Osteoporosis is a disease that affects the structural ingegrity of the skeleton, resulting in low bone density. Osteoporotic bones are more brittle and fragile, resulting in an increased risk of skeletal fracture. In the case of the elderly, hip fractures especially carry a very high morbidity rate, so preventing osteoporosis could literally save lives. Well, whenever a condition is labeled "life-threatening," it starts to get publicity, so we tend as a society to clamor for a treatment (rather than figure out why the condition has popped up in the first place). Currently, 10 million Americans have been diagnosed with the disease, with 8 million of them women. With this large of a market, big pharma has pooled a lot of money and resources to put together a marketing...errr...treatment plan to combat this disease. These drugs are called bisphosphonates and they include the brand names Boniva and Fosamax. Unfortunately, while enjoying lucrative sales (to the tune of making osteoporosis treatment a $12 billion per year business) they've only made it worse by ignoring the true cause of the disease and pushing drugs that may do more harm than good in the long run.
In fact, osteoporosis medications have been linked to an increased risk of fracture, especially for those who have been on the medications for more than five years (the x-ray of that horrific femur fracture at the beginning of this post is from a biphosphonate victim). The fractures commonly occur in the femur. The patients often suffered a painful, aching sensation for several weeks before the fracture occurred. The type of fracture suffered is similar to what one might experience after a very serious injury (like a car accident). However, these individuals who suffered these fractures experienced no trauma whatsoever, which left the ER docs scratching their heads. It took a while, but they finally figured out that these people all had one thing in common: they were all on osteoporosis medications. Whoops.
Eventually, the situation forced the FDA and WHO to evaluate the safety of these drugs. A class action lawsuit is now underway. Officials have now issued a warning on all these medications, including a clear warning on the label. But what good does a warning on a label do if your doctor has already prescribed the drug? Every drug has a side effect, so when people see these warnings, it doesn't even phase them anymore. In addition to the more recent discovery of increased fracture in weight bearing bones, Fosamax has been known for years to cause osteonecrosis of the jaw, a very painful condition which roughly translates to a "rotting or decay" of the jawbone. This condition has been noticed by so many surgeons that when they see it, they refer to it as "Fossy jaw." Cute.
How could this be? What are these drugs doing? Why aren't they working like they are supposed to? Aren't they supposed to prevent fractures? How could those well-meaning drug companies and government agencies let this happen?
The mechanism of so-called "osteoporosis medications" is to try to artificially make the bones more dense. Unfortunately, density does not always correlate with strength. Take lead for example. It is VERY dense; much denser than iron. Heck, Superman can't even see through it. But it is not very strong. Lead is roughly 50 per cent more dense than iron, yet iron has nearly 20 times more tensile strength than lead.
While drugs like Fosamax and Boniva have been shown to successfully increase the density of bones in clinical trials, they do little to increase the actual strength, which is key. The strength of the bone is what determines whether or not it will buckle like a belt when met with the stresses of movement (or in the case of the fracture victims, gravity itself).
Bones are alive. They maintain their strength through a dynamic system of continual destruction and rebuilding (like the "Doozers" and "Fraggles" from Jim Henson's Fraggle Rock....okay, I've dated myself with this reference but it works really well for this discussion). Please allow me to explain.
Our bones rely on a similar system to rebuild themselves so they can stay strong, allowing us to go about our lives and stay active well into our later years. This system is perfect. You wouldn't want to mess with it, right? Well, leave it to drugs like Fosamax and Boniva to throw a monkey wrench into that system. Remember those cute little Fraggles we talked about? The ones that helped me become the caring, heartwarming individual I am today? Well, osteoporosis drugs kill them. They figure that if you just kill off the Fraggles (osteoclasts), the Doozers (osteoblasts) can perform their work unhindered, leading to more bone mass and hopefully less fractures. It makes sense, right? The problem is that it made so much sense that no one ever thought to make sure that the premise would work long term.
If you're saddened about the sad plight of the Fraggles (or your aunt Martha's osteoporotic bones), you are not alone. Nevertheless, there can be a happy ending to this tale. Anyone who knows me will tell you that I'm not a doom and gloom guy. I like solutions and I love sharing them, so let's get to the good news: this can be prevented! But before we get to that, let's talk about what actually CAUSES osteoporosis in the first place.
One of the best things you can do for your bones is put pressure on them. That sounds a bit strange, but it's true. There exists a scientific law (not a theory or hyposthesis, but an irrefutable LAW) referred to as Wolff's Law. Wolff's Law states that bone will adapt to the loads it is placed under. When the load on a particular bone increases, the bone will remodel itself over time to become thicker and stronger to resist that sort of loading in the future (thanks to the Fraggles and Doozers!). The same thing happens to our muscles. People who weight train have bigger, stronger muscles while perpetual couch potatoes have small, weak muscles. In other words, use it or lose it!
Now when it comes to exercise, remember that the exercise must be weight bearing to get the best results. Things like hiking, aerobics, stair climbing, plyometrics, jumping rope, playing sports, running, and dancing are high impact exercises that are beneficial to maintaining bone integrity. For those with joint problems, low impact exercises like low-impact aerobics, elliptical training, yoga, walking, and treadmill work will do. Of course, if you have joint problems, you may want to see a Chiropractor, since that's what we specialize in relieving.
Another way to send a strong signal to your bones is to keep your muscles strong with resistance training. It's simple: muscles are attached to bone. By strengthening the muscles, you are placing more stress on the bones, forcing them to remodel in order to keep up. Weight training, training with resistance bands, swimming, and Pilates are examples of resistance training.
When it comes to diet, sufficient calcium intake is important (as long as you're not ingesting anti-nutrients that undermine your efforts). Obviously, milk and dairy contain a lot of Calcium, but so do some green vegetables (spinach, broccoli, peas, Brussels sprouts). If you don't consume dairy, supplements may be needed. Where most people usually fall short is in the intake of calcium's two best buddies, Vitamin D and magnesium, which are crucial to bone health. Vitamin D is important for the absorption of calcium. You can choke down calcium chews til kingdom come, but if you do not have adequate Vitamin D, you'll lose most of it through your stool. The best source of Vitamin D is sunlight, but for those of us who live in northern climates during the winter months (like perpetually cloudy Muskegon, Michigan), sun exposure is not consistent enough to provide us with Vitamin D. Good dietary sources of vitamin D are fortified milk (provided you can eat dairy), egg yolks, saltwater fish, and liver. Supplementation may be needed, but make sure your source is Vitamin D3, which is superior to D2. Follow the the link if you want to find out why: Vitamin D3 vs. D2. Magnesium plays a crucial role in the body's regulation of calcium utilization. Magnesium can be found in fruits, vegetables, nuts, seeds, and fish. It's also great for staying regular!
To summarize, you should always question any chemical you are putting into your body. Although I don't want to paint with too broad of a brush, most diseases of civilization are not managed well with medication. Lifestyle and dietary changes are a must. If you believe what Sally Field tells you on your television, go ahead and take your Boniva and hope those magic pills will help your bones stay strong into your golden years. However, it makes much more sense to eat more nutrient-dense food, eliminate foods that are deleterious to our health, and get more exercise. Not only will your bones get stronger, but you will improve your overall quality of life for the long haul.