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What You Should (and Shouldn't) Do to Treat Osteoporosis

Norton Shores Michigan Chiropractor - It is widely known that osteoporosis is a disease that affects the bones.  Most people either have it or know somebody that does.  However, they don't know what it really means or what causes it.  I'm a Chiropractor, so bones to me are like piano keys to Ray Charles.  Naturally, this disease pertains to my Muskegon practice because unhealthy bones cause unhealthy spines (and unhealthy patients).  My treatment is limited by the health of the bones and joints I am given to work with, so to speak.  Thus, osteoporosis is a big deal to me.

A Faustian Bargain

Osteoporosis is a disease that affects the structural ingegrity of the skeleton, resulting in low bone density.  Osteoporotic bones are more brittle and fragile, resulting in an increased risk of skeletal fracture.    In the case of the elderly, hip fractures especially carry a very high morbidity rate, so preventing osteoporosis could literally save lives.  Well, whenever a condition is labeled "life-threatening," it starts to get publicity, so we tend as a society to clamor for a treatment (rather than figure out why the condition has popped up in the first place).  Currently, 10 million Americans have been diagnosed with the disease, with 8 million of them women.  With this large of a market, big pharma has pooled a lot of money and resources to put together a marketing...errr...treatment plan to combat this disease.  These drugs are called bisphosphonates and they include the brand names Boniva and Fosamax.  Unfortunately, while enjoying lucrative sales (to the tune of making osteoporosis treatment a $12 billion per year business) they've only made it worse by ignoring the true cause of the disease and pushing drugs that may do more harm than good in the long run.

In fact, osteoporosis medications have been linked to an increased risk of fracture, especially for those who have been on the medications for more than five years (the x-ray of that horrific femur fracture at the beginning of this post is from a biphosphonate victim).  The fractures commonly occur in the femur.  The patients often suffered a painful, aching sensation for several weeks before the fracture occurred.  The type of fracture suffered is similar to what one might experience after a very serious injury (like a car accident). However, these individuals who suffered these fractures experienced no trauma whatsoever, which left the ER docs scratching their heads.  It took a while, but they finally figured out that these people all had one thing in common: they were all on osteoporosis medications.  Whoops.

Eventually, the situation forced the FDA and WHO to evaluate the safety of these drugs.  A class action lawsuit is now underway.  Officials have now issued a warning on all these medications, including a clear warning on the label.  But what good does a warning on a label do if your doctor has already prescribed the drug?  Every drug has a side effect, so when people see these warnings, it doesn't even phase them anymore.  In addition to the more recent discovery of increased fracture in weight bearing bones, Fosamax has been known for years to cause osteonecrosis of the jaw, a very painful condition which roughly translates to a "rotting or decay" of the jawbone.  This condition has been noticed by so many surgeons that when they see it, they refer to it as "Fossy jaw."  Cute.

How could this be?  What are these drugs doing?  Why aren't they working like they are supposed to?  Aren't they supposed to prevent fractures?   How could those well-meaning drug companies and government agencies let this happen?

Flawed Logic

The mechanism of so-called "osteoporosis medications" is to try to artificially make the bones more dense.  Unfortunately, density does not always correlate with strength.  Take lead for example.  It is VERY dense; much denser than iron.  Heck, Superman can't even see through it.  But it is not very strong.  Lead is roughly 50 per cent more dense than iron, yet iron has nearly 20 times more tensile strength than lead.

While drugs like Fosamax and Boniva have been shown to successfully increase the density of bones in clinical trials, they do little to increase the actual strength, which is key.  The strength of the bone is what determines whether or not it will buckle like a belt when met with the stresses of movement (or in the case of the fracture victims, gravity itself).

Bones are alive.  They maintain their strength through a dynamic system of continual destruction and rebuilding (like the "Doozers" and "Fraggles" from Jim Henson's Fraggle Rock....okay, I've dated myself with this reference but it works really well for this discussion).  Please allow me to explain.

Skeletal Physiology Explained Through Children's Programming!

Fraggle Rock, in addition to being a staple of my childhood television viewing experience, effectively demonstrates the dynamics of healthy bone remodeling.  In our bones, there are two types of cells at work, the osteoblasts and osteoclasts.  In Fraggle Rock, there existed a race of tiny builders called the "Doozers."  They would whittle radishes down into a material called a "Doozer stick."  They would take and use these materials to build fantastic subterranean architecture.  In our bones, we call these cells that build new bone osteoblasts.
The Fraggles were monkey-like cave dwelling puppets that would often burst into song when facing moral dilemmas, teaching children like myself the benefits of sharing, caring, and loving one another (no wonder I turned out alright....thank you, cable TV!).  But they had a dark side.  Despite their well-meaning nature, Fraggles had a RAVENOUS hunger for radishes, including Doozer sticks.  They couldn't help themselves.  They were like carb addicts forced to live next door to a Cinnabon.  Their lust for Doozer sticks would cause them to destroy the very building materials for the Doozers' creations, causing catastrophic loss of infrastructure throughout Fraggle Rock.  No more Doozer Macy's.  No more Doozer Starbucks.  Horrible, I know.
In our bones, the cells that act like Fraggles, eating and resorbing the old bone cells, are called osteoclasts. Although the Fraggles gorged themselves on Doozer sticks, destroying everything in site, the Doozers never fretted and always went right back to work, building more structures to replace the ones the Fraggles dined on.  This sytem worked well.  The Fraggles avoided mass starvation.  The Doozers had job security so the little Doozers could have smart phones and attend private school.  Songs were sung.  Life lessons were learned.  And most importantly, children like myself were entertained while mom and dad fixed breakfast or got ready for work.

Our bones rely on a similar system to rebuild themselves so they can stay strong, allowing us to go about our lives and stay active well into our later years.  This system is perfect.  You wouldn't want to mess with it, right?  Well, leave it to drugs like Fosamax and Boniva to throw a monkey wrench into that system.  Remember those cute little Fraggles we talked about?  The ones that helped me become the caring, heartwarming individual I am today?  Well, osteoporosis drugs kill them.  They figure that if you just kill off the Fraggles (osteoclasts), the Doozers (osteoblasts) can perform their work unhindered, leading to more bone mass and hopefully less fractures.  It makes sense, right?  The problem is that it made so much sense that no one ever thought to make sure that the premise would work long term.

Unintended Consequences

By destroying the osteoclasts, the old bone cells are not removed to make room for new bone cells, totally inhibiting the natural process of bone regeneration.  The old cells stick around longer and for a while your body keeps making new cells, so in the short term, the bone density increases.  However, your body is pretty smart.  It starts to sense that there are plenty of bone cells present, so the osteoblasts eventually slow down.  Essentially, your body doesn't make more bone because there is plenty there already.  What you are left with is bone that has become more dense due to the accumulation of old dead bone cells.  There is technically "more" bone which again is nice in the short term and looks good on a bone scan, but it becomes more brittle and actually weaker than what you started with before taking the medication.  All you have to show for it is a lot of empty pill bottles and the knowledge that you've helped a pharmaceutical company's stock rise a fraction of a point.

If you're saddened about the sad plight of the Fraggles (or your aunt Martha's osteoporotic bones), you are not alone.  Nevertheless, there can be a happy ending to this tale.  Anyone who knows me will tell you that I'm not a doom and gloom guy.  I like solutions and I love sharing them, so let's get to the good news: this can be prevented!  But before we get to that, let's talk about what actually CAUSES osteoporosis in the first place.

What REALLY Causes Osteoporosis (Hint: it's NOT a lack of Fosamax in your diet)

Humankind did just fine without osteoporosis medications for millennia.  And please don't say "but, but, but cavemen didn't love long so they couldn't develop osteoporosis!"   There is plenty of archaeological data showing that humans maintained bone density throughout their lives before our diets deviated from ancestral norms.  In addition, early (wo)man often lived to a ripe old age, as long as he or she didn't get eaten or succumb to illness.  Not to mention, high infant mortality skews average lifespan numbers.  Here's a link for "more info on how life expectancy gets skewed."
Osteoporosis is mostly a "disease of civilization," much like heart disease, type 2 diabetes, and obesity.  These conditions are rarely seen in our ancestors or in modern day indigenous peoples.  Certain foods and lifestyle factors in the western world, like the use of carbonated beverages and cigarettes, contain chemicals that actually demineralize bone, much like rust strips the metal off the old Trans Am your your uncle Lou has in his backyard.  Bummer, right?
Another relevant factor is the acid/base balance of the Western diet.  Many staples of the SAD diet (processed cheeses and meats, soft drinks, and grains, for instance) give off very acidic metabolic byproducts while fruits and vegetables give off more alkaline byproducts.  I am not saying you shouldn't eat meat because it gives off acid, as long as you avoid processed foods and eat enough fruits and veggies to offset it.  When the diet yields a net acid load, your body has to buffer it with a basic (alkaline) constituent.  Minerals in the body (Calcium, for instance) are alkaline (basic) and they get excreted by the kidneys in the urine, which means your body loses precious minerals that are normally used to create bone.  This is a fact.  By increasing your intake of fruits and vegetables (preferably vegetables) and cutting down on acid producing foods and beverages, you can restore acid/base balance and help decrease bone demineralization.  So, quit drinking soda and start eating more vegetables.  (Hint: you'll feel better, too)

Maintaining Bone Health Takes Guts

Gut irritation is another cause of bone demineralization.  Modern foods (grains, sugars, and processed foods in general) contain anti-nutrients like gluten, phytates, and lectin.  They (among other things) cause gut irritation, which prevents mineral absorption.  This is why people can take calcium supplements until they are blue in the face, but they may not improve their bone density.  The minerals don't get absorbed.   Celiac sufferers, for example, suffer from a life-threatening allergic reaction to gluten and they have horrible nutrient malabsorption issues.  Celiac sufferers also have high rates of....wait for it....osteoporosis!  "But I don't have celiac, so gluten doesn't matter to me!"  Not so fast.  These malabsorption issues affect everybody to some degree, it's just that celiacs experience it to a much larger extent and have more obvious symptoms.  Of course, when we look at the Standard American Diet, what makes up the base of our food pyramid?  Gluten-containgin grains!  If you want strong bones, stay away from gluten as much as possible.  Mankind existed for over a million years without and when gluten enters enter the diets of primitive people, bad stuff happens.  Personally, I cut gluten from my diet and I have experienced health benefits too numerable to mention.  I know that my experience does not make it valid, but there is plenty of science backing up the premise that gluten is not ideal for human  consumption when other more nutritionally dense foods are available.
Certain drugs can alter your body's ability to maintain bone density, as well.  Medications that are used for acid reflux and GERD (nexium, et al) disrupt your body's ability to absorb calcium.  Several papers have showed an association between the use of these drugs and an increased incidence of hip fracture (WebMD article).  Patients are only supposed to be taking these medications for 6-8 weeks maximum.  However, most patients I meet who are on these drugs have been on them for years, despite the widely known fact that these drugs cause osteoporosis.  The FDA has (finally) decided to do something about this one, as well.  Time will tell to see if it actually influences the habits of medical professionals who prescribe them.  All the label warnings in the world are worthless if the doctors still prescribe the stuff, after all.

Get Regular Weight Bearing Exercise

One of the best things you can do for your bones is put pressure on them.  That sounds a bit strange, but it's true.  There exists a scientific law (not a theory or hyposthesis, but an irrefutable LAW) referred to as Wolff's Law.  Wolff's Law states that bone will adapt to the loads it is placed under.  When the load on a particular bone increases, the bone will remodel itself over time to become thicker and stronger to resist that sort of loading in the future (thanks to the Fraggles and Doozers!).  The same thing happens to our muscles.  People who weight train have bigger, stronger muscles while perpetual couch potatoes have small, weak muscles.  In other words, use it or lose it!

Now when it comes to exercise, remember that the exercise must be weight bearing to get the best results.  Things like hiking, aerobics, stair climbing, plyometrics, jumping rope, playing sports, running, and dancing are high impact exercises that are beneficial to maintaining bone integrity.  For those with joint problems, low impact exercises like low-impact aerobics, elliptical training, yoga, walking, and treadmill work will do.  Of course, if you have joint problems, you may want to see a Chiropractor, since that's what we specialize in relieving.

Another way to send a strong signal to your bones is to keep your muscles strong with resistance training.  It's simple: muscles are attached to bone.  By strengthening the muscles, you are placing more stress on the bones, forcing them to remodel in order to keep up.  Weight training, training with resistance bands, swimming, and Pilates are examples of resistance training.

With a Little Help From My Friends

When it comes to diet, sufficient calcium intake is important (as long as you're not ingesting anti-nutrients that undermine your efforts).  Obviously, milk and dairy contain a lot of Calcium, but so do some green vegetables (spinach, broccoli, peas, Brussels sprouts).  If you don't consume dairy, supplements may be needed.  Where most people usually fall short is in the intake of calcium's two best buddies, Vitamin D and magnesium, which are crucial to bone health.  Vitamin D is important for the absorption of calcium.  You can choke down calcium chews til kingdom come, but if you do not have adequate Vitamin D, you'll lose most of it through your stool.  The best source of Vitamin D is sunlight, but for those of us who live in northern climates during the winter months (like perpetually cloudy Muskegon, Michigan), sun exposure is not consistent enough to provide us with Vitamin D.  Good dietary sources of vitamin D are fortified milk (provided you can eat dairy), egg yolks, saltwater fish, and liver.  Supplementation may be needed, but make sure your source is Vitamin D3, which is superior to D2.  Follow the the link if you want to find out why: Vitamin D3 vs. D2.  Magnesium plays a crucial role in the body's regulation of calcium utilization.  Magnesium can be found in fruits, vegetables, nuts, seeds, and fish.  It's also great for staying regular!

To summarize, you should always question any chemical you are putting into your body.  Although I don't want to paint with too broad of a brush, most diseases of civilization are not managed well with medication.  Lifestyle and dietary changes are a must.  If you believe what Sally Field tells you on your television, go ahead and take your Boniva and hope those magic pills will help your bones stay strong into your golden years.  However, it makes much more sense to eat more nutrient-dense food, eliminate foods that are deleterious to our health, and get more exercise.  Not only will your bones get stronger, but you will improve your overall quality of life for the long haul.

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