Osteopenia, Osteoporosis, Osteonecrosis

It’s been estimated that one in every three women, and one in every twelve men over the age fifty worldwide suffer from the bone weakening disease known as osteoporosis. Osteoporosis occurs when there is an imbalance between bone reabsorption (osteoclast cells) and bone formation (osteoblast cells). Bone is a living tissue that undergoes constant transformation. At any given moment, there are from one to ten million sites where small segments of old bone are being broken-down (reabsorbed) and new bone is being laid down to replace it. When more old bone is destroyed than new bone laid down, bone loss occurs. A generation ago, osteoporosis was only diagnosed after an elderly patient had either developed a spinal hump or broken a bone due to a minor fall. Prior to 1974, surveys showed that 77 percent of Americans had never heard of osteoporosis.

In 1992, in an effort to reduce the incidence of osteoporosis fractures, the World Health Organization (WHO) held an international conference, which was sponsored by two large drug companies and a drug-company foundation. Aided by new bone testing technology, experts at the conference were charged with determining the normal bone density mass. The researchers turned to an analysis of women in Rochester, Minnesota, which showed that 16 percent of post-menopausal women in that city would sustain a hip fracture in their lifetime. Looking at years of bone density scores, the WHO found that 16 percent of post-menopausal women had bone density readings of -2.5 or worse. So, under the new definition, anyone with a spinal fracture or a -2.5 T-score (bone density score) or worse had osteoporosis. The committee went further and decided that scores between -1 and -2.5 were the boundaries of a new condition, osteopenia, or low bone mass.

In a single conference, one disease, osteoporosis, had been expanded from an elderly person with a fracture to anyone with a -2.5 T score. And another condition, osteopenia, was created.

Critics of the criteria for the diagnosis of osteoporosis began to emerge almost immediately. One rationally minded expert disagreed with the idea that randomized numbers could determine who did and who didn’t have a disease. Dr. Steven Cummings, one of the world’s leading osteoporosis experts, declared, “What patients had were measurements, not disease.” This is analogous to the idea that everyone with elevated cholesterol has heart disease.

Many have continued to argue that the concept of peak bone mass has been oversimplified. Peak bone mass can vary as much as 100% in women of the same age from different cultures. And peak bone mass seems to have minimal effect on fracture risk: for instance, Asian women have a lower bone mass than Western women, but a lower fracture rate. Differences in ethnicity, diet, exercise, onset of puberty, and lifestyle make peak bone mass a very individual characteristic, hard to quantify—and not a good measure of bone health.

Nevertheless, once considered a rare disease associated with old ladies with a “dowagers hump,” osteoporosis has now become an epidemic with “experts” warning that half of all post-menopausal women are at risk.

How did osteoporosis go from a rare but serious disease to an epidemic that strikes fear into every middle-aged woman in America? One word: Merck.

The pharmaceutical giant, Merck, shrewdly launched an aggressive campaign to educate the public and their doctors that osteoporosis and the new disease known as osteopenia were now treatable with their new drug, Fosamax. Merck promoted portable bone-measuring devices that doctors could use in their offices. When Merck started, there were 750 dual-energy X-ray absorptiometry (DXA or DEXA) bone-measuring devices in the United States. Four years later, there were over 10,000 machines, which tested over 3.5 million people a year! The goal wasn’t to sell the drug to the elderly who actually had osteoporosis but to make it a primary care drug for the 40 million post-menopausal women. With sales of bisphosphonates approaching 5 billion dollars a year, the propaganda for these drugs now rival another once overly-hyped drug for osteoporosis prevention, Premarin. These drugs were the number one prescribed drug therapy in America in 2001. Of course, the results of The Women’s Health Initiative in 2002, which showed that, while estrogen did reduce bone loss, it also increased the risk of breast cancer, blood clots, heart attack, and stroke, sort of put a damper on estrogen therapy, to say the least. That same year there was an initial 80 percent drop in hormone therapy drug sales.

Sales of Fosamax and other bisphosphonates (Actonel and Boniva) increased 32 percent after the WHO study came out. These drugs do increase bone mass. However, they are also associated with numerous side effects, including upper gastrointestinal pain and erosion, esophagitis, ulcers, skin rash, diffuse bone pain, and osteonecrosis (bone death) of the jaw.

Previously, bisphosphonates had been used in laundry soaps, fertilizer, and anticorrosives for the textile and oil industries. A 1993 report discovered that a small percentage of bisphosphonates users experienced serious eye problems that could lead to blindness. Merck’s clinical trial showed that as many as 33 percent of the participants reported blurred vision. Even more troubling, another study quoted on April 4, 2006, by United Press International, found more than 2,400 patients who were taking the injected form of bisphosphonates had suffered bone damage to their jaws since 2001. In addition to the 2,400 patients who were taking the injected form, the study found 120 patients taking the oral form of the drug who had been stricken with such incapacitating bone, joint, or muscle pain that some became bedridden and others required walkers, crutches or wheelchairs. “We’ve uncovered about 1,000 patients (with jaw necrosis) in the past six to nine months alone, so the magnitude of the problem is just starting to be recognized,” Kenneth Hargreaves, of the University of Texas, reported to the Los Angeles Times. And we need to consider that the FDA estimates that only 10 percent of adverse drug events are ever reported. Rats given high doses developed thyroid and adrenal tumors. Fosamax also causes deficiencies of calcium, magnesium and vitamin D, all essential for the bone-building process.

Another commonly prescribed osteoporosis drug, Evista, is a selective estrogen receptor modulator. It is promoted as a safe way to increase estrogen without any of the side effects of hormone replacement therapy. But, of course, there are side effects, which include hot flashes, leg cramps, flu-like symptoms, blood clots (heart attack and stroke), and peripheral edema.

The osteoporosis propaganda campaign has caused women to believe that they must take a drug to prevent being bent over with spinal fractures or succumbing to a life threatening hip fracture. No doubt, the prospect of having a broken bone due to osteoporosis is quite frightening. However, the average age of hip fractures for a woman is 79. The lifetime risk of hip fracture for a white American female age fifty or older is 17.5 percent. Over a lifetime, the risk of a vertebral fracture for this same group is estimated at 15 percent. Certainly these percentages should make us pause and take note.

However, leading bone expert, and author of Better Bones, Better Body, Susan E. Brown, PhD, states: “Osteoporosis, by itself, does not cause bone fractures. This is documented simply by the fact that half of the population with thin osteoporitic bones, in fact, never fracture.” It is important to know that over 90 percent of hip fractures occur from falls, not weak bones. Falls cause fractures, not weak and crumbling osteoporitic bones.

In a 1989 edition of The Journal of the American Medical Association, it was reported that the use of anti-anxiety drugs known as benzodiazepines (Klonopin, Ativan, Valium, Xanax and other tranquilizers) increased the risk for hip fracture by 70 percent.

Bone does not fracture due to thinness alone. A 1995 edition of the New England Journal of Medicine reported that in 65-year-old women with no previous history of a 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, low blood pressure, and lack of muscle strength.

Dr. Mark Helfand, a member of the U.S. National Institute of Health osteoporosis consensus panel, comments: “I think even people who agree that osteoporosis is a serious health problem can still say it is being hyped. It is hyped. Most of what you can do to prevent osteoporosis later in life has nothing to do with getting a test or taking a drug.”

Drug therapy may be appropriate for those with advanced bone loss, especially since 20 percent of those age seventy or older with hip fractures never recover. But, before starting on potentially dangerous drug therapy at the first sign of bone loss, patients need to be educated on the role nutrition plays in ensuring optimal bone health. There are at least eighteen key bone-building nutrients essential for optimal bone health. Vitamins D, E, C, B12, K, folic acid, and minerals, including boron, calcium, magnesium, copper, and zinc, are needed for proper bone production and restoration. All of these nutrients have been shown to reduce and, in some cases, restore optimal bone mass.

I think patients would be better served by using prevention and optimal nutrition instead of taking a bone-eating prescription.

Rodger Murphree, D.C., has been in private practice since 1990. He is the founder and past clinic director for a large integrated medical practice located on the campus of Brookwood Hospital in Birmingham, Alabama. He is the author of Treating and Beating Fibromyalgia and Chronic Fatigue Syndrome, Heart Disease: What Your Doctor Won’t Tell You, and Treating and Beating Anxiety and Depression with Orthomolecular Medicine. He can be reached at [email protected], 1-205-879-2383 or visit www.treatingandbeating.com.

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