporosis - otherwise one of two of them in a life time
11
Jane, I wish you would quit recommending these drugs. After 2 years using Forteo, with results that changed my osteoporosis to osteopenia, I was told I needed to use another drug to maintain my benefit. At the time Prolia was new, and the specialist said "it is so safe I would have my mother use it". Well, it wasn't safe for me. After 2 injections I was having difficulty walking and the doctor gave me a third injection without even an x-ray to locate the problem. A hip replacement surgeon ordered a MRI and found I had fractures of my hip and pelvis. Until they find a way to determine who will or will not benefit I would never recommend this drug. Also, after spending some years on the NOF website Inspire I know that my story is not unique.
51
@Lallie Wetzig I agree. After all I’ve read I’ll take my chances without these drugs.
19
How do these recommendations change for someone suffering from dementia?
Medical procedures and drug regimens can be extremely difficult for patients like this to follow, and the outcome of a hip fracture can determine whether or not the patient is suitable for residence in an assisted living facility.
13
As I explained "triage" theory of Dr. Bruce Ames, based upon genetic study, our body seems to select blood coagulation for the allocation (short-term necessity) of scarce vitamin K, and body ignores usage of scarce vitamin K for age-associated conditions (long-term necessity) such as bone fragility after estrogen loss (osteocalcin) and arterial calcification linked to cardiovascular disease". Therefore researchers advise that sufficient vitamin K is necessary for optimal function of vitamin K-dependent proteins that are important to maintain long-term health.
https://academic.oup.com/ajcn/article/90/4/889/4597018
12
Though necessity of vitamin D for osteoporosis is well-publicised, we don't know much about the fact that vitamin D prevents "fall and fracture" because low level in vitamin D will lead to "impaired muscle function and mobility", which is a leading cause of falls in seniors, and can lead to broken bones and other injuries. "A randomized controlled trial of the effects of vitamin D on muscle strength and mobility in older women with vitamin D insufficiency." https://www.ncbi.nlm.nih.gov/pubmed/21054285
Though necessity of supplementation of micronutrients has been denied by many mainstream scientists often, we need to reconsider the "triage theory" by Dr. Bruce Ames", a renowned scientist of our time, saying " micronutrient deficiencies cause insidious damage that
accelerates age-associated chronic disease". He says that our body constantly makes priority decision for the usage of scarce micronutrients for short-term necessity than long-term necessity. Because of this, most people in deficiency of vitamins, minerals etc. encounter chronic degenerative diseases like osteoporosis, dementia etc. etc.
http://www.bruceames.org/Triage.pdf
9
Angry readers are attacking Jane as proxy of our conventional medicine, not personal, I assume.
Many people seem to think nutritional/exercise approach requires long-term therapy in order to get better results. However, vitamin D therapy for the improvement of muscle strength and mobility took only a year, in spite of decades of their negligence in nutrition.
Similar quick recovery is occurring for the Alzheimer's patients, who also have suffered from decades of deterioration, by the lifestyle changes centering in nutrition. Dr. Dale Bredesen of UCLA and his group of doctors have recovered executive function, cognition and memory of over 200 Alzheimer's and MCI etc. patients in relatively short time in spite of the fact that their deterioration of brains had continued over decades.
Please read 16 doctors therapy report from nationwide medical institutions including Cleveland Clinic.
https://www.omicsonline.org/open-access/reversal-of-cognitive-decline-100-patients-2161-0460-1000450.pdf
11
Osteoporosis is not a disease, it is a risk factor for a bone fracture. And it accounts for only about 5/6 of the total risk for a fracture.
The other 5/6 risk factors include poor muscle tone, poor balance, poor eyesight, poor lighting, slip and trip hazards in the home, no or inadequate railings, etc. All of these factors can be addressed and improved without drugs.
Calcium supplements have been associated with increased heart attacks and strokes, and the evidence does not show that they are effective in reducing fractures. It is much, much better to get calcium from the diet, especially dark leafy greens.
And the drugs to increase bone density may actually slightly increase bone density, but they do not appear to reduce the risk of hip fractures by much, if at all. Bone density is a poor proxy for bone strength.
87
Dark leafy greens... to get 1,200 mg of calcium/day you only have to eat at least 12 CUPS of the very best of them (and they're not all the same)! By all means eat lots of them, they're good for you, but probably not the keystone for getting calcium for most people. Canned (with bones) salmon and sardines are loaded with calcium, as is dairy of course (even non-fat).
24
@John, actually, "one cup (190 grams) of cooked collard greens has 266 mg — a quarter of the amount you need in a day (28)." Other plant sources of calcium include beans, almonds, and seeds. https://www.healthline.com/nutrition/15-calcium-rich-foods#section1
Also, 1200 mg of calcium/day sounds excessive. "Newer data, based on calcium balance studies in which researchers make detailed measurements of the calcium going in and out of people, suggest that the calcium requirement for men and women is lower than previously estimated. They found calcium balance was highly resistant to change across a broad range of intakes, meaning our body is not stupid. If we eat less calcium, our body absorbs more and excretes less, and if we eat more calcium, we absorb less and excrete more to stay in balance. Therefore, current evidence suggests that dietary calcium intake is not something most people need to worry about." https://nutritionfacts.org/video/are-calcium-supplements-effective/
21
@Dr. J
A doctor who knows something about nutrition?
Wonders never cease.
9
My grandmother had just recovered from a hip fracture ans was able to go home. Within a few weeks, she sat down in a swivel chair which turned and dumped her to the floor and she broke her other hip. That did her in. This article mentions several instances of people falling a second time. I would think the first preventative measure should be to safety check the home: remove obstacles and slippery rugs, make sure you've got handrails in the bathroom and stairways, and get rid of evil swivel chairs.
65
I know someone who within the past ten years received one of the annual bone loss treatments...Reclast sounds familiar, though I’m not certain if that is what my friend received. She now is contending with very expensive and painful jaw necrosis, visiting dentists and specialists, losing teeth, struggling to heal.
36
Calcium on the artery wall can be scraped off and be transferred to bone and muscle by vitamin K. Joint usage of vitamin D and K is most useful. "Vitamin K2 is associated with the inhibition of arterial calcification and arterial stiffening, which means that increased vitamin K2 intake could be a means of lowering calcium-associated health risks." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566462/
Secondly, we need to lower the level of homocysteine, a toxin for brain, artery wall and endocrine system, in order to prevent osteoporosis. "Recent data suggest that homocysteine (Hcy), folate, vitamin B6 and vitamin B12 affect bone metabolism, bone quality and fracture risk in humans." https://www.ncbi.nlm.nih.gov/pubmed/16197307
Most older people need to test their homocysteine level, though current testing done by major labs are not precise. In my case, test result by Quest was 25% higher than the retested at Cleveland Clinic. This is because homocysteine starts to leak out from red blood cells instantly after blood sampling. Labs need to remove red blood cells from the sample ASAP after sampling. http://mthfr.net/elevated-homocysteine-level-or-laboratory-error/2012/03/02/
Older people need to take "methyl" B-12, folate and B-6 to lower homocysteine because their methylation became poor.
23
Precisely! This is information that my (dental) patients never have. I frequently see patients taking calcium and D3, but Never K2. I "suggest" that without K2, the calcium goes to arteries and kidneys, but will not help bone density. But since I am only a dentist, I ask them to talk to their MD about this. Frustrating. @Wind Surfer
30
@Wind Surfer
"Homocysteine is a common amino acid in your blood. You get it mostly from eating meat. High levels of it are linked to early development of heart disease. In fact, a high level of homocysteine is a risk factor for heart disease. It's associated with low levels of vitamins B6, B12, and folate, as well as renal disease" - webmd. I'd like to see more about how diet affects osteoporosis. Does eating meat and dairy increase risk? Are vegans with healthy diets having less risk for osteoporosis? After my mother-in-law's brutal kyphosis spinal collapse that sent to a nursing facility permanently, I am genuinely quite upset the public is not provided with evidence-based advice, only sales pushes from drug companies and meat/egg/dairy. I'm vegan since November 2018 and my chronic severe back pain vanished within a month of banning animal products from my diet.
8
@Grant Chyz
Expecting most doctors to know that much is asking a lot.
6
The usual nonsense from Ms. Brody. Taking medications to "help" with bone loss PALES in comparison to the direct, immediate benefits derived from resistance training. Resistance training improves bone density by putting stress on bones, with greater force resulting in greater results, which is why heavy weights with fewer repetitions are typically recommended for bone (and muscle) benefits.
Doctors--at least doctors who are interested in something other than dispensing prescriptions for pills--know this. Ms. Brody does not. So, if you wish to fight osteoporosis with magic pills, go for it. The rest of us will be at the gym.
113
@Greg Gerner Nailed it!
14
In her defense I think she is giving exactly what doctors would advise and the problem here is that they never seem to advise eating right and exercise. They simply aren’t taught that...better living through big pharma only is the medical school motto.
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@Greg Gerner - with all due respect, I am a 67 year old Caucasian short woman - have been going to the gym for years and yet I still have osteoporosis (started with ostopenemia and at that time my doctor did not recommend that I start additional medication). I am also a breast cancer survivor and take arimedix which is an estrogen blocker - but unfortunately also causes weight loss. Because I've been going to the gym for so many years, no one was more surprised than me to get osteoporosis - but my oncologist has said all the things I did were the right thing to do but sometimes it's just genetic (and being a short Caucasian woman is apparently a higher risk factor). And yes, I avoided taking meds for some time...I just started taking them (so far with no ill effects)...and yes, I continue to go the gym where I do resistance training and weight bearing exercises.
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I agree with most everything the author has written. However I do think stability training and testing should be included for at risk individuals. Drugs needs need not always be the first line of defense.
The article mentions a man and wife falling in the same place in a house. Fall proofing your home is necessary. As people age it may become necessary to remove the scatter rugs and improve lighting near stairs to help prevent falls.
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