Do Osteoporosis Drugs & Calcium Prevent Fractures?

Recent studies indicate that  high levels of calcium are potentially dangerous to your cardiovascular system, and increases both calcification of arteries and MI risk.  

There is a much better option for long-term bone health.

Your physician tells you that your Bone Mineral Density (BMD) is low (2.5 standard deviations below average and that you have osteoporosis) and he wants you to go on one of the prescription medications to prevent bone fractures. He or she goes on to tell you that these drugs have been found to reduce your risk of a fracture by 50%. Sounds impressive and necessary…so you get nervous. Just the image of an incapacitating hip fracture, is enough to make you rush out to fill a prescription for bisphosphonate drugs like Fosamax, Boniva or Actonel. Aclasta, Aredia, Bondronat, Didronel, Reclast, Skelid and Zometa.

Being scared sometimes makes people do things too quickly without gathering all of the facts. Also over reliance on their doctors recommendation without independent research of their own, can sometimes lead to uninformed choices.

As you will learn shortly, these drugs can have some very serious side-effect and in addition, many experts are troubled by the quality of bone that these drugs create. In addition the 50% reduction in fracture risk quoted by the manufacturers of these drugs and some physicians, is at best misleading and at worst down right deceptive.

Let’s say that everyone had a 100% risk (a certainty, 100 out of 100 people would all have a fracture sometime after age 65). Then a drug that reduced that risk by half so that only 50 out of 100 people would have a fracture, might be a drug worth taking, assuming it was safe and wasn’t going to hurt you because of serious side-effects. This drug (if one existed, it doesn’t) could legitimately state it reduced fracture risk by 50%

 

 

 

What if your risk was only 2% of having a fracture sometime after age 65? In others words only 2 out of every hundred people will experience a fracture and 98 will never have one. Another way of saying this, is that if you take absolutely NOTHING, the odds are 98% in your favor of never having a fracture. Would you then be in a rush to use this or any other drug?

How do drug manufacturers play with the quoted efficacy percentages to fool you into thinking these drugs work much better than they really do?

Well, they do a study approved by the FDA and show that when you take their drug, instead of 2 people out of 100 people experiencing a fracture, only 1 person out of 100 people experienced a fracture. So they report the drop from 2 out of 100 to 1 out of 100 people as a 50% reduction in fracture rate. And to make matters worse, many physicians quote this misleading 50% drop in fracture rate to their patients.

Another way of putting this into perspective is that for every hundred people who take this drug, 98 of them didn’t need it, but it gets worse. The 98 who didn’t need but took it anyway are now exposed to, what in some cases, can be very serious side-effects.

In addition to the multiple, potential side-effects of these drugs which will be listed shortly, these drugs do not create new healthy bone, instead they create bone that is unnatural and nothing like new bone formed by the body.

Instead of the body’s normal process of breaking down old bone (known as resorption, which is carried out by cells called osteoclasts) and rebuilding new strong bone with other cells known as osteoblasts, these drugs stop the rebuilding of new bone by stopping resorption (turning off the osteoclast activity).

So people wind up with bone that is architecturally very different from new bone created by the body. This bone does allow for minerals to be absorbed which can quickly in the short term reduce fracture risk by the tiny absolute amount described above, but many researchers are concerned about the long-term wisdom of using these drugs to create this “unnatural type of bone”.

In fact, recent research has shown an increase in femur fractures in patients who have taken these drugs for 5 or more years. These drugs have demonstrated no benefit for primary prevention. This means that for men or women who may have below average BMD (bone mineral density) but whom are not diagnosed with osteoporosis, there is no reason to take these drugs, yet the drug companies and some physicians recommend them to these lower risk patients as well. It just doesn’t make sense.

Potential Side-effects:
So, In addition to not giving much absolute protection from fractures, you will also be exposed to the following side-effects, some of which, though low in risk, can be very serious and even life threatening:

•Ulcers of the esophagus

• Esosphageal cancer

• Upper GI irritation

• Irregular heartbeat

• Fractures of the femur

• Low calcium in the blood

• Skin rash

• Joint, bone, and muscle pain

• Jaw bone decay (osteonecrosis)

• Increased parathyroid hormone (PTH)

*Users of some of these drugs can develop osteonecrosis of the jaw which is associated with significant and death of jawbone tissue. The Journal of the American Dental Association reports that osteonecrosis is actually more common than initially thought.

**An article in the New England Journal of Medicine stated that 23 cases of esophageal cancer have been reported due to Fosamax. Then, in an issue of the American Dental Association, were reports that the drug’s jaw die off risk is actually more common than initially thought. The jaw bone die off is actually known as a disease.

*** As reported by the American Society of Bone and Mineral Research

There are Sensible, Effective and Much Safer Options to Reduce Your Fracture Risk

High dose calcium is NOT a needed or even sensible option, no matter what your doctor tells you.

Regarding Calcium and the ubiquitous advice given by so many healthcare professionals to consume anywhere from 1000-1500 mg. for bone health, it is just plain wrong and recent studies indicate that these high levels of calcium are potentially dangerous to your cardiovascular system, increasing both calcification of arteries and MI risk.

Vitamin D & K for Calcium Absorption

The problem is not that most of us don’t get enough calcium but that the calcium we get doesn’t get absorbed efficiently into our bones. This calcium is then free and available to go deposit where we don’t want it, into the insides of our arteries, causing calcification which can lead to decreased arterial function, high blood pressure and cardio-vascular disease.

It might surprise you that the Chinese and Japanese cultures, which historically eat little or no dairy products and therefore get less than half the calcium that is in American diets containing dairy, have substantially lower fracture rates than Americans.

Cultures that consume far less than the 1500 mg of calcium per day recommended by many physicians, experience much lower fracture rates than we do. This is because their diets contain some specific ingredients that help calcium to enter their bones.

These two ingredients are Vitamin D and Vitamin K. In the proper amounts both of the simple vitamins have been shown to be incredibly safe and healthy for many reasons beyond just bone health, and can safely decrease fracture risk in susceptible people.

For professionals who specialize in staying on top of the literature that is published about the benefits of certain herbs and dietary supplements, it is well known that vitamin D, vitamin K and magnesium are KEY players in bone health.

Two recent studies, one examining the fracture reducing potential of bisphosphonate drugs and the second measuring the fracture reducing potential of Vitamin D, demonstrated that Vitamin D is perhaps more effective than the drugs, with none of the inherent risks and side-effects of the drugs.

Interestingly, several studies have shown that both Vitamin K-1 and K-2 have decreased fracture risks in humans without increasing Bone Mineral Density (BMD).

In fact, it is my opinion, that intakes of magnesium (at least 500 mg/day), vitamin D (at least 1000 IU/day) and vitamin K-1 and K-2 (at least 500 mcg/day) with small daily amounts of calcium from dairy or 250-500 mg/day from a supplement, will offer more protection against fractures than these dangerously high doses of 1000-1500 mg of calcium per day that are being recommended, without all of the unwanted health risks.

Cardiologist routinely measure “coronary artery calcium” (CAC) levels because they are known to be a reliable marker for atherosclerosis. Calcium actually can build up in the arteries, a phenomenon known as “arterial calcification”, which can also lead to stroke, heart attack and eye problems.

In fact, a recent study of 24,000 people, done at the University of Zurich, suggests that older Americans taking calcium supplements to reduce fracture risk may be increasing their risk of getting a heart attack. The researchers said this risk came about only in those taking dietary supplements of calcium and not in those getting their calcium from food.

The researchers reported an 86% increase in heart attack risk in people who took regular supplements of calcium versus those who didn’t take any supplements.

The study is somewhat controversial with some experts questioning “why there would be increased heart attack risk with taking dietary supplements of calcium but not with taking foods containing calcium?”

Personally, I don’t know why this surprises these experts because many foods that contain calcium also contain magnesium which is very important for bone health. Other factors in foods like vitamin K may help the calcium to get into the bone and not be absorbed by the arteries which is dangerous.

The bottom line for me is:  If you eat reasonable amounts of dairy products you probably don’t need to supplement calcium at all.  If you don’t eat dairy products at all you can still get sufficient calcium from foods such as:

Salmon 6-8 ounces 440 mg.

Shrimp 6 ounces 300 mg.

Mackerel 6 ounces 600 mg.

Kale, collard greens, broccoli (1 cup) – 200 mg.

Almonds 6 ounces 700mg

Walnuts 6 ounces

I suggest that for normal healthy, men and women no more than 500 mg /day of calcium is necessary. If you have normal digestive function calcium carbonate is fine despite what certain advertisers state. If you do have digestive issues and perhaps are low in stomach acidity, then calcium citrate is a good choice.

Regarding the amounts of Vitamin D to take, I suggest that you start with 2500 IU per day. When you get your blood checked ask your physician to also measure you calcium levels. I believe optimum levels are between 50 ng/ml – 80 ng/ml.

As for the Vitamin K, though both form K-1 and K-2 have been shown to work, a product containing a combination of both K-1 and K-2 in the amounts of 1-2 mg (1000-2000 mcg) and 200 mcg respectively should be adequate.

Knowledge is power. Empower your health,

Curt Hendrix, M.S. C.C.N. C.N.S.