Saturday, 4 December 2010
The Things They Do To Women. Part Two - Osteoporosis.
First of all, let's define what the problem is. If you or a loved one has had a DXA-scan any reading below -2.5 is seen as osteopenia not osteoporosis. You have the precursor to osteoporosis. Your bone mineral density is low but even if it's 2.5 (that's -2.5SD) you are not ill, you are just getting older (unless you have hyperparathyroidism that is). Most will be women and postmenopausal. Why? Well, the menopause alters the hormone level and that to some extent governs the levels of osteoclasts and osteoblasts. The former remove density and the latter build it, in a natural process that lasts most of our lives. As the repository of calcium, the bones will give it up, when the body needs it elsewhere, and reabsorb it when it does not. Largely the process is governed by the parathyroid, but also the levels of Vitamin D3 and intake of calcium from the gut have a part to play. As we get older, our ability to keep our bones strong naturally declines, so it happens to us all, with very few exceptions.
Men are somewhat less susceptible, as they do not suffer from the loss of hormones in the same way as women, but men do get it, but it is less severe or predominant than in women. So none are ill, just getting older. Why then is any importance attached to it? Well, it can be crippling to a very small cohort, who have repeated fractures or their spine starts to crumble. These are rare, but becoming less so. But all of us lose some bone density, as part of the ageing process, it is inevitable. Calcium supplements are often prescribed, or they, were until a scare about these being contributory to MI (Heart Attack), in women went about, but on the whole western populations do not suffer from any scarcity of calcium, in the diet. We do suffer from a dearth of both Vitamin D3 and magnesium however, which can be contributory to bone density and is hypothesised by some to be part of the reason for density loss.
However, if we all lose some density as we age, do we need to diagnose it as an illness? We don't, unless our careers are determined by looks, do much to hide wrinkles, or hair loss or the myriad symptoms of ageing. What's so special about bone density? Well, it can make money, a lot of money. Both for the makers of dual Xray absorptiometry machines and 'Big Pharma', who produces various drugs which are alleged to halt it's progression or even increase density. Largely targeted at women (of course) these machines measure the absorption of radiation and via an algorithm and express this as a T-score. If you are thin or heavy the measurement can be 'skewed' as the algorithm is based on thickness of the bones and averaged out. So thicker/thinner than average can alter the true result.( If you do get a scan, then try to have any repeats done on the same machine, to ensure differences are measured against the original). But overall the scan itself, is not really dangerous as it uses very low levels of radiation.
"Bone mineral density testing is a poor predictor of future fractures, but an excellent predictor of the start of drug use."said Barbara Mintzes, in the BMJ, not so long ago. She was referring to the alliance between Merke and the makers of DXA scanners, formed at the outset of the Osteoporosis 'Industry' (1995). Their drug, Fosamax, was the first in the market. It suppresses the action of Osteoclasts and as a result, bones become harder, but, not necessarily stronger. Tensile strength tends to be lost and bones becomes harder but more liable to shatter. Like glass or an eggshell.
Biphosphenates have been linked to the very problem that they were designed (allegedly) to prevent. As well as thigh bone fracture they have also been linked to Necrosis of the jaw bone. Frankly they are also pretty awful to take as well, requiring that you do so on an empty stomach, with copious amounts of water, stand or sit upright for half an hour, all to prevent damage to the oesophagus, for which it is alleged they can cause cancer. What are they? Well, pretty much a type of washing soda; in other words a pretty caustic product and you drink this? Would any man do this? I think not. This information might help in any decision. but the overwhelming evidence is that Alendronic Acid (Fosamax etc) will only decrease the risk by some 1%, at the expense of exposure to some quite horrific side effects, let alone the misery of taking the damn stuff. A simple but scientific explanation is detailed in the link that may help.
As may be realised, I am a little partisan about this problem and there is little science available in the form of any real studies. Most available, were undertaken way back in the 1990's, and by 'Big Pharma', who had much to gain from sales of a new product for a new 'illness'. The bone the drugs strengthen, is cortical bone (the outside layer). They do little or nothing to strengthen trabecular bone (the internal core). So an overall increase in density will show up on a DXA scan (although not a lot) but it will be predominantly cortical density, which will do little to nothing, to reduce your chance of fracture (absolute reduction of 0.5%). A warning, although a somewhat low level one has been issued from the FDA about the use of these drugs causing fractures. It seems to be related to the length of time of use, but my feeling that time should be never.
The intake of Cola drinks has been associated with bone density loss, so it's a good idea not to drink them. They're pretty toxic any way as I have related previously, so it's not a loss. Drinking milk, won't really help although many will tell you it will. But dietary calcium is abundant, the trick being to boost absorption, without any associated heart problems, so Vitamin D3 intake needs to be increased especially in winter when the sun is low and you're wearing lots of warm clothing. So supplementation is needed. At least 1000iu but maybe a lot more. So get a 25(OH)D3 test to ascertain levels. Take load bearing exercise and indeed, any exercise that helps to maintain suppleness (Pilate's?). Asian women suffer somewhat less than Western women, in general, which is attributed to their intake of fermented soy products. Soy is said to boost or even emulate Oestrogen, but I emphasise 'fermented' soy, not that Soy, the Food Cartels sell; that is not what the Japanese consume, so leave out the appalling soy milk. You need fat, to metabolise Vitamin D3, because it's fat soluble, so 'low fat' is not a good idea if you want to boost bone health. Oh, and fortified dairy products use inferior synthetic D2 not D3, which is poorly absorbed. Best use full fat 'real milk'. You know, the one with the cream on top, preferably Jersey, Guernsey of Buffalo.
It should also be understood that a DXA scan result is a 'surrogate end point'; that is, a marker chosen by those, who wish to sell a drug, that alters that end point. It does not guarantee you will not get a fracture, or indeed reduce the risk by more than 1%. The 'clinical end point' would be an actual fracture. But intake of a toxic substance that largely does not do 'what it says on the tin', is merely to line the pockets of 'Big Pharma', to no useful purpose. It is likely, that if we screened every woman over 50, for bone density, the overwhelming majority would be found deficient. You see, the starting point, the zero on the T-score is a woman in good health at 30. So set the score impossibly high so most will fail to meet it and you have the largest cohort to treat, all of womankind.