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Certified Clinical Densitometrist and Bone Health Expert

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Osteoporosis - Information You Need to Know

Tuesday, April 12, 2011
 
Osteoporosis - Information You Need to Know

Osteoporosis is a growing problem. Each year, low trauma fractures are increasing – especially as the baby boomers age. Presently, in the United States there are 700,000 spine fractures, 350,000 hip fractures and 300,000 wrist fractures each year. The financial and personal costs are staggering – especially with hip fractures. We are inundated with advertisements on television, magazines and radio from drug companies and supplement companies. Does anyone have THE answer for everyone? The answer to that is a huge NO. I am frustrated with the false advertisements and false claims from both drug and supplement companies. The following are some important points for you to understand bone health and the diagnosis of osteoporosis.

  • Bone health is very complex and there is no one-size-fits-all approach.
  • A diagnosis of osteoporosis does not mean you are losing bone presently.

It is possible you may never have built up a normal peak bone mass. Here are a few examples of why some people do not reach a normal peak bone mass by the age of 30.

    • Eating disorders
    • History of smoking cigarettes and or significant consumption of soft drinks or alcohol during formative years. Approximately 80% of our lifetime bone mass is laid down by the age of 18.
    • Poor diet – high in sugar, salt and low in nutritive value
    • Taking medications that result in bone loss – many exist
    • Having ever used prednisone 5 mg/day for 3 months or more
    • High anxiety
    • Depression
    • Hyperthyroidism
    • Hypothyroidism – not managed properly
  • Gastrointestinal problems are common and are integral to your health condition.

If you have a digestive problem, go to a health practitioner who can help you diagnose your problem. Yesterday, a woman told me her gastroenterologist said that coffee is good for digestion. This is not true and underscores the fact that many medical doctors do not know nutrition.

  • Is it possible to increase bone density with nutrition and weight bearing exercise?

Yes, whole body vibration and weight training can increase bone mass. Significant walking/hiking seems to maintain hip bone density, but not the spine.

Have you gained bone density? – if you or a patient has increased bone naturally, I would love to hear from you. We need to gather this information since studies on natural methods are scant. In fact, some companies that boast of increased bone density may have extremely weak supporting data. For instance, the studies may have been done on rats or may only report on positive lab results.

  • Medications that claim to increase bone density have side effects.

Medications in the category of bisphosphonates are the most common medications prescribed for osteoporosis. After 5 years of ingesting these medications, a small percentage of people are experiencing more, not less, fractures. These fractures occur with little or no trauma. This is pointing to poor bone quality – in other words, these medications may build some bone, but after 5 years of taking them the bones may become more fragile in some people.

  • Supplement companies that claim that their product will increase bone density are most often misleading and incorrect.

With supplements you may see a small percentage of bone gain over a period of time, especially if you are deficient in vitamin D, magnesium or calcium, or resolved an underlying digestive problem such as Celiac disease. One company boasts an increase of 25% in one year – this is a false claim. There is no supplement or medication that can build bone at this level. In fact, building bone 2-3% each year is amazing. It is possible to build up to 10% in one year, but that is rare and usually follows the correction of a major underlying problem such as primary hyperthyroidism.

  • Bone density tests can be analyzed incorrectly – In other words, are your gains or losses real?

Increases of bone density based on ultrasound of the calcaneus (heel bone) may be false or misleading. One company shows increases in 3-6 months for their product Osteodenx of 25-30%. This is a bogus claim and not humanly possible. Their proof, using the heel bone, is either artifact or staged. Either way, the doctors involved with this product should know the heel bone densities that they advertise as proof are not real.

  • Is it ever necessary to use bone medications?

Yes, some people have significant osteoporosis that does require aggressive treatment. In my opinion, medications for osteoporosis have been significantly overprescribed. In addition, many medications on the market may result in more harm than good if not monitored correctly.

  • What is the difference between bone density and bone quality?

If you have low bone density, that will impact your bone quality. However, you can have good bone density and poor bone quality. Many things impact bone quality including digestive health, nutritional factors, smoking cigarettes and many other lifestyle and hereditary factors. There are cases where people have a good bone density yet experience a fragility fracture that may indicate poor bone quality.

  • Has your bone density test been analyzed correctly?

The International Society of Bone Densitometry notes that there are errors regarding patient set up (technician errors) and errors in interpreting osteoporosis DXA scans. Unfortunately, doctors who analyze reports are not necessarily fully trained. Make sure you retain a copy of your report + the computer generated report data. This is analogous to having an x-ray report + the x-ray itself to read.

  • Are you actively losing bone?

A single bone density test does not mean you are losing bone. Perhaps you never reached peak bone mass.

o   Example:  During your teenage years you did not eat a healthy diet, smoked cigarettes, or had an eating disorder or a chronic digestive disorder. All of these risk factors can hamper building a good bank account of bone. So your diagnosis today may be low bone mass (osteopenia) or osteoporosis but your bones are stable – no bone is being lost.

  • What is the best way to determine if you are losing bone?

o   Two consecutive bone density tests of the lumbar spine and hip on the same exact machine. You cannot compare on two different machines.

o   Lab testing to look at potential bone loss which include bone turnover markers: Bone specific alkaline phosphatase, osteocalcin, CTx or NTx , 24 hour urine test. There are many other tests to include depending on your case history and the severity of your osteoporosis. Some others include: serum calcium, parathyroid, vitamin D. Again, each case is different and will require different lab tests.

  • What is a statistically significant decrease in bone mineral density?

Each DXA machine (dual energy x-ray absorptiometry) should have a least significant change (LSC) for their facility, but many do not.

o   Example: There is always an error factor when any diagnostic equipment is used. DXA machines are very accurate, but the least significant change for a DXA machine is 2.77%. Then there is a technician’s precision assessment based on in-house testing. This could add an additional 1-2%. In order to know if your bone density test is reliable your bone mineral density would have to be above or below the least significant change.

o   One way to know if the facility that you use is using the best evaluation methods is to ask what the LSC is for their facility. If they have not performed the in-house testing they will not have a LSC value.

NOTE:  I owned an osteoporosis center in Oakland 15 years ago – we calibrated our DXA machine daily, and the accuracy of our testing was excellent when we did in-house testing for precision of the technologist and DXA machine combined.

  • What is the expected rate of bone loss with aging?

After the age of 35 (some data suggests earlier) the expected bone loss is .5 to 1% a year. For the 10 years around menopause (mostly after) a woman can lose 1-2% a year.

  • How often should I have a repeat bone density?

This is a great question and the answer again is different for everyone. Here are a few examples:

o   You are 5 years post menopause, and you have osteopenia (low bone mass). You have had two bone density tests and no appreciable bone loss. Wait two years and then repeat the tests.

o   You are in peri-menopause and you have borderline osteoporosis (-2.5 SD) and you have had only one DXA – repeat the DXA after one year.

o   You have celiac disease and significant osteoporosis (-3.0SD and lower) – retest one year later unless your bone density is stable.

  • Do we all lose bone with aging?

Yes and no. If you live to be 90, you will likely lose bone mass. However, you can stabilize bone loss and build bone but it takes effort, including exercise, healthy eating habits and a good digestive system.

  • How do I know if my doctor analyzed my case properly?

Your doctor should spend considerable time taking notes on your medical history, analyzing your diet and supplements, and they should also be able to read the reports sent to them from the radiologist. Bone health needs to be individually analyzed.

  • How do I slow bone loss or build bone?

o   Weight lifting has been shown to increase bone density. Impact exercise such as jumping, running, and tennis have been shown to increase bone density.

o   Whole body vibration (low amplitude) high frequency is another option for building bone. This is a comfortable vibration, not a heavy vibration. Clinton Rubin, PhD is the researcher that vibration companies quote. However, they are not using the frequency or the amplitude that he is recommending. To view the interview I did with him click here.

o   Maintain a healthy diet leaning on alkaline foods – if you are having difficulty with making good food choices, get help – Your Bones Are What You Eat!

o   Digestive health – any digestive problem is a risk factor for bone loss. Medications such as proton pump inhibitors (nexium, prilosec etc.) cause bone loss.

o   Take supplements known to increase bone density that are balanced for you! This is important – each person’s bones are different from the next. Calcium is often under or over supplemented. An adult should ingest 1,200 to 1,500 grams daily from ALL sources. Vitamin D, magnesium and other nutrients need to be in balance. It is always best to get as much as you can from the foods you eat, then supplement when necessary.

It is my belief that whatever health condition we have, we need to understand the condition so that we can open a dialogue with our health care providers. I have seen many patients who have bounced around from doctor to doctor, all of whom have prescribed different medications or supplement regimens.

What are the most important things you can do when you are diagnosed with low bone density or osteoporosis?

  • Make sure you have a diet that supports bone health – remember, what is good for the bones is good for the heart.
  • Healthy digestive system – work with an alternative health care practitioner to diagnose and guide you to good digestive health.
  • Exercise – impact exercise – see section above on how to build bone.
  • Make sure your case has been analyzed correctly – obviously, this is more difficult for lay people to assess, but the more you learn about osteoporosis, the more you will be able to know if your doctor is assessing your case individually.

Future newsletter articles

  • What exactly does the diagnosis of osteoporosis mean? What are the T scores and Z scores?
  • Vitamin K and bone – will vitamin K reverse osteoporosis?
  • Calcium and magnesium balance
  • The 10 top foods to consume if you have osteoporosis.
  • Some people with significant osteoporosis do need medications. I will review my thoughts on when medications should be considered. These will include: bisphosphonates, Forteo, bio-identical hormones, Miacalcin, Prolios, and strontium Ranelate and citrate, Evista.

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