Unfortunately even the experts say that the tests currently available tell us very little about actual bone health. The most common test ordered to diagnose "osteoporosis" is called the DEXA or DXA scan and is a dual-energy X-ray absorptiometry scan which sends two low dose beams of radiation through the body to assess bone mineral density. It was developed and refined enough by 1988 to be used in determining osteoporosis risk. It soon became the standard because it could provide a measurement of bone density through a painless noninvasive process using minimal radiation. By 1995 they were found in many hospitals, imaging centers and doctors offices.(1) Within 6 years of the DXA scan being developed, the World Health Organization (WHO), a non-profit organization, had redefined the criteria for osteoporosis with an international standard that uses the density testing and deviations from a young person’s bone density to arrive at a diagnosis. Now millions qualified for a disease that had been rare a few years earlier.(6) Additionally, according to Gillian Sanson, in her book, The Myth Of Osteoporosis, WHO is not a neutral or independent organization but one who gets funding. She writes that the study group that defined the diagnosing threshold was funded by three major drug companies. There are many international groups who do not agree with this means of diagnosis. She writes that peak bone mass is “virtually indefinable” as it can vary by race, gender, family history, geographical region and even between seasons.(6) In a New Zealand television documentary, a woman was scanned by two different major brands of DXA machines in different cities and she was given completely different diagnoses, from having no issues at all, to close to the threshold of osteoporosis. Since this is a new science and we don’t have anything to compare it to, it can be very inaccurate.(1) The elderly of today had a different history growing up and this seems to matter according to what the experts say. Even WHO states that there are several problems using the BMD (bone mineral density) tests only. In many Member States, this test is not available or is really only used for research due to expense. They state that tests are not reimbursable in some states even if available and drug treatments are approved. There have been other techniques developed but there is no guidance on how to use these with or without DXA at this point. A second major problem they have identified, is that this test alone is not optimal for the detection of individuals at high fracture risk. They even admit that the majority of “osteoporotic” fractures will occur in individuals with a negative test.(12) The International Osteoporosis Foundation (IOF) says that results from different devices should not be compared and a history of vertebral fracture, osteoarthritis or scoliosis will affect results. According to Oregon State University, although BMD is a convenient clinical marker to assess bone density, it is not the sole determinant of fracture risk because we cannot detect the matrix component of bone. Bone quality as identified by architecture and strength and a person’s balance and mobility, also factor into risk assessment and should be assessed when deciding on interventions.(8) Unfortunately, there is no international reference standard for DXA machines. This allows manufacturers to set their own, often high standards which can result in widely varying diagnoses. It has also been found that results vary from machine to machine, and from country to country.(1,4,5,6) Despite this type of information available, the IOF still says that low BMD is among the strongest risk factor for fracture.(10)
Now let’s look at the testing itself and how they use comparison to reach a diagnosis. T-scores are used as the main criteria for comparison and diagnosis. T-scores are established by using the peak bone mass of a young, white female (or male), about 30 years old, to compare the aging bones to. One standard deviation is related to about 10-12% difference in bone mass.(13) There is also a measurement called a Z-score which compares average bone density of same age and gender but as you can see below, the T-score is used as the main reference. The Z-score is used to diagnose secondary osteoporosis and is used for people younger than 50 or pre-menopausal.(130) The American Bone Health website says “in 1994, the World Health Organization (WHO) reviewed the worldwide data on bone density testing and fracture risk. Prior to this publication, (see reference 14 for publication) many bone density testing centers reported results by comparing a patient to other patients of the same age. The WHO concluded that, based on studies of older women, reporting the relation of the bone mineral density (BMD) to the average peak bone mineral density of a 30-year old would be more appropriate.”(13) Why I must ask? It seems more appropriate to compare those of similar age and not someone much younger at their peak bone mass. Remember, loss of density is normal with the aging process. Now we will always get a deviation and it then looks like something that needs treatment. According to an article in American Journal of Roentgenology (Diagnostic Imaging and Related Sciences), “Actually, in the United States, T-scores are more generally calculated from a reference white database for individuals of all races and ethnicities and for both sexes. Hence, African-American, Asian, and Hispanic women receiving a DEXA examination in the United States would most commonly have their T-scores based on a white female reference database. Males of all ethnicities receiving a DEXA examination would have their T-scores based on a white male reference database." This is based on the 2007 Position Statement of the International Society for Clinical Densitometry (ISCD), which recommends, “Use a uniform Caucasian [white] (non-race-adjusted) female normative database for women of all ethnic groups. Use a uniform Caucasian [white] (non-race-adjusted) male normative database for men of all ethnic groups.”(16) Yet many sources say that ethnicity, sex and country impact results. As stated before, there is also no international reference point for the manufacturers of the scans so each has established their own data resulting in vastly different standards between brands of machines.(6) Dr. Simpson says in Dr. Lani's No-Nonsense Bone Health Guide, if the same exact machine is not used, you cannot make a comparison and cannot calculate rate of change. Reliable accurate results also also depend on the technician as they can be poorly trained in placement and technology.(1) Gillian Sanson also states in her book, that to further limit accuracy, the sites often measured are hip and spine but bone density can vary throughout our skeleton. Measuring one or two places doesn’t show the big picture. In one group studied, measuring the neck of the femur, 17% would have had osteoporosis by WHO standards and when the entire hip region was scanned, only 6 % would have had it. She also writes that the British Columbia Office Of Health Technology Assessment analyzed findings of 14 major review groups and they concluded that “BMD testing does not result in a reduction of fractures and is therefore not a cost-effective public health strategy. A British study found that other factors were more accurate in predicting hip fractures including current kyphosis, history of epilepsy, steroid use, low body weight, circulation in the feet and poor trunk ability. After 80 years old, at least half of all hip fractures are linked to mechanical factors, not bone fragility.(6)
There are other tests available to look at bone health but they may give false results depending on a person’s overall health condition, medication use and hormonal status, among other factors. Some doctors recommend urine tests to check for abnormal calcium excretion, and to detect resorption and formation markers but the marker tests need more testing themselves to confirm accuracy. Dr. Simpson, in her book, recommends further testing to get a whole picture of health including CBC, blood chemistry panel, TSH, Vitamin D and depending on the individual, parathyroid function test, GFR and creatinine to establish kidney function, magnesium, RCB, phosphorus, sex hormones, cortisol, HS-C-reactive protein, ESR, prolactin, celiac profile, homocysteine, protein electrophoresis (to rule out multiple myeloma), calcitriol and lipid peroxides as indicated.(1) Doctors may also order a CT (Computerized Tomography) X-ray scan or single-photon absorptiometry (DXA is dual) which is mainly used for extremities.(19,67)
NUMERICAL DATA-STIRRING UP FEAR
There is an absence of internationally consistent and agreed-on criteria for measuring the statistics themselves regarding who is at risk and they are all very different. The US and New Zealand say half of women and 1 in 8 men will have a fracture related to osteoporosis, yet Canada reports that approximately 16 % of women and only 5 % of men even have osteoporosis. The National Health and Nutrition Examination Survey III states the age-adjusted prevalence of osteoporosis in women aged 50 yrs or older is 21% in European-Americans, 16% for Mexican-Americans and 10% for African-Americans. Dr. Susan Ott from the U of W, says that counting the number of fractures related to osteoporosis is difficult and requires strict criteria. Another thing to remember is that our elderly men and women went through a depression and wars, so they may have had poor eating habits during critical bone building times in their lives, thus comparative testing and statistics may be affected.(6) American Bone Health reported that “in 2012, a highly respected group of researchers reported on following nearly 5,000 women over 65 who did not take an osteoporosis drug and did not have osteoporosis. Over many years, researchers routinely measured bone density. The new report tells us that, in this age group, bone loss is really quite slow and it takes many years for bone loss to accumulate. The average older woman with normal bone density loses only about 5% of her bone density in 10 years. Because of this slow loss over time, the researchers found very few women moved from a normal or low bone density category to a level indicating osteoporosis. In fact, even after 15 years only 1 in 10 women had crossed this important threshold.”(17) According to NIH, “Annual decreases in bone mass of 3%–5% per year frequently occur in the first years of menopause, but the decreases are typically less than 1% per year after age 65.”(30) Dr, Brownstein, in his book Drugs That Don’t Work And Natural Therapies That Do!, states that ”Most hip fractures occur after a fall, but most falls (over 99%) do not result in a hip fracture”(4)
PHARMACEUTICAL TREATMENTS
Regarding the medical treatment of bone health, I feel it is important to give you some very crucial information about medications and doctors in general before we proceed further. Gillian Sanson, in her book, states that medicalization of menopause which is a normal process, has now paved the way for medicalization of bone mineral loss. Public perception is that modern technology and medicine have found ways to decrease or eliminate health risks.(6) A study done at Johns Hopkins University published in 2016 and reported in the Journal of American Medical Association puts things into perspective. It reported that 250,000 people a year die of medical errors. Another 106,000 die of properly prescribed medications. They state that doctors are the third leading cause of death in the U.S.(6,127,128) Harvard University Center of Ethics reported that properly prescribed drugs (aside from misprescribed, self-prescribed and overdosing) cause 1.9 million hospitalizations per year and another 840,000 hospitalized patients per year have serious adverse reactions making 2.74 million serious adverse reactions to prescribed medications. This makes prescription drug deaths the fourth leading cause of death next to strokes.(129) I am shocked at this information and needed to share. Please pay attention. Medical doctors and medicine are the third and fourth leading causes of death in America!
In Gillian Sanson’s book, she writes that there is no evidence osteoporosis drug therapies prevent hip fracture in the elderly. It makes much more sense to consider lifestyle and environmental factors.(6) One class of drugs that came out in 1995 to treat low bone density, called bisphosphates, inhibit the resorption of bone by poisoning the osteoclasts. The half-life of Fosamax, one of the most popular bisphosphates, is over 10 years. Half-life means the amount of time it takes for half of the drug to be eliminated from the body. Once this drug is bound to the bone, the body has no way of ridding itself of it, thus disrupting normal function of the bones for over 20 years. Resorption declines while deposition continues. Increased density does not mean increased strength. The most common of these drugs are Fosamax, Actonel, Boniva, Didronel, and Zometa. These drugs also have many other adverse effects including bone and muscle pain, spontaneous fracture of the thigh, muscle pain, worsening of asthma, esophageal erosion, stomach ulcer, worsening of any gastrointestinal problems. dizziness, severe skin reactions, electrolyte disturbance and osteonecrosis (bone death) of the jaw.(4,18) The perfect system God designed will not work properly for over 20 years after taking this medication and can result in poor bone healing as well as many other issues. Sanson showed that Fosamax claimed to reduce hip fractures by 50%, when in a study of just over 2000 women in three years there were 22 (2.2%) of the women with hip fractures on the placebo and 11 (1.1%) fractures in those on Fosamax. The actual math for this is a reduction of 1.1%, not 50%. I checked the manufacturer, Merck's website and their information on Fosamax is still doing this kind of math.(6, 18) I was actually quite surprised and disappointed about this. As a registered nurse of over 30 years, I wouldn't take any of these medications and would warn family and friends to really do their homework to see if there was anything else they could try first if their doctor recommended any of these.
Hormone Replacement Therapy (HRT) is another treatment listed for low bone mass. It was brought on the market over 40 years ago for many menopausal complaints and women were told that it would help improve bone density as well as many other wonderful effects to decrease aging. Early studies of this treatment claimed all sorts of positive results like reduction of heart disease and decreased bone loss. Recent studies now show that it causes breast, ovarian and endometrial cancer, heart disease, stroke, blood clots, increased risk of developing asthma and lupus erythematosus.(6) Since low bone density is not a disease requiring treatment, a diagnosis of established osteoporosis (bone fracture) should be addressed before there is any discussion of this treatment.(6)
Forteo (by Eli Lilly and Company) is another medication that came out in 2002. It is a synthetic form of parathyroid hormone. It is given by injection and has a long list of side effects, with common ones including hypo and hypertension, anemia, chest pain, limb pain, nausea, vomiting, diarrhea, gastrointestinal disorder, dizziness, pneumonia, sciatica, rash and can cause increased blood calcium which can be very dangerous. This medication carries a black label warning and has strict prescription regulations based on the concern over the association of this drug with bone tumors in animal studies.(68, 69)
Prolia produced by Amgen, Inc. is called a monoclonal antibody and came out in 2010. Adrienne Rothstein, PharmD during the FDA analysis, noted that Adverse Events of Special Interest are infection, new malignancy, tumor progression, dermatologic events, pancreatitis, ocular adverse events, cardiovascular adverse events, hypocalcemia, osteonecrosis of the jaw, hypersensitivity/immunogenicity and bone histomorphometry findings.(71) The warnings and precautions state that this drug can cause hypocalcemia, serious infections, atypical subtrochanteric and diaphyseal femoral fractures, jaw osteonecrosis and that multiple vertebral fractures may occur following discontinuation of Prolia. The most common adverse reactions reported with Prolia in patients with postmenopausal osteoporosis are back pain, pain in extremity, musculoskeletal pain, hypercholesterolemia, and cystitis. The most common adverse reactions reported with Prolia in men with osteoporosis are back pain, arthralgia, and nasopharyngitis.(70)
Calcitonin nasal spray is another treatment sometimes recommended. Calcitonin is a natural hormone found in our body. Calcitonin salmon is not derived from salmon but is made synthetically, patterned after the calcitonin made by salmon. In humans, cells in the thyroid gland make calcitonin. Factors that regulate our synthesis and secretion of calcitonin are not well understood. A number of other hormones and input from the nervous system have been shown to stimulate calcitonin release. Calcitonin seems to play a minor role in regulating blood concentrations of calcium and phosphorus but humans with chronically increased or decreased blood levels of calcitonin do not show abnormal serum calcium levels. They state that side effects from calcitonin salmon are not common, but some people experience reactions similar to an allergy such as hives, difficulty breathing, swelling and additionally can experience chest pressure, chills, weakness, dizziness, upset stomach, hot flashes, headache, nasal congestion, nasal irritation and back and joint pain. Long term use of calcitonin salmon could lead to the development of anti-calcitonin antibodies, making the treatment worthless.(6, 72, 73) I am skeptical of any man-made hormone that is used as if it is the same as what our body would excrete in need. It controls activity of the osteoclasts. According to Dr. Schneider’s book, there was very little variation in bone density and no change in hip or leg bone density with this treatment.(5) There was a study done that did show that salmon Calcitonin nasal spray at a dose of 200 IU daily significantly reduced the risk of new vertebral fractures in postmenopausal women with osteoporosis,(74) but Dr. Schneider comments on this study in her book. She states that this study was not conducted in a standard randomized double-blind fashion and the doctors who had patients in the study were able to see the bone density tests which then led to a high drop-out rate. At the end of the 5 year study only about half of the participants remained. They studied several different dosages of this medication and because so many of the women who lost bone density did not finish the study, their observations that risk was reduced may not be valid.(5) The study does not mention the drop-out rate or why they did, and was published anyway as if this was a successful treatment.
Calcitriol is another option that is being recommended. It is a derivative of Vitamin D, called a Vitamin D analog and is thought to stimulate bone formation by helping our body to use more calcium found in supplements or foods and regulating the production of parathyroid hormone. This one has serious side effects that they state are uncommon. Some of them include bone pain, muscle pain, urinary difficulties, hallucinations, fever, difficulty breathing or swallowing and irregular heart rate.(75) Although it stimulates release of calcium from the bone, several studies have concluded that it does not increase bone formation.(1) There is limited evidence of reduction of vertebral fractures and use is restricted to supervised use by patients that have poor sunlight exposure and needing above normal Vitamin D. There is a potential risk that this can cause kidney damage with long term use.(6) and it appears that it can affect the liver too as side effects listed include pale, fatty stools and yellowing of the skin or eyes and are cause for liver concerns.(75)
Other treatments include fluoride but this seems to actually increase fracture rates over time and has other adverse side effects. Strontium Ranelate is not approved in the US and has no evidence of significant increase in bone formation. Estren is in research stages. Growth Hormone has study results that are mixed. Progesterone has mixed study results and can have adverse side effects. DHEA has had no studies confirming bone density increasing effects and Ipriflavone, a synthetic isoflavone had no difference noted in bone density and had adverse side effects.(5,6)
WHAT ABOUT SYNTHETIC (PHARMACEUTICAL) VITAMIN SUPPLEMENTATION
The 2013 copy of Annals of Internal Medicine had an editorial titled, “Enough is Enough: Stop Wasting Money On Mineral Supplements” and was co-authored by five doctors including three professors from Johns Hopkins University. They wrote that based upon the most current research, “Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided.” While they do not rule out the possibility that some supplements may have “small benefits” for certain people, they state that clinical trials are not suited to find very small effects so future attempts to study these effects “are likely to be futile.” They concluded that “we believe that the case is closed-supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful.”(77)
CALCIUM SUPPLEMENTS
The NIH states that calcium is the most abundant mineral in the body and is found in some foods, added to others, obtainable in supplement form and present in some medicines, like antacids. It is required for vasodilation, vascular contraction, muscular function, nerve transmission, hormone secretion, intracellular signaling and more. Less than 1% of the body’s calcium is needed to support these activities and blood calcium is tightly regulated. It does not fluctuate with short-term changes in dietary intakes as the body uses bone tissue as a reservoir and source of calcium.(30)
Both the National Academy of Sciences and the National Osteoporosis Foundation recommend a total daily intake of 1200 mg elemental calcium from both dietary and supplemental sources for women over the age of 50. Dietary sources are preferred due to greater calcium absorption and, possibly, because of a lower risk of vascular disease, particularly in light of a recent meta-analysis which reported that calcium supplementation increases the risk of cardiovascular events. Even with the knowledge of risk of vascular disease from these supplements, they say, “Calcium supplements, when taken, should be in conjunction with meals to maximize gastrointestinal absorption. Select populations at higher risk for reduced dietary calcium intake include older individuals and those with lactose intolerance, vegetarian diet or poor eating habits.”(9) The NIH reports that around 43% of Americans take supplements with calcium and about 70% are older women. They also report that some older women likely exceed the upper limit when calcium from food and supplements together.(30)
A greatly concerning study by Johns Hopkins University from 2016 based on research from ten years, remarks that a “Calcium-rich diet could be beneficial for the heart, but supplements seem to increase the risk of plaque buildup in arteries and heart damage. It showed that calcium does not really make it to the bone tissue especially in older adults and can cause a plaque buildup in the arteries and cause damage to the heart." The writing goes on to say, “It could be that supplements contain calcium salts, or it could be from taking a large dose all at once that the body is unable to process," says John Anderson, a nutrition professor at the University of North Carolina at Chapel Hill. Several studies in the past have shown that calcium supplements accumulate in the body's soft tissue, rather than making it into the bones or being completely excreted in urine.(20) Another study found a relationship between calcium supplementation and increased risk for dementia in elderly women in a 5-year follow-up study. The association was mainly confined to individuals with cerebrovascular disease, including a history of stroke or presence of ischemic lesions.(21) And finally, hypercalcemia can lead to kidney damage.(27) I'm glad they are telling some of the truth here and there.
VITAMIN D SUPPLEMENTS
Vitamin D is not actually a vitamin at all, but a hormone that promotes the absorption of calcium as well as other vital activities in our body. Besides sun exposure, it is also present in foods, especially oily fish (see Part 3 & 4 for more information). In our body, our skin can produce it’s own from sunlight and a common cholesterol. There are some experts who believe that certain at-risk groups who get no sun exposure (ex: hospital or long-term care facility bound) might benefit from supplementation. A meta-analysis published in 2018 noted that increasing levels of Vitamin D in the general population is unlikely to lower the risk of bone fractures in healthy people. Current evidence does not support the idea that Vitamin D supplementation increases bone mineral density or reduces the risk of fractures or falls in the elderly and despite several hundred systemic reviews and meta-analysis, there is no highly convincing evidence that Vitamin D plays a clear role in any beneficial outcome.(76) Tim Spector, M.D. writes an article about the dangers of Vitamin D supplements. He states that virtually no vitamins or supplements have really been shown to have any benefit in proper randomized trials with normal people unless they have severe deficiencies. Lutein for macular degeneration is one that has showed some benefit. While several studies failed to find any protective effects from vitamin D, others have been more worrying. A study done in Finland of 409 elderly people suggested that vitamin D did not offer any benefits compared to placebo or exercise and that fracture rates were actually slightly higher. Higher than average levels can also be due to genes. He writes that trying to bring everyone up to a standard normal target blood level is seriously flawed and is like our approach to a one-size-fits-all diet. In his informative article, he writes that “Until now we have believed that taking vitamin supplements is "natural" and my patients would often take these while refusing conventional "non-natural" drugs. Our body may not view supplements in the same misguided way. Vitamin D mainly comes from UV sunlight converted slowly in our skin to increase blood levels or is slowly metabolised from our food. In contrast, taking a large amount of a chemical by mouth or as an injection could cause a very different and unpredictable metabolic reaction.” He goes on to say that our gut microbes are responsible for producing about a quarter of our vitamins and a third of our blood metabolites and respond to changes in vitamin levels in our gut lining. Artificial amounts of chemicals will upset sensitive immune activities. The usual prescribed dose in most countries is 800 to 1,000 units per day (so 24,000-30,000 units per month). In two randomized trials, Vitamin D became a dangerous substance at around 40,000 to 60,000 units per month.(22) A clinical trial where high doses of Vitamin D were given to reduce risk of falls, concluded that the higher doses had no effect on lower extremity physical performance and increased the risk of falls and fractures.(23)
An article published through Harvard Medical School in 2017, noted that Vitamin D deficiency could have developed because a person is ill and spends less time outside, eats poorly or is less active and the deficiency is due to illness, not deficiency. Also disease can cause inflammation which can affect Vitamin D blood levels. Blood levels may also be lower in everyone, but especially in obese people, because it is stored in the fat giving inaccurate results. More is not better as we see from the above studies. Taking a supplement randomly could be toxic in some rare cases, potentially causing hypercalcemia (too much calcium in the blood), then forming dangerous deposits in tissues or vessels.(24) Ian Reed, professor of medicine at University of Auckland also believes that disease causes low Vitamin D levels, as being unwell often leads to spending less time exposed to sunlight.(29) It would do them well if the doctor prescribed time in the sunshine.
Researchers looking at national survey data between 1999 and 2014 found that more and more are taking unsafe amounts of Vitamin D. They consider unsafe amounts to be more than 4000 IU per day. They recommend no more than 600 to 800 IU for most people.(24) If you do feel the need to supplement, be careful about amounts. It makes me wonder how this affects our organs and vessels in the long run as we could be doing damage that is unseen and clinical tests do not seem to be keeping up with “experts” recommendations. Via the Oregon State University website, they reiterate that there is no consensus regarding use of supplements in the prevention of fractures related to osteoporosis and falls by community-dwelling older people.(8)
Lastly from the NIH again, they report that among four trials done with the lowest risk of bias, looking at 44,505 people, there was no effect of calcium with or without Vitamin D on fracture risk at any site. Another meta-analysis of calcium on bone mineral density showed that supplementation produced only small, initial, non-progressive increases that were not likely to result in significant clinical reduction in bone fracture risk. The U.S. Preventative Services Task Force came to the conclusion that there is currently insufficient evidence to assess the balance of benefit and harm of combined Vitamin D and calcium supplementation to prevent fractures in premenopausal women or in men. For postmenopausal women out in the community, the task force found the evidence was insufficient to assess benefit vs harm for combined supplementation, and found clearly no benefit supplementing with smaller doses of those nutrients for this purpose.(30)
It seems that the medical community has many different opinions about bone health testing and treatments. Even with the wide-spread information, things are becoming clearer to those who seek the truth. Knowledge and understanding are sometimes hidden and need extensive searching. I am thankful for the people who have been looking further into these areas and those who monitor the medical community. Now let's move on to more a more natural look at health and remedy.
Stand firm then, with the belt of truth buckled around your waist,
Ephesians 6:14
Please continue with Part 3 OSTEOPOROSIS: Finding The Truth-Exercise &
Nutrients, where we will discover more natural ways of ensuring bone health.
REFERENCES (available at the end of Part 4)
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