Category: Bone Health

by Marcelle Pick, OB/GYN NP

The brief acceleration of bone loss (also called resorption) that every woman experiences during menopause indicate that a dip in estrogen levels promotes bone resorption—and research has borne this out. It’s one reason many doctors prescribe Hormone Replacement Therapy (HRT). Furthermore, evidence shows that low doses of estrogen does slow bone loss, inhibiting osteoclast activity, but plateaus at about seven years post-menopause. What’s more, progesterone seems to be just as beneficial for bone formation, encouraging osteoblast activity.

However, once HRT is discontinued, bone loss accelerates to reach its age-appropriate rate. Most of these studies are rarely carried out for longer than a few years, at which point bone loss may have stabilized itself. So HRT may hold the train at the station, but it will eventually depart. And there’s no indication that HRT therapy has any long-term effect on fracture risk in women over 75—when most fractures occur.

Remember that bone function is a two-way street; if resorption is delayed, then so is formation—so no bone is lost, but no new bone is made. What effect does this have on bone strength (an answer the makers of Fosamax have yet to discover).  No studies have been done to examine what the long-term side effects on bone are following HRT therapy.

Evista (raloxifene) is a selective estrogen receptor modulator similar to tamoxifen. It is often prescribed to women with osteoporosis. Developers claim it reduces fractures without the risks of HRT. Side effects include increased hot flashes, leg cramps, flu-like symptoms, blood clots and peripheral edema, among others.

What’s appears to be more important is to promote your bodies natural hormonal balance throughout adulthood so that bone growth stays consistent or only slightly slower than bone loss. This can be difficult during perimenopause, when progesterone levels fluctuate, or if you’ve had your ovaries removed at an early age.

For more information, read our many informative articles in our Bone Health and Bioidenticals and HRT sections.

by Marcelle Pick, OB/GYN NP

Breaking a bone is scary, there’s no doubt. And when it is a major bone, like your pelvis, hip, or spine it can be debilitating. But the numbers surrounding the prevelance of wrist, hip, and spine fractures and osteoporosis just don’t match up with what we know.

Most fractures occur as the result of falling. Wrist fractures occur most often from women bracing themselves as they fall and have less to do with fragile bones than the conditions of the fall. As response time declines with age, women are less able to throw their arms up in time and end up falling on their hips.

Statisticians will tell us that more than one third of people over 65 will fall at least once. About half of them will have a fracture (15%). If you have established osteoporosis, the risk of life-impeding fracture is elevated because once an osteoporitic bone is broken it is very difficult to mend.

Hip Fractures

Hip fractures are particularly frightening because they have the most impact on a woman’s quality of life. After age 75, 30% of people with hip fractures don’t recover enough to fully engage in their usual lives. By 90, one third of all women may experience a hip fracture.

But these figures are misleading when it comes to osteoporosis because at least half of all hip fractures after age 80 can be attributed to a fall caused by other factors—not a bone spontaneously breaking. And in most cases where bone fragility was a factor there were other co-factors.

The statistic you need to heed is that over 85% of women turning 50 years old today with a life expectancy of 80 will not have a hip fracture, regardless of their bone density. Perhaps by then we’ll all feel comfortable wearing aerodynamic hip pads under our clothes—a simple device proven to prevent broken hip bones.

Spine fractures

Losing height and getting a hump are two images of osteoporosis seared into our brain by the media—but the truth behind spine fractures is less daunting. Most vertebral fractures are due to compression and are symptom-free.

Spinal compression occurs when the cushioning tissue between each vertebrae deteriorates over time—it has nothing to do with osteoporosis unless you have been diagnosed with spinal osteoporosis. Losing height for the vast majority of women is just part of gravity’s pull.

Spinal deformity caused by hairline fractures in the vertebrae can cause curvature of the spine and back pain: the dreaded “dowager’s hump.” The chance of developing this condition is exceedingly rare in women under 80.

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by Marcelle Pick, OB/GYN NP

Early use of bisphosophonates—the class of drugs that includes Fosamax (alendronate), and Actonel (risedronate), was industrial: corrosion prevention, laundry soaps, and fertilizer. They were used primarily in the textile and oil industries.

Scientists only discovered that bisphosphonates inhibit bone resorption (or bone loss) in the late ‘60s. Bone scans proved that the drugs increased bone density as long as they were taken regularly. FDA approval of Fosamax for use in the treatment and prevention of osteoporosis occurred in 1995. Since then these osteoporosis drugs have quickly gained market share, fueled by dire warnings of the impending osteoporosis crisis.

There have been no studies how these drugs effect bone and overall health with long-term use. The longest study spanned three years. And now that we know that inhibiting bone loss also inhibits new bone growth—its very likely that we are creating a generation of women with dense but old and brittle bone. But how will we know?

Since almost 40% of women over 50 are considered at risk for osteoporosis, it seems we are in the midst of yet another grand public experiment the scale of which rivals the early days of Hormone Replacement Therapy (HRT). It’s what the industry calls “post-market surveillance” and you are paying for it.

Merck, the parent company of Fosamax (as well as Vioxx) claim that their drug is safe is taken as directed (upon rising, with a full glass of water at least 30-60 minutes before breakfast). Inflammation of the esophagus and stomach lining can occur if you lie down too soon after taking the pill. They assert that long-term use has no ill affect.

While this may be true for women who use the drug for a limited time (6-24 months), over time the side effects appear to worsen. Women taking Fosamax for more than a couple years report serious bone and joint aches and increasing pain and discomfort (perhaps a side effect of accumulating old bone with no new bone growth?).

What’s more, a 1993 report discovered that a small percentage of bisphosphonate users experienced serious eye problems that could lead to vision loss; one third of the study group complained of blurred vision. More troubling is the small group of people in a recent study who were on corticosteroids and then Fosamax-like drugs: 1 in 12 had their jawbone deteriorate.

I see this borne out in my practice all the time. Women come to me on Fosomax who are experiencing the beginning of systemic failure—which makes sense when you think that this is a class of drug in the same family as cleansing powders! What’s more, most of these women could do more to prevent bone loss by making certain lifestyle changes, without the risk. Afterall, to get FDA approval, you only have to prove your drug is more effective than a sugar pill.

If reading the news about Vioxx and other drug recalls is not enough to convince you that pharmaceutical companies have their bottom line at heart, not the public’s interest, consider this quote from FDA employee and whistle blower Dr. David Graham: “But, when there are unsafe drugs, the FDA is very likely to err on the side of industry. Rarely will they keep a drug from being marketed or pull a drug off the market… There’s no incentive for the companies to do things right. The clinical trials that are done are too small, and as a result it’s very unusual to find a serious safety problem in these clinical trials. Safety flaws are discovered after the drug gets on the market.”

I think it’s time we stop being guinea pigs. Osteoporosis is an easily preventable and highly treatable disease—it just takes a little work.

For more information, read our many informative articles in our Bone Health and Bioidenticals and HRT sections.

 

by Marcelle Pick, OB/GYN NP

Bone fractures are scary, there’s no doubt. And when it is a major bone, like your pelvis, hip, or spine, a fracture can be debilitating, even life-threatening.

Many women think that osteoporosis or low bone density is a leading cause of bone fractures — one reason why the disease is so frightening. But the statistics just don’t show that osteoporosis is a major cause of fractures of the wrist, hip, or spine.

Most fractures occur as the result of falling. Wrist fractures occur most often from women bracing themselves as they fall. And not many falls are caused by osteoporosis. As response time declines with age, women are less able to throw their arms up in time and end up falling on their hips.

Statisticians will tell us that more than a third of people over the age of 65 will fall at least once. About half of them will have a fracture (i.e., 15% of the total will have a fracture). If you have established osteoporosis, the risk of a life-impeding fracture is elevated because once an osteoporotic bone is broken it is very difficult to mend.

Hip fractures

Hip fractures are particularly frightening because they have the most impact on a woman’s quality of life. After age 75, up to 30% of people with hip fractures don’t recover enough to fully engage in their usual lives. By age 90, a third of all women may experience a hip fracture.

But that doesn’t mean that hip fractures are caused by osteoporosis. Even after the age of 80, at least half of all hip fractures are the result of a fall caused by other factors — not a bone spontaneously breaking. And in most cases where bone fragility was a factor there were other co-factors.

A study published in 1995 in the New England Journal of Medicine reported that in 65-year-old women with no previous history of hip fracture, a number of other factors were more significant than bone density in predicting fractures, such as tranquilizer and sleeping pill use, poor coordination, poor vision and depth perception, past history of hyperthyroidism, being tall, low blood pressure and rapid pulse, and lack of muscle strength. The general health of the woman was also a significant factor in predicting bone fractures.