Osteopenia is a condition that only recently started to be thought of as a problem that required treatment. Until the early 1990’s, only a handful of people had even heard of the word. But osteopenia has transformed from a rarely heard word into a problem that millions of women swallow pills to treat.
The term “osteopenia” was never originally meant to be considered as a disease -- it was a research category used mostly because some thought it might be useful for public health researchers who like clear categories for their studies.
But in 1995, a man named Jeremy Allen was approached by the drug company Merck. The pharmaceutical giant had just released a new osteoporosis drug called Fosamax. Since osteoporosis is a serious problem that affects millions of women, the potential market for Fosamax was enormous. But the drug wasn’t selling well.
Allen persuaded Merck to establish a nonprofit called the Bone Measurement Institute. On its board were six of the most respected osteoporosis researchers in the country.
But the institute itself had a rather slim staff: Allen was the only employee.
In 1997 the institute and several other interested organizations successfully lobbied to pass the Bone Mass Measurement Act, a piece of legislation that changed Medicare reimbursement rules to cover bone scans. More and more women got bone density tests (at Merck’s urging), and the very existence of the word "osteopenia" on a medical report had a profound effect.
Millions of women were worried by the diagnosis. And when clinicians saw the word 'osteopenia' on a report, they assumed it was a disease. Merck did not disabuse them of the notion.
There are no long-term studies that look at what happens to women with osteopenia who start Fosamax in their 50’s and continue treatment long-term in the hopes of preventing old-age fractures. And none are planned.
I don’t believe for a minute that Merck’s motivation for pushing the label “osteopenia” was to make it convenient for the researchers. It’s very clear that Big Pharma has one overriding goal—a handsome sales report at the end of the quarter.
Since 2003, annual sales of osteoporosis drugs have about doubled to $8.3 billion, and $3 billion of that was from Fosamax alone.
Convincing you that you have a disease when you don’t is nothing short of medical molestation. It’s unethical, self-serving, and demonstrates the upside-down priorities of the pharmaceutical giants.
But it isn’t surprising, I’m sorry to say.
Manipulating Research and Massaging Data
The manufacturers of osteoporosis drugs exaggerate the benefits and downplay the risks of so-called bone-strengthening drugs, according to a report in the January 2008 issue of British Medical Journal (BMJ)[i].
The paper states that the strongest single risk factor for fracture is falling, not osteoporosis.
Authors emphasize that “drug treatment is not a panacea,” and that women with osteopenia have such a low risk of fractures that drug treatment provides no benefit at all—but comes with all of the risks.
The paper states:
“What the drug makers do is argue that the effect of treating pre-osteoporosis (osteopenia) and osteoporosis is similar. This move to treat pre-osteoporosis raises serious questions about the benefit-risk relationship for low-risk individuals and about the costs of medicalizing and potentially medicating an enormous group of healthy people.”
The paper also states that all four studies cited by drug companies to substantiate the benefits of giving osteoporosis drugs to women with osteopenia were exaggerated[ii]. For example, one study claimed a 75 percent reduction in the risk of fracture, but the real risk reduction was only 0.9 percent.
These same studies also downplayed the potentially harmful side effects of these drugs. In one, they simply “forgot to mention” that raloxifene (Evista by Eli Lily) increased your risk for blood clots.
The BMJ article also mentions that many of the authors of the four studies were employees of the pharmaceutical industry, not surprisingly.
New Tools for Calculating Your Fracture Risk
In response public concern about the risks of these drugs, the World Health Organization recently developed an online tool meant to help physicians and patients determine when treatment for deteriorating bones is appropriate. It’s called FRAX (Fracture Risk Assessment Tool), and it claims to take into account risk factors other than bone density alone.
Before you get too excited about this handy new tool, it turns out that FRAX is proving to be as controversial as osteopenia.
It just so happens that FRAX was developed by the same people who came up with the faux-disease osteopenia in the first place! It’s no surprise, then, that the advised threshold for medication is too low.[iii]
There is some promise, however, offered by another tool called the FRISK (Fracture Risk Score), which was developed by an independent group of scientists[iv]. The FRISK score is based on multiple-site bone mineral densities (BMDs) and other risk factors such as likelihood of falling, bone mass, body weight, and other variables.
What You Risk With Fosamax
Merck tried to hide the fact that Fosamax is causing jawbone death, a disease now known to oral surgeons as Bisphosphate-Related Osteonecrosis of the Jaw (BRONJ) or “Fossy Jaw,” a nasty side effect of Fosamax and related drugs that is difficult to treat.
Essentially, the condition causes your jawbone to rot and decay—quite ironic considering the drugs are primarily taken by people looking to strengthen their bones.
In addition to BRONJ, bisphosphate drugs have also been associated with:
Hypocalcemia (blood calcium levels are too low)
With a resume like this, it’s not surprising that Merck may have intentionally tried to keep the side effects of Fosamax under wraps—what drug representative would want to share this information with potential clients?
Merck did the same thing with their tragically dangerous painkiller, Vioxx.
Fosamax: Works on Bone Cells AND Soap Scum
Bisphosphonate drugs like Fosamax, Actonel and Boniva, are problematic because they stay in the bone indefinitely and disrupt the normal bone regeneration process.
Healthy bones maintain their strength from a continual process of bone breakdown and bone rebuilding. Osteoclasts are the cells that break down your bone, and osteoblasts are the cells that rebuild it.
Fosamax and similar drugs poison your osteoclasts, permanently killing them—the normal bone repair process is halted. So, your bones will indeed get denser. However, denser bones are NOT stronger bones, which is the part they don’t tell you. In fact, eventually your bones become weaker and more prone to fracture.
Because bone is a dynamic structure that requires the removal of unhealthy bone and REPLACEMENT with new bone to stay strong. Fosamax does NOT build any new bone. It only kills the cells that break bone down, so your bone is not benefitting from its natural regenerative process.
But don’t throw out that Fosamax just yet!
It’s in the same chemical class (phosphonate) as the cleaners you use to remove soap scum from your bathtub. So, maybe you can make use of it in your bathroom after all.
Osteoporosis MYTHS: Calcium and Protein
I have already busted the myth that you need to use a bisphosphonate drug to keep your bones healthy. But there are two other myths that need dispelling:
Osteoporosis is caused by calcium deficiency: Bone is composed of at least a dozen minerals, and if you focus exclusively on calcium supplementation you are likely going to worsen your bone density and actually increase your risk of osteoporosis.
Overconsumption of calcium creates other mineral deficiencies and imbalances, which then increase your risk of heart disease, kidney stones, gallstones, osteoarthritis, hypothyroidism, obesity, opportunistic infections and type 2 diabetes.
A high-protein diet leads to osteoporosis: The myth that eating a high protein diet will cause calcium loss through the urine is simply false. Consuming plenty of high quality protein, like free-range eggs and grass-fed meats, ensures that you’ll have the amino acids your body needs to form a strong bone matrix.
My Prescription for Bone Health
These simple guidelines will help you maintain or increase your bone strength safely and naturally, without the use of drugs:
Increase your consumption of vegetables based on your body's unique nutritional type. If you find it difficult to eat the recommended amount of vegetables you need daily, you can also try vegetable juicing. Make sure your veggies are fresh, organic, locally grown vegetables that are not genetically modified.
Consume a healthy balance between omega-6 and omega-3 fats, and reduce or eliminate the amount of processed vegetable oils such as corn, canola, safflower, and soy.
Eat according to your nutritional type. This will ensure that you’re getting enough nutrients for your bones, as well as helping to correct your omega-6 to omega-3 ratio.
Avoid gluten, a grain protein that has been shown to decrease bone density. Gluten is found in wheat, barley, rye, oats and spelt.
Avoid soda and sugar, which increase bone damage by depleting your bones of calcium.
Avoid steroids, especially if you have asthma or any other autoimmune disease. Steroids increase your risk for osteoporosis.
Consider supplementing with vitamin K2 if you are not getting enough from food alone. Vitamin K2 serves as the biological "glue" that helps plug the calcium into your bone matrix. The dose is about 185 mcg per day.
Get enough vitamin D, ideally from proper amounts of sun exposure. Vitamin D builds your bone density by helping your body absorb calcium.
Exercise. Studies show that exercise is just as important to your bone health as eating a calcium-rich diet. Strength building exercises like weight training are especially helpful here.
Consider natural progesterone[v], which can increase your bone strength. It does this by serving as a growth promoter for the osteoblasts (the cells that build bone). For more on progesterone, please review Complications Regarding Progesterone Cream
[i] Jarvinen T.L.N., Slevanen H., Khan K.M., Heinonen A., and Kannus P. “Shifting the focus in fracture prevention from osteoporosis to falls” BMJ (January 19, 2008) 336:124-126
[ii] Edelson E. “Bone strengthening drugs may be overprescribed” (January 18, 2008) The Washington Post
[iii] Murphy K. “Splits form over how to address bone loss” (September 7, 2009) New York Times
[iv] Henry J.H., BSc(Hons), Pasco J.A., Sanders M.S., Nicholson G.C., and Kotowicz M.A. “Fracture risk (FRISK) score: Geelong osteoporosis study” (October 2006) Radiology 241:190-196
[v] Dr. John R. Lee website, Osteoporosis Page