Osteoporosis: maybe not worth worrying about

In 1993, a World Health Organization study group established clear-cut definitions of osteoporosis and osteopenia. (Osteoporosis is a thinning of the bones due to depletion of calcium and bone proteins; osteopenia is bone density that is below "normal.") Their definitions are based on the bone density of healthy young adult women. Thus, if your bone density doesn’t measure up to that of a young person, you either have osteopenia or osteoporosis.

As it turns out, the WHO study was funded by three drug companies: the Rorer Foundation, Sandoz, and SmithKline Beecham. These companies stood to benefit greatly if bone mineral density testing was adopted into routine medical care—which it has been. Because loss of bone density is a normal part of aging, millions of woman use drugs hoping to prevent and treat osteoporosis.

The most dangerous result of falling for an older person is a hip fracture. But bone mineral density tests identify only a small part of the risk of hip fracture. For women between the ages of 60 and 80 only one-sixth of their risk of fracturing a hip is identified by bone density testing. Just as important are muscle weakness, the side of effects of other drugs, declining vision and cigarette smoking.

What’s more, the osteoporosis drugs don’t protect women from hip fractures. It’s true that Fosamax and other drugs used to treat osteoporosis do increase bone density. But the real reason for taking the drugs is to reduce fractures, especially hip fractures. They do not. (One study, for example, showed that the risk of hip fractures actually went up with Fosamax treatment.) The reason drugs like Fosamax are ineffective is that they act on only one of the two bone types—the outer, hard cortical layer. They do not add bone to the internal structure called the trabecular bone, which works like a three-dimensional geodesic dome to provide additional strength to the areas of the skeleton most vulnerable to fracture, such as the hips, wrists, and spine. 

A new class of drugs, such as Evista, are designed to protect bones the same way that natural estrogen does, but without the risk of hormone therapy. But research shows that in women with osteoporosis, Evista reduces only vertebral fractures, not fractures of the hip or wrist.

The best protection against hip fractures is—you guessed it—exercise. Example: The NIH conducted a study of osteoporotic fractures in which they followed 10,000 independently-living women aged 65 and older. Over the seven years of the study, women who exercised moderately had 36 percent fewer hip fractures than the least active women. In this case, the reduction of hip fractures among those who exercised was twice that achieved with Fosamax.

It will come as no surprise to you that I’ve never had a bone mineral density test. Thank goodness my bones seem pretty good, because I’ve taken some pretty spectacular falls.

Next week: plantar fasciitis--a home remedy

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