To Your Health
Bone Vivant
By James N. Dillard, M.D.

(March 18, 2010)    In medicine, we always have an opportunity to make you worse. It is a matter of common knowledge that the father of our nation, George Washington, was probably put to death by his own doctors with a combination of the mercury-containing compound calomel and excessive bloodletting. This is why the key phrase in the doctor’s Hippocratic Oath is “primum non nocere,” or “first, do no harm.”

In every age, we doctors tend to get a bit arrogant about what we think we can do for you and what we think we know — not that I would ever imply that doctors can be arrogant, ahem. But sometimes we get treatments wrong and cause unexpected adverse outcomes. Excessive reliance on pharmaceutical drugs to cure all ills may be part of the problem.

Last Thursday, my colleague Dr. Melvin Rosenwasser, professor of orthopedic surgery at Columbia University Medical Center, presented research at the American Academy of Orthopaedic Surgeons’ annual meeting in New Orleans. Dr. Rosenwasser’s study of 112 postmenopausal women indicates that those who have been on the bone-strengthening bisphosphonate drugs for more than four years may be at higher risk for femur (thigh bone) fractures.

The bisphosphonate medications include Actonel, Fosamax, Boniva, Zometa, and Reclast. They block some of the normal breakdown of the calcium structure that occurs as cells turn over old bone and make new bone. The problem is that after four or more years these drugs may leave too much old bone, making the structure brittle.

Dr. Rosenwasser is not suggesting that we abandon the bisphosphonate medications for the treatment of osteoporosis, but that perhaps they should not be used long term. So what else can you do?

Many factors contribute to keeping your bones strong. Adequate dietary calcium, vitamin D, and protein are critical. But is the typical American diet with dairy products the best way to prevent osteoporosis?

    Paradoxically, countries where almost no dairy products are consumed have very low rates of osteoporotic fractures, and the industrialized nations that consume the most dairy have the highest rates of fractures. The explanation may not be about the calcium, but more about the acid-producing nature of these diets.

    When your diet contains too much animal protein, starch, and simple sugars, you produce excess acid in the body that needs to be neutralized. The body will draw calcium out of the bone stores to neutralize the acid. A diet rich in vegetables, berries, and fruit does not produce this excess acid and will tend not to leach calcium from the bones.

    So it may not be how much calcium you consume, but rather whether you can hold it in your bones. This theory has been knocking around in the natural medicine world for years, but now it is gaining traction in the mainstream scientific community.

    Even the usually old-fashioned New York Times health columnist Jane Brody has explored this excess dietary acid concept, in her column on Nov. 23, 2009. I recommend that you read it on the Times Web site. Evidence is mounting that calcium, vitamin D, dairy products, and exercise may not be adequate in keeping your bones strong.

    I reported on the dangerous prevalence of vitamin D deficiency in North America in The Star of May 21 last year, and it’s available on the paper’s Web site. Many people in this country do not get enough calcium, or waste it with the typical American high-acid diet. Diuretics and stomach acid blockers can inhibit calcium absorption. And most of us don’t get enough bone-strengthening exercise.

    The best exercise to strengthen bone includes some weight-bearing impact on your frame, to stimulate bone formation. Excessive impact can contribute to osteoarthritis in the joints, so most experts recommend some simple jumping jacks each day. You don’t have to become a runner.

    According to the federal government’s Agency for Healthcare Research and Quality, Americans had more than 254,000 hospital admissions in 2006 for injuries related to bone-thinning disease. Fractures of the hip, spine, and ribs were among the most common. There was a dramatic rise in the rate of such hospitalizations over just one decade. In 1995, the rate of hospital stays for osteoporosis-related injuries was 55 per 100,000 people; in 2005, it was 85 per 100,000, despite our modern drugs.

    From a nutritional standpoint, a mostly vegetable and fruit diet with only moderate amounts of high-quality protein from organic game, soy, eggs from ground-raised (not corn-fed) chickens, and deep-water fish is best. Supplements could include calcium citrate balanced with magnesium, 1,200 to 1,500 units of vitamin D3 per day, and the trace minerals boron, manganese, zinc, and strontium.

    There is new evidence for the role of the mineral silicon as choline-stabilized orthosilicic acid at 6 to 12 milligrams per day, but you should consult a nutritionally trained practitioner for exact recommendations.

    The prevention of osteoporosis may be the strongest argument in favor of the use of hormone replacement therapy after menopause. For many women, this can be a relatively low-risk option and certainly warrants a conversation with your doctor.

    Taking a multifaceted approach to osteoporosis prevention and treatment makes the most sense. A few years of bisphosphonate therapy is probably fine, but other non-drug measures are essential. Make no bones about it — the “one pill fixes all” notion sold to you by the drug companies may not be wise for the long run.

    With regular bone density testing, thoughtful use of medications, good nutrition, and plenty of exercise, you should be on the path to bona fide success.

    Questions can be directed to Dr. James N. Dillard at jdillard@ehstar.com.