Pharmaceutical companies make billions of dollars profit from Boniva, Fosamax, Actonel, Reclast, Zometa and other osteoporosis drugs. Prescribed to millions of patients, these drugs are intended to treat and prevent osteoporosis and are the primary tools used in the effort to prevent hip and spine fractures. However, recently published research demonstrates that these drugs are not terribly effective at fracture prevention, and may actually cause harm to some patients. Let’s briefly discuss this research as well as effective strategies to promote healthy bone density and fracture prevention.
Regarding poor efficacy of osteoporosis medicines, researchers reporting in the British Medical Journal and the Journal of Internal Medicine found that a woman with osteoporosis would need to take osteoporosis drugs for three years to have a 1-in-175 chance that the medicine would help her avoid a broken hip. The research team concludes that this “dominant approach to hip fracture prevention is neither viable as a public health strategy nor cost effective.” Use of osteoporosis drugs to prevent fractures of vertebrae (bones of the spine) is also ineffective; the researchers found that there is no evidence that osteoporosis drugs would either provide a clinically relevant reduction in vertebral fractures or reduce the related risk of death.
Furthermore, osteoporosis drugs actually cause harm to some people. Several studies have shown that osteoporosis drugs can cause atypical fractures, especially of the femur (the long bone in the upper leg). In the jaw, osteoporosis drugs can cause bone destruction known as osteonecrosis. Osteoporosis drugs also cause a variety of gastrointestinal problems including ulcers, constipation, indigestion and more. In addition to the adverse effects highlighted here, there is a long list of other “serious” and “common” potential adverse effects related to osteoporosis drugs.
Osteoporosis is characterized by a loss of bone mass and decreased bone density, which causes bones to become fragile. Fragile bones are obviously at greater risk of fracture, especially in the hip, spine, wrist and shoulder. Hip fractures are generally considered the most serious because they cause people to be bedridden, which can further deteriorate health. Approximately 20 percent of people suffering hip fractures die within the following year.
It is important to note that the recent studies do not dispute claims that osteoporosis drugs can help to increase bone density. The concern raised by researchers is that, despite any ability to improve bone density, osteoporosis drugs do not effectively reduce the risk of fracture. The reason for this seeming paradox is that fractures are primarily caused by falls and not simply by fragile bones.
In fact, a large study involving women aged 65 years and older showed that osteoporosis was responsible for only 15 percent of all low-trauma fractures. Plenty of people who do not have osteoporosis fall and break bones. And plenty of people who do have osteoporosis do not fall and never sustain fractures. It turns out that asking the question, “Do you have impaired balance?” is a more accurate predictor of hip fracture than is osteoporosis. Falling is a greater risk of fracture than is osteoporosis.
Falls are very common among older people. The risk of falling increases with age, reduced physical strength and reduced physical function. Muscle weakness is a major factor causing increased risk of falling with older age. It is critically important for seniors to adopt lifestyle habits (such as proper exercise and nutrition) which promote building and preserving muscle mass and strength.
The British Medical Journal research team warns that the strong emphasis on drug treatment has distracted people away from other strategies that can be used to prevent fractures, such as nutrition and exercise. The researchers affirm that strategies involving nutrition and exercise work “for anyone, regardless of bone fragility, and the benefits encompass the entire human body.” In other words, in the effort to prevent osteoporosis and related fractures, exercise and nutrition are more effective than drugs.
The Erlangen Fitness and Osteoporosis Prevention Study (EFOPS) demonstrated “the high anti-fracture efficiency” of exercise programs. The EFOPS scientists “strongly encourage” older adults to engage in exercise programs due to the favorable effect of exercise on also reducing most other risk factors associated with increasing age (in addition to fracture prevention). The final results of the 16-year EFOPS project were recently published in the journal Osteoporosis International.
Chiropractic care, which aligns the spine and posture, can help to reduce the risk of falls by improving flexibility and balance. Moving and positioning the body properly for routine tasks is also important in fracture prevention; for instance, bending forward to lift with straight knees is a common cause of osteoporosis-related fractures of spinal bones. As many people are unfamiliar with proper body mechanics and healthy exercise practices, our office employs an exercise physiologist to assist patients with these important activities.
Nutrition is a critical component in prevention and management of osteoporosis. The diet should emphasize fresh vegetables and fruits, lean protein and healthy fats. Processed foods and added sugar should be avoided; if it is sold in a box or a bag, it is probably processed food. Added sugar should be avoided. Nutritional supplementation can also be beneficial. For instance, a highly absorbable form of calcium such as microcrystalline hydroxyapatite concentrate (MCHC) can help to build the framework necessary for strong bones. Magnesium, vitamin D and other nutrients can also be beneficial. In health care offices like ours, laboratory analysis is used to develop personalized dietary and nutritional supplementation programs for individual patients.
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