For years I’ve avoided putting my patients on fosamax and related drugs for “bone health,” because according to the package insert, these drugs don’t make bones healthy. They prevent part of the natural cycle of bone growth, called bone resorption, and by doing so make them denser looking on bone scans. Dense bones might sound like a good thing, but realize that a stick of chalk would look really dense on XRay, and it snaps in your fingers. Healthy bone that won’t break when you slip and fall is a matrix of protein and minerals, and just adding more minerals without combining them in the normal way with protein won’t help.
This week, I finally found a picture proving these drugs may be harmful when taken for years and years (like most people do). What the picture shows us is a line of dark, where no radiation got absorbed because the bone is fractured. You can access the journal at http://www.familypracticenews.com/home and look for the May 1, 2008 edition. The title of the article is “low bone mass frequently gets overtreated” and the author is Nancy Walsh.
Luke says the title should be “Drugs for preventing fractures actually cause fractures!” I agree. Don’t you think this might deserve front page? I mean, it’s the tenth most commonly prescribed class of drugs in the US, worth about 4.6 billion per year. But it’s buried inside, on page 21. How many doctors do you think will find it there when our desks are piled with magazines full of hundreds of articles every week?
In case you can’t access the article online, the picture caption reads: “Subtrochanteric fractures can occur when bone turnover is overly suppressed.” Clearly, the drugs have side effects that most people don’t suspect, and one of them is an increased risk of fractures. For more, see “why you don’t want to suppress bone turnover” below.
So how can you keep your bones healthy?
Hands down, the best way to build healthy bones is to be active. Exercise helps keep your proprioceptive (balance) nervous system in shape and it keeps your mind sharp, both of which help to prevent falls – the number one cause of fractures.
Exercise does something else to keep your bones strong, too. Many people think their bone strength is an inherited, genetic trait that they have no control over. But that’s not true. When astronauts returned from 30 day space missions, their doctors were shocked to find how weak their bones had become: in 30 days, their bones had aged 50 years. How could that be?
It has to do with the fact that bones are always growing, which we knew, but we had not expected to find that bones were quite as responsive to gravity as they are. Just the tug of your weight every day helps keep them from deteriorating. If you exercise, the healthy stresses act like growth signals, and actually trigger growth hormone release which, among other hormones, is required to keep your bones strong.
The other key ingredient to healthy bones is food.
Everyone things of calcium when they think about bones, and many people take supplements. But for every ten molecules of calcium, your bones need one molecule of magnesium. Taking calcium pills that are not balanced with magnesium may cause calcium to deposit around your joints instead of in your bones, creating bone spurs and contributing the arthritis. Magnesium is one of the few supplements I recommend because our soils are depleted and few foods contain very much of this overlooked bone-building mineral.
If you can’t drink milk or dairy products, go ahead and get a calcium supplement. But truly the best way to get your calcium is by eating foods that are naturally calcium rich, like dairy. What else is there? Well nuts and dried fruit do have some calcium, but a great source of calcium and all the bone building minerals that should be on everyone’s grocery lists is fish with bones, like canned sardines and salmon. I have one patient who buys salmon fish heads and pressure cooks them for 30 minutes until the bones are soft, and then shapes it into a patty and eats it. She says it’s quite delicious. We actually have taste buds that detect minerals like calcium and magnesium, so as odd as it sounds, cooked bones actually taste good to us.
And vitamins are just as important as minerals.
Vitamins A, D, and K help your body put the minerals you eat into bone. Without them, all those minerals you’ve eaten go right through you. Most people can make D in their skin when they go out in our tropical sun, but not everyone can. If your bone density is low, you should get your level tested. Vitamins A, D, and K are fat soluble, and so they don’t get absorbed into your body unless you eat them with a little bit of fat. Research shows the most effective carrier of these important nutrients is saturated fatty acids. This may be one reason why studies show time and time again that low fat diets don’t make people healthier.
Why You Don’t Want To Suppress Bone Turnover
Bone turnover is the ongoing process by which your bones respond to stress. Your bones are always growing, even at age 90. Not in length, but internally. Your bones are supported by internal struts, very much like the struts criss-crossing beneath the Brooklyn Bridge. From time to time, your bone struts wear out and need to be repaired. The repair process is called “bone turnover.” The article does not give doctors any clue what they meant by “when bone turnover is overly supressed.”
Why wouldn’t the article give us any hints? It was actually a journalist’s summary of a talk given by Dr. Stephen Honig, who serves on the speakers bureau of Novartis Pharmaceuticals. And so with that fiduciary relationship in place, I doubt anyone listening to his seminar got the full story either.
Bottom line is I have yet to find reason to start any of my patients on these drugs. Why not? Because aside from suppressing bone turnover and causing bones to break if you use them “too long,” they cause a few ugly little problems your doctor probably didn’t disclose before handing you the prescription:
- Muscle aches, sometimes disabling
- Esophagitis, and rarely, the acid drug erodes through the esophagus perforating it and killing people
- Osteonecrosis – this is a condition in which segments of bone die and sometimes need to be removed. Very inconvenient if the affected bone is in your jaw or your neck.
Of course if he or she did tell you, you should thank him. Unfortunately, since we’re getting paid less and less every year (so that your insurance company can afford to subsidize expensive prescription medications like Fosamax) fewer and fewer doctors have enough time to read up on the side effects themselves, much less inform their patients.