Mending the broken bone business

A fascinating interview with orthopaedic surgeon Dr Nick Birch on what’s wrong with the current medical approach to bone health, and how to fix it.

10 February 2025

A couple of weeks ago, I received an email from UK orthopaedic surgeon Dr Nick Birch, who had stumbled across one of my articles on osteoporosis, The great osteoporosis scam, whilst searching for a National Public Radio program which I had referenced in that article.

Nick sent me several papers on Radiofrequency Echographic Multi Spectrometry (REMS), a technology which not only measures bone density, but more importantly, the degree of fragility of bones – which is a far more accurate predictor of fracture risk than DXA. And REMS, being ultrasound-based, involves no exposure to ionising radiation, unlike DXA.

Impressed, I reached out to Nick to invite him to discuss REMS and what it has to offer older women and others at risk of fragility fractures. Our conversation turned out to be far more wide-ranging, covering topics that I know will be of great interest to my readers. Nick and I discussed the broken bone business and what it does to women’s self-concept and lifestyle choices; how practitioners should be advising and treating women at risk of fragility fractures; the loss of the art of medicine and its replacement by what can only be described as a factory model of medical education and practice; the death of informed consent; and much more.

This is an interview that you’re going to want to watch several times, to pick up all the pearls of wisdom that Nick dropped. I’m sure you will agree with me that we need more doctors like Dr Nick Birch – doctors who actually care about their patients, and respect their right to make educated decisions about their own health and well-being.

I’ve included links to all the articles that Nick and I discussed, and I encourage you to explore these resources to better inform and empower yourself to resist the broken bone business.

Show notes

This is the NPR program that Nick was searching for when he stumbled across my article on the broken bone business:

Here’s the paper by Fuggle et al which establishes the comparability of REMS to the current gold standard of bone mineral density (BMD) measurement, DXA, and also the superiority of REMS in identifying people at high risk of fragility fractures:

This is the latest (January 2025) US Preventative Services Task Force report on screening for osteoporosis to prevent fractures, the conclusions of which Nick criticised on the grounds that DXA is far from a good predictor of risk of fragility fractures:

The accompanying editorial by Dr Susan Ott critiqued the USPSTF report on multiple grounds, including the lack of consideration given to racial and ethnic differences in bone mineral density and fracture risk; the long-term effects of osteoporosis medications that are likely to be prescribed as a direct result of BMD screening; and the futility of treating a condition directly caused by age-related changes in bone metabolism, with drugs that suppress a crucial element of that metabolism:

This is the Cochrane review on alendronate (a bisphosphosphanate drug) for prevention of osteoporotic fractures:

Here’s the publication profile of Belinda Beck of Griffith University, whom Nick praised as a leading researcher in the use of resistance and impact exercise to improve bone health and increase lean mass: