Osteoporosis

This is what osteoporosis will do to you:

Osteoporosis

Normal bone and osteoporotic boneAbout your bones

Bone is living tissue made up of specialised bone cells and, like the rest of the body, it is constantly being broken down and renewed. In childhood, more bone is made than is broken down, and bones therefore grow. Bone growth is nearly complete by the end of puberty, with only a small increase in bone strength occurring after the late teenage years.

From the mid 30s on there is a mismatch between bone production and bone breakdown. This results in a gradual decrease in bone strength with increasing age in both men and women. Bone needs exercise, just like muscle, to gain strength.

In addition, oestrogen has a fundamental role in maintaining bone strength in both men and women. The levels of oestrogen in the body fall at menopause and this speeds up the rate of loss of bone. During the first five years after menopause the average woman loses up to 10 percent of her total bone mass.

What is osteoporosis and why does it matter?

Osteoporosis occurs when bones lose their strength and density because of calcium loss, become fragile, and fracture (break) more easily. The word “osteoporosis” literally means bones with holes -brittle bones.

Osteoporosis particularly affects women in their middle and later years. (It is quite different from osteoarthritis which affects joint surfaces.)

Osteoporosis has no symptoms and its main health impact is the increased risk of fractures or breaks. Breaks are most common in the spine, hip and wrist and often occur after only a minor fall. Osteoporotic fractures of the spine cause loss of height, pain and gradual development of the “dowager’s hump. This hump is caused by compression of the spinal fractures due to the force of gravity.

How common is osteoporosis?

More than one in every two women, and one in three men, will develop bone fractures due to osteoporosis. By the age of 70, more than one in five women will have been hospitalised with a fracture of the upper limb, spine or lower limb. Half of the people suffering hip fractures lose independence and require long-term nursing care. Osteoporosis costs Australia’s health care system $800 million per year.

Who is at risk?

The following factors all increase the risk of osteoporosis:

  • a family history of osteoporosis (parent, sibling, grandparent); especially with a family history of fracture.
  • inadequate amounts of calcium in the diet;
  • cigarette smoking;
  • alcohol (more than 2 standard drinks per day for women);
  • caffeine (more than 3 cups of tea or coffee per day);
  • lack of exercise;
  • early menopause, before the age of 45;
  • having a thin, small body;
  • prolonged absence of the menstrual period, which can occur as a result of excessive dieting or excessive exercise, and results in lowering oestrogen;
  • long-term use of certain medications, such as corticosteroids for rheumatoid arthritis and asthma and thyroxine for an under active thyroid.

Risk factors for fracture include all of the above plus:

  • A prior osteoporotic fracture
  • A family history of osteoporotic fracture
  • An increased risk of falls

How can the risk be reduced?

Diet

Eat a healthy diet – plenty of fresh fruit, vegetables and whole grains. In particular, eat foods that are rich in calcium. Calcium is vital to build and maintain strong healthy bones, aid muscle function and aid function of the nervous system. The minimum recommended daily intake of dietary calcium is:

Category*
Age (years)
Calcium (mg)

Children

1-3

500

4-8

700

 Girls

9-11

1000

12-18

1300

Women

19-50

1000

>50

1300

Pregnancy/Lactation:

14-18

1300

19-30

1000

31-50

 1000

Boys

9-11

 1000

12-18

1300

Men

19-70

1000

>70

1300

*Source: National Health and Medical Research Council. (2006) Executive Summary of Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes. Commonwealth Department of Health and Aging, Australia, Ministry of Health, New Zealand.

Dairy foods are the best source of calcium. They contain high levels of calcium which is easily absorbed by the body. Low fat varieties are available to reduce the risk of weight gain or raised cholesterol levels.

Calcium rich foods

Canned fish with edible bones is also a good source of calcium. The calcium found in many other foods, including vegetables and nuts, is not efficiently absorbed into the body.

Post-menopausal women should have at least 1300mg of calcium each day (three glasses of milk or equivalent). Women who have difficulty consuming this amount should take a calcium supplement at night.

Although calcium does not prevent bone loss, it is important in the over-all prevention of osteoporosis when combined with exercise, oestrogen and other therapies.

Foods rich in calcium

Dairy foods
Fruit and Vegetables
  • Milk, 1 cup: 300 mg

  • Yoghurt, 200g 300 mg

  • Cheddar cheese, 1 slice: 300 mg

  • Cottage cheese, 200g: 190 mg

  • Lemon, 1 only: 110 mg

  • Dried figs, 1 only: 60 mg

  • Broccoli, 100g: 70 mg

  • Pumpkin, 100g: 40 mg

Fish
Soy Products
  • Sardines (with bones)100g: 300 mg

  • Salmon (with bones) 100g: 300 mg

  • Calcium fortified soy milk 250 ml: 290 mg

  • Soy or kidney beans, 70g: 70 mg

Miscellaneous
  • Almonds, 50g: 125 mg

  • Ovaltine, 10g: 250 mg

  • Pizza with cheese, 150g 240mg

  • Quiche Lorraine, 150g 260mg

  • Sesame seeds (black) 1 tbs: 200mg

Exercise

Regular weight bearing exercise including resistive exercise with weights increases bone mass at all ages, stimulates bone growth, and improves flexibility and coordination. Recommended activities are: walking, jogging, tennis, dancing for at least 30 minutes three to four times a week. Exercise also improves balance and reduces falls.

Other Measures

  • Avoid cigarette smoking
  • Reduce alcohol and caffeine intake
  • Prevent falls where possible

Can hormone replacement therapy help?

Oestrogen replacement at menopause prevents bone loss, but only as long as the therapy continues – that is, as long as the woman remains on Hormone Replacement Therapy (HRT).

When the woman stops taking oestrogen, bone loss begins again. The dose of oestrogen required may be different for different women. All women should consider oestrogen to prevent bone loss after menopause, particularly those women who enter menopause with a low bone mineral density or with an early menopause.

Oestrogen replacement is often necessary to prevent bone loss in young women who do not ovulate regularly, such as may occur in anorexia and with polycystic ovaries. When oestrogen therapy is not appropriate other therapies may be prescribed.

How is osteoporosis diagnosed?

The most reliable way of diagnosing osteoporosis is by measurement of bone density. This is usually, and most reliably, done by the technique known as DEXA. DEXA uses X-ray technology, involves minimal radiation, is accurate, and can be used to monitor the effects of treatment and/or to monitor for disease progression as time passes.

What about fractures?

Fractures of the spine can occur without symptoms yet if present they herald a dramatically increased risk of further fractures. They are diagnosed on simple spinal x-rays.

How do I know what my risk of fracture is?

There are many new ‘calculators’ or computer based tools your doctor can easily use in a simple consultation to estimate your risk of fracture. These include the World Health Organisation FRAX tool. http://www.shef.ac.uk/FRAX/

What can be done for women with osteoporosis and an increased fracture risk?

It is never too late to seek treatment. Treatment can halt bone loss and significantly reduce the risk of fractures.

HRT is effective for osteoporosis and fracture prevention but is mostly prescribed when a woman has reduced bone density and menopausal symptoms.

Medications prescribed for women who have had, or at very high risk of, a fracture include alendronate, etidronate, raloxifene, zoledranate and strontium. All these treatments appear also to strengthen bones and reduce fractures, and they may improve bone density.

This is an area of intensive ongoing research. For further information, contact: The Jean Hailes Foundation for Women’s Health, Tollfree 1800 151 44

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HRT increases bone density and prevents osteoporotic fractures

Every study confirms that estrogens are the most effective way of increasing bone density and preventing osteoporotic fractures even in low-risk women. This treatment is very safe when started in women under the age of 60. It is more effective and beneficial than the bisphosphonates that are frequently used by bone physicians as first choice and by general practitioners unsure about the safety of estrogen therapy. These non-hormonal drugs with their considerable long-term complications should have no place in maintaining bone density in women under the age of 60. For the recently menopausal women receiving estrogen therapy for climacteric symptoms such as flushes, sweats or vaginal dryness, there will be a considerable increase, up to 15% in 10 years to such an extent that osteoporotic fractures 20 years later in the older women are much less likely to occur. If these women have low bone density, even without typical menopausal symptoms, estrogens must be seen as first-choice therapy. For those younger women with severe osteopenia or osteoporosis due to premature menopause, early hysterectomy and oophorectomy or anorexia with amenorrhoea, estrogens are an essential long-term treatment.

HRT protects the intervertebral discs

Important recent studies from several centres have shown conclusively that estrogens prevent collagen being lost from the intervertebral discs, thus maintaining their strength and function. These discs make up one-quarter of the length of the spinal column and act as cushions preventing crush fractures of the vertebral bodies. It is these crush fractures that lead to loss of height and the lordosis of the upper spine known as the Dowager’s hump. This important protective effect of estrogens seems to be unique as bisphosphonates and the other non-hormonal treatments of low bone density do not have any beneficial effect upon the disc

– Prof John Studd.

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Menopause Int. 2011 Dec;17(4):137-41. doi: 10.1258/mi.2011.011112. Epub 2011 Nov 25.

Prevention of osteoporosis: one step forward, two steps back.

Source

National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, UK. j.stevenson@imperial.ac.uk

Abstract

For many years, hormone replacement therapy (HRT) was the mainstay for osteoporosis prevention in postmenopausal women until a large randomized clinical trial raised serious safety concerns. This resulted in a big drop in HRT use and its demotion by regulatory authorities to second-line treatment. Many clinicians now feel that HRT is not safe to use, and recommend various alternatives for the treatment of osteoporosis. But how effective are these alternative therapies, are they any safer than HRT, and how do their costs compare? This review questions the validity of the safety concerns about HRT, and highlights the safety concerns about alternative therapies. It concludes that HRT is as safe as the other treatment options, and its efficacy and low cost demand that it be restored as a first-line treatment for the prevention of postmenopausal osteoporosis. Other therapies are available for use in osteoporosis, and the bisphosphonates are particularly effective for the treatment of the established disease. However, they must be used selectively and with caution, and are best restricted to those patients who are elderly or have severe disease. New treatments are emerging, but again caution must be taken until any long-term adverse effects have been identified.

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Taking calcium may be harmful.

Posted by

 

More and more evidence is gathering that taking extra calcium in the form of tablets/pills may be harmful. This interesting article today confirms it.
4dm79x8k-1338861850
There’s no evidence suggesting that a calcium-rich diet causes heart problems. Rachel James

 

People taking calcium supplements to mitigate their risk of developing bone disease (osteoporosis) may be doing more harm to their health than good. That’s because a growing body of research shows the supplements confer little benefit and increase the risk of developing heart disease.

Calcium supplements have also traditionally been thought to reduce the risk of heart attacks because they produce small beneficial changes in both blood pressure and blood cholesterol levels. We set out to test this idea in a trial we had originally designed to check the effect of calcium supplements on fractures and bone density.

To our surprise, what we discovered was that heart attacks were actually more common in the (randomly selected) women who received calcium supplements than those who had randomly been given inactive tablets.

When we published this study in the British Medical Journal in 2008, it caused widespread surprise among doctors working in the area, as well as the general public. So to test whether this was the true effect of calcium supplements, we decided to do a meta-analysis of studies about taking them.

First, we contacted all the researchers who had carried out large trials of calcium supplements in the past to see whether they’d kept records of the medical problems that occurred in the course of the trials.

Data were available from 93% of trial subjects (almost 12,000 people) and these confirmed our finding that women who received calcium tablets in the studies had a 20% to 30% increase in heart attack risk.

We subsequently added to this database the results from other trials in which the intervention was calcium and vitamin D, rather than calcium alone. This showed the same effect – a 25% increase in the risk of heart attacks and a 15% increase in the risk of stroke.

These results were based on almost 29,000 people participating in research and so were much more reliable than the results we had published previously.

From these analyses, we were able to determine that the number of heart attacks and strokes apparently caused by calcium supplements was greater than the number of fractures that they appeared to prevent. Naturally, we concluded that the use of calcium tablets was likely to be doing more harm than good and should be discontinued.

It’s very important to note that none of our analyses included the effect of calcium-rich foods, and there’s really no evidence suggesting that a calcium-rich diet causes heart problems.

 

Matt Reinbold

 

The reason for the difference between tablet supplements and food remains uncertain, but it may be related to the increase in blood calcium level that’s seen for several hours following the large dose of calcium in tablet form. In contrast, calcium in food is absorbed more slowly and has very little impact on blood calcium levels.

Elevations of blood calcium levels have previously been shown to increase the risk of heart disease, possibly through producing calcium deposits in the walls of blood vessels and accelerated arterial disease.

A number of other researchers have now looked into these questions. This month, researchers from Germany reported that individuals taking calcium supplements appear to almost double the risk of heart attacks compared with people not taking supplements. And again, those who have high dietary calcium intakes tend toward lower risk of heart disease.

The German study didn’t randomly assign participants into groups taking calcium or placebo tablets, but simply reported events in individuals who had made the decision to take supplements independently. This is a less reliable way of determining the effects of an intervention than a randomised trial. Nonetheless, this observational study provides supportive evidence for the results of our trial analyses.

Last year, researchers in Sydney studied the effects of calcium supplements in a very elderly group of individuals living in hostels. One-third of the 600 people in the group died during follow up. Death rates increased by 47% in those randomised to calcium and death from heart disease was increased by 76%.

So the weight of evidence that calcium supplements are bad for the heart has steadily increased. What, then, should people do in the face of these findings?

Calcium supplements are mainly used to reduce the risk of fractures from osteoporosis (a bone disease that leads to increased likelihood of fracture). But there are other important measures that will also contribute to osteoporosis prevention, such as regular exercise, not smoking, maintaining a healthy body weight, regular sunlight exposure to maintain vitamin D levels, and removal of falls hazards in the home (such as loose rugs, power cords, and slippery floors).

A steady supply of calcium is important for bone health, but research clearly shows this should be derived from a balanced diet that includes several servings of dairy products, or other calcium sources, such as dark green vegetables or tofu.

Women in their 60s and men in their 70s should have their risk of osteoporotic fractures formally assessed. This usually involves bone density measurement.

People found to be at high risk of fractures should consider using one of the medicines proven to safely reduce fracture risk. This is likely to be more effective than relying on the weak anti-osteoporotic effects of calcium supplements, which come at an unacceptably high price – the increased risk of heart disease.

================================================================================

PMID:
22120943
[PubMed – in process]
Menopause Int. 2011 Jun;17(2):63-5. doi: 10.1258/mi.2011.011012.

National Osteoporosis Society’s Position statement on hormone replacement therapy in the prevention and treatment of osteoporosis.

Source

National Osteoporosis Society, Bath, UK.

Abstract

Hormone replacement therapy (HRT) has been shown to increase bone density, reduce the risk of fracture and can successfully relieve menopausal symptoms. From a time when HRT was the major therapeutic option for the management of osteoporosis, women and their clinicians now have a range of treatments available. Following the publication of the Women’s Health Initiative (WHI) and the Million Women Study highlighting potential side-effects, such as breast cancer, heart disease and stroke, many doctors and women are now reluctant to use HRT. The National Osteoporosis Society felt that the role of HRT in the management of osteoporosis needed to be clarified. Using the Charity’s expert clinical and scientific advisers, and through public consultation with members and key stakeholders, a Position Statement has been published. We conclude that HRT has a role to play in the management of osteoporosis in postmenopausal women below the age of 60 years. The key recommendations of the Position Statement are presented in this paper.

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Climacteric. 2011 Apr;14(2):217-9. Epub 2010 Nov 25.

‘PROFOX’–the post HRT nightmare.

Source

London PMS and Menopause Centre, London, UK.

Abstract

The recent report of a two-fold increase in esophageal cancer in women taking oral bisphosphonates is yet another reason to question current relegation of hormone replacement therapy (HRT) to a minor role in the correction of many problems occurring in the younger postmenopausal woman. Women under the age of 60 years with low bone density, flushes, sweats, vaginal dryness, loss of libido and climacteric depression would be treated with estrogens by gynecologists and most general practitioners. It is regrettable that bone physicians use bisphosphonates as first-line therapy in this age group, in spite of the growing number of serious complications reported. Similarly, psychiatrists have little experience in the use of estrogens for the reproductive depression syndrome of postnatal depression, premenstrual depression and perimenopausal depression, but use antidepressants. The adverse effects reported in the 2002 Women’s Health Initiative study are given as justification for not using estrogens, although serious complications did not occur in women starting HRT before the age of 60 years. But, in reality, the objection to estrogens from psychiatrists and bone physicians preceded this study by decades and was a result of their unfamiliarity with this treatment. Regrettably, PROFOX (PROzac + FOsomaX) will become an established treatment for women who really need estrogens.

===============================================================================

This appeared in the International Menopause Society Update on HRT 2011.

Postmenopausal osteoporosis

HRT is effective in preventing bone loss associated with the menopause and decreases the incidence of all osteoporosis­related fractures, including vertebral and hip fractures, even in women not at high risk of fracture. Based on evidence of effectiveness, cost and safety, HRT can be considered as one of the first-line therapies for the prevention and treatment of osteoporosis in postmenopausal women, younger than 60 years, with an increased risk of fracture

CLIMACTERIC 2011;14:302–320. Updated IMS recommendations on postmenopausal hormone therapy

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Womens Health (Lond Engl). 2009 Nov;5(6):637-47.

Long-term prevention with hormone-replacement therapy after the menopause: which women should be targeted?

Source

Center for Clinical & Basic Research a/s, Ballerup Byvej 222, DK-2750 Ballerup, Denmark. peter.alexandersen@ccbr.com

Abstract

For decades, hormone-replacement therapy (HRT) was considered safe and was the first choice in prevention of postmenopausal osteoporosis induced by estrogen deficiency. Numerous experimental and epidemiological studies further supported a protective effect of exogenous female sex hormones on atherogenesis and coronary heart disease (CHD) in women after the menopause. However, the fact that these promising results were not translated into lower incidences of CHD events in hormone-treated women compared with placebo in subsequent, large, randomized studies of healthy subjects as well as women with known CHD raised a very intense debate concerning the safety of HRT in terms of cardiovascular risk. A critical mass of data points toward a protective influence of HRT on cardiovascular disease end points in early postmenopausal women, but increased harm in elderly women, especially those with abdominal adiposity or metabolic syndrome. Once the quasi-hysterical reaction to the largest of the randomized studies (the Women’s Health Initiative) has abated, a future strategy should be to concentrate on identifying those relatively few individuals who are not suitable for HRT, as HRT still remains the most thoroughly investigated pharmacological prevention strategy of osteoporosis.

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Little gain, high risk from long-term bisphosphonates

A A A
15th May 2012

Lynnette Hoffman

LONG-TERM use of bisphosphonates is again being called into question, with researchers suggesting little extra gain and considerable risk for treatment beyond five years.

Given the rare but serious side-effects linked to prolonged use of the therapy, including atypical subtrochanteric fracture and osteonecrosis of the jaw, commentary published online in the New England Journal of Medicine called for reconsideration of which patients are given the drugs and for how long.

Patients with low bone mineral density at the neck after three to five years of treatment were at highest risk for vertebral fractures and are therefore the most likely to benefit from continued treatment, the authors suggest. Those with existing vertebral fractures who have a somewhat higher T score for bone density (but still below -2.0) may also benefit, but those with a T score above -2.0 were low risk and “unlikely to benefit”.

But Australian & NZ Bone & Mineral Society president-elect Professor Markus Seibel said the debate missed the point since most patients with osteoporosis failed to receive any treatment at all.

“I don’t know what the fuss is about [regarding] how long should we be treating, when we know from so many studies that compliance with most osteoporosis treatments is less than suboptimal,” he said.

Fifty per cent of patients on oral bisphosphonates come off the treatment within 1–1.5 years, he said. Advice to re-evaluate low risk patients was reasonable, he said.

N Eng J Med 2012; online 9 May

Another danger of Fosamax:
CMAJ. 2012 May 15;184(8):E431-4. Epub 2012 Apr 2.

Inflammatory ocular adverse events with the use of oral bisphosphonates: a retrospective cohort study.

Abstract

BACKGROUND:

There have been several published reports of inflammatory ocular adverse events, mainly uveitis and scleritis, among patients taking oral bisphosphonates. We examined the risk of these adverse events in a pharmacoepidemiologic cohort study.

METHODS:

We conducted a retrospective cohort study involving residents of British Columbia who had visited an ophthalmologist from 2000 to 2007. Within the cohort, we identified all people who were first-time users of oral bisphosphonates and who were followed to the first inflammatory ocular adverse event, death, termination of insurance or the end of the study period. We defined an inflammatory ocular adverse event as scleritis or uveitis. We used a Cox proportional hazard model to determine the adjusted rate ratios. As a sensitivity analysis, we performed a propensity-score-adjusted analysis.

RESULTS:

The cohort comprised 934 147 people, including 10 827 first-time users of bisphosphonates and 923 320 nonusers. The incidence rate among first-time users was 29/10 000 person-years for uveitis and 63/10 000 person-years for scleritis. In contrast, the incidence among people who did not use oral bisphosphonates was 20/10 000 person-years for uveitis and 36/10 000 for scleritis (number needed to harm: 1100 and 370, respectively). First-time users had an elevated risk of uveitis (adjusted relative risk [RR] 1.45, 95% confidence interval [CI] 1.25-1.68) and scleritis (adjusted RR 1.51, 95% CI 1.34-1.68). The rate ratio for the propensity-score-adjusted analysis did not change the results (uveitis: RR 1.50, 95% CI 1.29-1.73; scleritis: RR 1.53, 95% CI 1.39-1.70).

INTERPRETATION:

People using oral bisphosphonates for the first time may be at a higher risk of scleritis and uveitis compared to people with no bisphosphonate use. Patients taking bisphosphonates must be familiar with the signs and symptoms of these conditions, so that they can immediately seek assessment by an ophthalmologist.

Osteoporosis: Its Time to Stop Treating Healthy Women

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The Women’s Health Activist
November/December 2011

By Cindy Pearson

One after another, I watched the women come to the microphone. We had been sitting near each other all morning, waiting to speak at a Food and Drug Administration (FDA) meeting on osteoporosis. I went first, then sat down to watch the other speakers. Nearly a dozen women had come to tell their stories. Some were nervous. Others spoke confidently in front of the large crowd. They were from all around the country, and a variety of backgrounds.  I listened carefully as they spoke, but I was also struck by what I was seeing.

The women were similar to one another in very striking ways: they were all older, energetic, vibrant, with great posture, nice clothes and attractive hairstyles. Sound familiar?  It should. The women who gave their personal testimony looked a lot like the women featured in osteoporosis drug advertisements. But, unlike the women depicted in the ads, the women at the FDA meeting weren’t there to talk about how bisphosphonates helped them stay healthy. Instead, they told the FDA that bisphosphonates were hurting healthy women, and they used their own personal experience to make case for sweeping change in how bisphosphonates are used.

Most of the women who spoke at the FDA meeting had experienced a sudden and unprovoked broken leg. They talked about turning to put a piece of paper in the trash can, stepping away from the kitchen sink, or walking down the sidewalk — and suddenly collapsing in agonizing pain as their leg gave way. All of these women had been healthy and active before their leg broke. Some had been able to return to their normal activities after their leg healed; others had to endure multiple surgeries, delayed healing, and lingering worry that their next fracture might be just a step away. All of the women agreed that the way drug companies market and clinicians prescribe bisphosphonates is wrong and must be changed. These women echoed and reinforced NWHN’s position, which I presented at the meeting. We believe the FDA should limit bisphosphonate use to five years, and that clinicians should stop prescribing these drugs to healthy adults based solely on the result of a bone mineral density (BMD) test that finds osteopenia.

The NWHN will use all the advocacy tools at its disposal to press the FDA to make changes in how drug companies are allowed to market bisphosphonates like Fosamax, Actonel, Boniva and Reclast (as well as the many generic bisphosphonates) to healthy women. In the meantime, though, we want women and their clinicians to know what the data say about these drugs.

More isn’t better:  Women who took a bisphosphonate for five years and then stopped had no fewer fractures than women who stayed on the drug for another five yearsFive years seems to be the safest maximum time to take these drugs Some studies have reported an increased risk for these fractures after just four years.

Watch for warning signs of thigh fractures: At the meeting, women echoed the recommendations we’ve reported in the WHA (SKF to add date), that anyone taking a bisphosphonate who experiences one-sided pain in the thigh or groin should have an X-ray to determine if a fracture is imminent. Surgery may still be required to strengthen the bone, but it’s much easier to fix a bone before it breaks completely.

Avoid oral surgery if you can:  No one is exactly sure how often this happens, but the best estimate is that no more than 1 out of every 1,000 people taking bisphosphonates experiences jaw bone decay. An FDA-commissioned exploratory study about this found a four-fold increase in diagnosed cases of jaw bone decay among people who had taken bisphosphonates for over four years.It’s hard to know what to do to prevent this, other than taking care of your teeth and trying to avoid dental treatments from which your jaw might not heal well, such as oral surgery. Given how long bisphosphonates remain in the bone, it’s impossible to reduce the amount in your system by stopping the prescription shortly before oral surgery. So, it is very important to let your dentist know if you’re taking bisphosphonates.

Keep walking – but pay attention to your feet:Women speaking at the FDA meeting brought up another possible complication of bisphosphonates: broken bones in the feet. This complication hasn’t yet been reported in medical journals, but that lack of attention is about to change. With the help of Jennifer Schneider, a physician who herself has experienced an atypical femur fracture, women have collected over 100 accounts of bisphosphonate users who’ve had a femur fracture.  Interestingly, 30% have also had a fracture of the long bones in their feet (metatarsals). This is a great example of community-led research that is designed and conducted by the affected individuals and that raises important issues to be explored more fully in the future. In the meantime, there aren’t any specific preventive measures a bisphosphonate user can take, and the women who spoke out at the hearing wouldn’t advise stopping exercise. But they do want others to know about their experience, and be aware of the possible association between the drug and broken foot bones.

Stay away from the bone mineral density scanner:  Just say no! That’s our advice to almost all women under age 65, and maybe even many women 65 and older as well. WHA readers are familiar with NWHN’s critique of bone mineral density (BMD) screening.  Unless you have a serious medical condition that creates fragile bones, or a very strong history of fragility fractures in your family, do not get a BMD test before you’re 65. If you’re White, you’re likely to be diagnosed with “osteopenia”, a condition that means nothing more than that your bones are less dense than the average 20-something’s. If you’re a woman of color, you’re likely to get a number that doesn’t tell you or your clinician anything at all, since women of color were left out of studies manufacturers used to define “normal” BMD. If you’re over 65, the age at which the U.S. Preventive Services Task Force recommends BMD screening, you can take stock of your own risk factors and make an informed decision.

For more information about osteoporosis, bone density screening, and preventing factures, read NWHN’s Osteoporosis fact sheet at www.nwhn.org.  To contact the women who are involved in researching femur fractures, Jennifer@Jenniferschneider.com. To get up-to-the-minute updates on NWHN’s advocacy work on this and other issues, sign up for our e-alert list (www.nwhn.org) and friend us on Facebook (https://www.facebook.com/NWHN.ORG)

Cynthia Pearson is the NWHN Executive Director

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  2. Yes you are so right, I am lucky I found this site and Dr Holloway. I had my first appointment yesterday and was very impressed by his knowledge on hormones (or lack of) .
    It was confirmed “again” for Osteoporosis that your diet and a hormone I was lacking (along with the other hormones I am also lacking) will do more for Osteo than the Calcium I have been taking for over 20 years.
    In fact the Calcium, with Magnesium and D did nothing, the Chemotherapy I had last year obviously did not help either.

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