Keeping Your Bones Healthy for Life


By Tamara Sachs, MD T


he current approach to osteoporosis illustrates two of the big- gest problems in medicine today.


Drug Therapy First is the myth that only drug therapy works, especially when faced with a serious condition. This is the Big Pharma model of medicine which often frightens people by misusing statistics and overestimating the risks of developing a serious condition. This distracts us from and trivializes the very real side effects the drug treatments may have.


The combination of for-profit medicine, constant drug adver-


tisements on TV, fear of litigation, shorter office visits and little reimbursement for lifestyle medicine all contribute to the overuse of prescription medication. Since properly prescribed medications are one of the top 5 causes of death of Americans today, it is urgent that we use medications more selectively and only when the benefits clearly outweigh the risks. This is not the current practice when it comes to preventing bone fractures; instead, many effective non- drug treatments are ignored. Drug treatment for osteoporosis has become a reflex based on a measurement of bone density that is often misinterpreted.


Medications for osteoporosis should only be used as part of a


comprehensive approach and for a very limited but specific time frame, to maximize their usefulness and minimize their risks.


Bone density is typically measured when it is at its worst, around menopause, and then compared to the bone density of young women. We then call the normal, predictable bone loss due to the loss of estrogen around menopause a new disease: osteope- nia. This scares women into thinking that drug treatment now will prevent a fracture later, and that is very misleading. Bone density (BD) scores must be age-matched to be at all useful (called a z score) and even then, BD is not able to accurately estimate your personal risk of breaking a bone. But when statistics are misused, the deci- sions we make are more emotional that factual.


Lifestyle and Diet Secondly, like many chronic diseases, osteoporosis is a direct result of lifestyle and diet choices over the course of a lifetime. But as a society, we do not value or invest in prevention. We allow conventional medicine to wait until chronic illness progresses, then symptoms and their consequences are treated with expensive


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drugs and high tech interventions. Rather than a preventive medical model, we have a Big Pharma model and there is simply no profit to be had from a comprehensive plan for bone health that tries to minimize both bone fractures and the use of medications.


Healthy Bone Physiology The reason we measure bone density is to try and prevent bone


fractures in our senior years. But there is much more to preventing bone fractures than bone density. Like every other part of our body, bone is dynamic living tissue made up of cells. New cells replace old cells and old bone that has been damaged or worn gets replaced with healthier young bone. This happens bit by bit, in a process called remodeling, just like in a home.


Think of bone as a savings account. During childhood and until our 20s, we make bone deposits. We need to build enough strong bone to last us our lifetimes, including as we age, when we will be making more bone withdrawals than deposits. Women lose bone earlier in life but men lose bone too. By our late 20s our bony house is mostly built and for the rest of our adult life, we maintain it by slowly remodeling it, removing old and damaged bone as required, and replacing it with new young healthier bone. It takes about 8 to 10 years for this process to gradually replace our entire skeleton, thus keeping our bones healthy. Osteoporosis and bone fractures can occur if not enough good bone was ever made or if more bone was lost or damaged than we could replace in time.


There are three key aspects of bone that make it healthy and


resistant to fractures: density, quality, and how the remodeling is done, called bone turnover.


Bone Density: The density of bone is a measure of how much


bone you have, but bone density says nothing about the composition or quality of that bone. This is one reason why bone density is such a poor predictor of bone fracture except at the extremes.


Bone Quality: The quality of your bone gives it its strength and its resilience (its ability to bend a bit and not break, like a young tree). We know what goes into good quality bone: a core of protein made hard by numerous different minerals, far beyond calcium, ar- ranged in a very structured and organized pattern. Without the right amounts and ratios of these minerals, the quality of bone is reduced.


Bone quality is also impacted by how much bone damage has accumulated. Bone is damaged in the same way that all other tissues


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