Prescription Alternatives
Page 54
Growth hormone may be a good choice for those who are deficient, in small, physiologic doses that mimic what the body would produce naturally. Because it needs to be taken by injection and is financially out of reach for many, it is fortunate that there are several things you can do to enhance your body’s own production of this youth-preserving hormone. Growth hormone secretion is stimulated after a meal rich in dietary protein. Growth hormone secretion can also be stimulated during a fast, as well as during and after exercise. Within a few months, a moderate program of weightlifting can produce increases in lean muscle mass equal to those produced by growth hormone injections.
Chapter 20
Drugs for Osteoporosis and Their Natural Alternatives
Although cardiovascular disease is the leading cause of death among American women, osteoporosis is the disease they are most likely to develop as they age. Four out of 10 white women in the United States will fracture a hip, their spine, or a forearm due to osteoporosis. As many as 5 out of 10 will develop small fractures in their spine, causing great pain and a shrinking in height. This amounts to 15 to 20 million people affected by a crippling and painful disease that is almost entirely preventable and reversible.
Osteoporosis is a gradual decrease in bone mass and density that can begin as early as the teen years. Bone mass should be at its peak in the late twenties or early thirties, but thanks in large part to a poor diet and lack of exercise, many women are already losing bone in their twenties. Bone loss occurs more rapidly in women than in men, especially right around the time of menopause, when an abrupt drop in estrogen and progesterone accelerates bone loss.
When you think of your bones, you may imagine a dead skeleton, but your bones are living tissue just like the rest of your body, and they need a good supply of nutrients and regular exercise. New bone is constantly being made, while old bone is being reabsorbed and excreted by the body. In fact, it’s important for the old bone to go away so that the new, better quality bone can take its place. Our larger long bones, such as our arm and leg bones, are very dense, and they are completely replaced about every 10 to 12 years. Our less dense bones, such as our spine and the ends of our long bones, turn over every two to three years. Thus, as you can see, we always have the opportunity to be creating better bone for ourselves.
We all hear about how having enough calcium in the diet and taking estrogen can help prevent osteoporosis, but there is a much bigger nutritional and lifestyle picture to look at when we are talking about preventing this bonerobbing disease. The most important element of bones is minerals. Without minerals we don’t have bones. The most important bone minerals are calcium, magnesium, potassium, phosphorus, and fluoride. Equally important is the balance between the minerals. Too much phosphorus or fluoride will create poor bone structure.
Without enough magnesium, the calcium can’t be absorbed into the bone. Vitamins are also involved. For example, vitamin B6 works with magnesium to get calcium into your bones. Vitamin D and vitamin K also help orchestrate the movement of calcium into bones.
The hormones testosterone, estrogen, and progesterone are also actively involved in the making and unmaking of bone. Testosterone and progesterone build bone, while estrogen slows bone loss.
In osteoporosis, the old bone is being taken away faster than new bone is being made, causing the bones to lose density and become thinner and more porous. The integrity and strength of our bones are related to bone mass and density. The bones of a woman with osteoporosis gradually become thinner and more fragile. A progressive loss of bone mass may continue until the skeleton is no longer strong enough to support itself. When that happens, bones can spontaneously fracture. As bones become more fragile, falls or bumps that would not have hurt us before can cause a fracture. Bone loss seems to be most severe in the spine, wrists, and hips. Unfortunately, there are usually no signs or symptoms of osteoporosis until a fracture occurs.
Early Signs of Osteoporosis
Gradual loss of height
Gum disease, loose teeth
Sudden insomnia and restlessness
Nightly leg and foot cramps
Persistent low back pain
Bone Mineral Density Testing
Menopausal women are a huge market for conventional medicine, and one relatively recent technology that has been used to scare millions of women into thinking they have osteoporosis when they really don’t is bone mineral density (BMD) tests. These tests do not take into account the differing size of bones in large women and small women, so small women almost always come out showing low on BMD tests, while large women almost always come out looking OK, even when they aren’t. The true usefulness of a BMD test is only in serial tests where you are comparing your own test results. This means that you should get a bone density test when you are in your thirties or forties and use that as a baseline to compare future tests against. That is the only real way you will know if you are losing bone. If you are petite, please do not be scared into taking Fosamax, Evista, or synthetic estrogens by a poor BMD level. The amazing truth about BMD is that no study has ever shown it to consistently and significantly correlate with fracture rate. Taking tranquilizer drugs that cause falls has a much higher correlation than does low bone density! This is likely because factors besides density affect the risk of fracture, including elasticity and toughness. BMD is used as a gauge of bone health not because it’s the best test, but because doctors have a machine that measures it.
Should You Take Hormone Replacement Therapy to Prevent Osteoporosis?
There is a misconception that osteoporosis begins at menopause. In reality, bone mass begins declining in most women in their mid-thirties, accelerates for three to five years around the time of menopause, and then continues to decline at the rate of about 1 to 1.5 percent per year. Because bone loss accelerates at menopause, and because estrogen levels decline at menopause, conventional medicine has adopted the belief that osteoporosis is an estrogen deficiency disease that can be cured with estrogen replacement therapy. This is only partly true.
Your Risk of Osteoporosis Is Higher If You:
Are a woman
Have a family history of osteoporosis
Are white
Are thin
Are very short
Are very tall
Went into menopause early
Have a low calcium intake
Don’t exercise
Smoke cigarettes
Drink more than two alcoholic drinks daily
Are on chronic steroid therapy (e.g., prednisone)
Are on chronic anticonvulsant therapy
Are taking drugs that can cause dizziness
Have hyperthyroidism
Eat too much animal protein (e.g., large servings or at more than two meals a day)
Use antacids regularly
Drink more than two cups of coffee daily
The missing pieces of this puzzle are diet and lifestyle, plus the bone-building hormone progesterone, which drops much more precipitously at menopause than estrogen does. (Progesterone refers to the natural hormone, not the synthetic progestins. See Chapter 19 for more detailed information on natural hormones.)
There is no question that estrogen can slow bone loss around the time of menopause, but the scientific evidence is very clear that after five to six years, bone loss continues at the same rate, with or without estrogen. A very large study, published in the New England Journal of Medicine (NEJM) in 1995, studied risk factors for hip fractures in white women. After following over 9,500 women for eight years, researchers found no benefit in estrogen supplementation in women over the age of 65.
How Aware of Osteoporosis Are You?
A Gallup poll sponsored by the National Osteoporosis Foundation found that:
• 75 percent of women believed they were familiar with osteoporosis.
• 80 percent were not aware that it was responsible for disabling fractures.
• 90 percent were surprised to learn that osteoporosis frequently causes death.
&n
bsp; • 60 percent could not identify the risk factors of osteoporosis.
In the NEJM study, risk factors for hip fractures included:
• Being tall (they fall farther)
• Poor overall health
• Previous hyperthyroidism (high thyroid)
• Treatment with long-acting benzodiazepines or anticonvulsant drugs (which made them dizzy, drowsy, and more likely to fall)
• Heavy coffee drinking (which depletes calcium)
• Lack of exercise
• Poor depth perception (which would naturally increase the tendency to fall)
Prescription Drugs for Osteoporosis
A number of pharmaceutical drugs are being used to treat osteoporosis, none of which work very well and all of which have unpleasant side effects. The most heavily prescribed prescription drugs for osteoporosis are the bisphosphonates—Fosamax, Didronel, Boniva, and Actonel. They all stop bone loss by powerfully inhibiting the resorption of old bone, which is the medical way of saying that they slow bone loss. The good news is that the bisphosphonates stop a cycle where bone is being lost faster than it is being replaced. The bad news is that when old, poor-quality bone is not taken away, new healthy bone cannot replace it. In other words, the inhibition of bone loss also inhibits bone building. Both are essential for healthy bones. BMD testing shows increased density, but this is only one measure of bone quality and occurs because the old bone is denser than new bone. That doesn’t mean it’s of good quality; in fact all indicators are that it’s not. The increased BMD is due to increased mineralization of the bone, but increased bone mineralization eventually leads to increased brittleness.
Research into elasticity, a key component of healthy bone, showed that those taking a bisphosphonate had significantly reduced elasticity compared to a placebo. Other research showed that bisphosphonate treatment significantly reduced bone “toughness,” a measure of the ability to resist breaking.
Another issue with the bisphosphonates is that suppression of bone resorption reduces the ability of the bone to repair itself. Normal wear and tear on the bones causes “microdamage,” which in healthy bone is repaired when the damaged bone is resorbed and new bone is put in its place. The bisphosphonates inhibit this repair process, and the damage accumulates over time.
A group of bone researchers from the University of Texas Southwestern Medical Center reported on a group of nine patients, all taking a bisphosphonate long term, who had spontaneous fractures in unusual places. Up to two years later, some of the fractures had not healed. An examination of bone quality showed “severe depression of bone turnover” and thus a deterioration of the bone’s ability to repair itself. The authors point out that in some of the patients, the bone turnover suppression may have been increased by taking estrogen (which also slows bone resorption) or glucocorticoids (e.g., prednisone).
Ironically, bisphosphonates also significantly deplete calcium, so much so that they are approved by the Food and Drug Administration (FDA) for treating hypercalcemia, or excess calcium.
The prestigious British Medical Journal published an article titled “Drugs for Pre-Osteoporosis: Prevention or Disease Mongering?” The article points out that
Osteoporosis is a controversial condition. An informal global alliance of drug companies, doctors, and sponsored advocacy groups portray and promote osteoporosis as a silent but deadly epidemic bringing misery to tens of millions of postmenopausal women. For others, less entwined with the drug industry, that promotion represents a classic case of disease mongering—a risk factor has been transformed into a medical disease in order to sell tests and drugs to relatively healthy women. Now the size of the osteoporosis market seems set to greatly expand, as the push begins to treat women with pre-osteoporosis. These are women who are apparently at risk of being at risk, a condition known as osteopenia that is claimed to affect more than half of all white postmenopausal women in the United States.
The article concludes that “. . . we need to ask whether the coming wave of marketing targeting those women with pre-osteoporosis will result in the sound effective prevention of fractures or the unnecessary and wasteful treatment of millions more healthy women.”
The drug companies that sell bisphosphonates keep coming out with studies showing that these drugs reduce the risk of fracture. However, their research leaves out many important bone health markers, dodges important questions, and uses questionable statistical juggling to prove their points. When drug researchers cherry-pick their questions, limit their answers, and fiddle with the numbers, patients become guinea pigs regarding long-term health risks. While long-term consequences are unfolding, the drug companies make millions, if not billions, of dollars. Thanks to incomplete research it will be years before we really understand the full long-term consequences of using bisphosphonates.
We do know, thanks to a large study published in the Journal of the American Medical Association, that there isn’t any benefit to using bisphosphonates for more than five years. It’s important to understand that once the bisphosphonates are deposited in the bones, they never go away. They’re with you for life. We don’t even know to what extent bone building can begin again after bisphosphonate treatment is stopped. As you’ll read later, bisphosphonates come with other possible serious risks and side effects.
Boniva (ibandronate sodium) is an extremely high dose of bisphosphonate taken once a month. It’s a new drug, so you are a guinea pig if you use it. We simply don’t know what the long-term effects may be of taking that high a dose of a bone-turnover-suppressing drug. Furthermore, while Boniva has been shown to reduce the risk of vertebral (spinal) fractures, there is no evidence that it reduces the risk of nonvertebral fractures such as those of the hip, feet, and arms. Although vertebral fractures can be debilitatingly painful, hip fractures carry a high risk of death within a year after they occur.
Reclast (zoledronic acid) is a bisphospho-nate given once a year by IV (in the vein). It is FDA approved for treating Paget’s disease but is being aggressively marketed to postmenopausal women. We don’t know the long-term consequences of long-term use of Reclast.
Bisphosphonates may be a reasonable short-term treatment to slow bone loss in extreme cases, but it’s difficult to understand how their use can be otherwise justified. As you’ll read later in this chapter, there are numerous safe and effective ways to slow bone loss and build bone. They involve more attention than taking one pill a month, but they address the underlying causes of bone loss.
Examples of Bisphosphonates
Alendronate (Fosamax)
Etidronate (Didronel)
Ibandronate sodium (Boniva)
Risendronate (Actonel)
What Do They Do in the Body? They slow bone loss by inhibiting the mechanism by which old bone is reabsorbed.
What Are They Prescribed For? They are prescribed for osteoporosis and osteopenia.
What Are the Possible Side Effects? Severe heartburn that can cause permanent damage to the esophagus, stress on the kidneys, impaired fertility, diarrhea, constipation, fever, low calcium, vitamin D deficiency, magnesium deficiency, flatulence, rash, headache, and severe and sometimes incapacitating bone, joint, and muscle (musculoskeletal) pain.
A rare but terrible side effect of bisphosphonates has emerged recently, which is osteonecrosis of the jaw, or death of jawbone tissue. Most of the women who got this disease were on IV (in the vein) bisphosphonate to treat bone cancer.
Rats given high doses of these drugs developed thyroid and adrenal tumors.
CAUTION!
The long-term consequences of using these drugs are poorly studied.
What Are the Interactions with Other Drugs? Bisphosphonates may raise levels or prolong the effects of aspirin. This drug may increase the effects or prolong the action of ranitidine. These drugs may reduce the effects of antacids and calcium supplements.
What Nutrients Do They Throw out of Balance or Interact With? These drugs can cause a deficiency in just about every nutrie
nt important to healthy bones, including calcium, magnesium, and vitamin D.
What Else to Take If You Take These Drugs. A good mineral supplement.
Miscellaneous osteoporosis drugs
Raloxifene (Evista)
What Does It Do in the Body? Raloxifene is a synthetic estrogen known as a selective estrogen receptor modulator (SERM), which means that it has some of the effects of an estrogen but not all. The goal of creating raloxifene was to have the estrogen property of slowing bone loss without the cancer-causing properties and other negative side effects of estradiol and estrone.
What Is It Prescribed For? Osteoporosis.
What Are the Possible Side Effects? Hot flashes, leg cramps, increased risk of blood clots in the veins, pain, rash, sweating, gastrointestinal problems, endometrial disorder, fluid retention, weight gain, muscle pain, sinusitis, pneumonia, laryngitis, flu syndrome, headache, and conjunctivitis. It can deplete the B vitamins, especially vitamin B6, which is essential for a healthy nervous system.
CAUTION!
Raloxifene caused cancer in animals in dosages from 0.3 to 34 times the dosage level normally prescribed to postmenopausal women. In other words, a dosage equivalent to three-tenths of the dose used to prevent osteoporosis caused both benign and malignant cells to form in these animals. It’s unnecessary to resort to a drug like this when natural hormones and other alternatives can do the job more safely.
Calcitonin-salmon (Calcimar, Salmonine, Osteocalcin, Miacalcin)
What Does It Do in the Body? This hormone is made by the thyroid gland that can temporarily slow bone loss. The long-term side effects are not well known, and its effectiveness diminishes rapidly after a few years.
What Is It Prescribed For? Osteoporosis.
What Are the Possible Side Effects? Flulike symptoms, back pain, respiratory problems such as cough and bronchitis, high blood pressure, angina, rapid heartbeat, irregular heartbeat, hyperthyroidism, numbness, insomnia, anxiety, dizziness, headaches, vision disturbances, swollen lymph glands, nausea, loss of appetite or increased appetite, dry mouth, diarrhea, rash, increased sweating, and tinnitus (ringing in the ears).