Bone mineral density (BMD) scanning is big business, and millions of older women (and many men too) are prescribed drugs like Fosamax, on the basis of their scan results.
But bone density testing has been conclusively proven to be useless at predicting an individual’s risk of fracture.
Here’s what the British Columbia Office of Health Technology Assessment had to say, in their review of the evidence for the effectiveness of BMD testing (1):
“BMD testing does not accurately identify women who will go on to fracture as they age. BMD testing is unable to accurately distinguish women at low risk of fracture from those at high risk.”
The Swedish Council on Technology Assessment in Health Care reached the same conclusion (2):
“There is no scientific evidence to support the use of bone density measurement as a screening method in healthy, middle-aged individuals.”
The Catalan Agency for Health Technology Assessment also agrees (3):
“BMD has a poor ability to identify, in individuals without a high fracture risk, those who will have a fracture from those who will not. The evidence is insufficient to recommend BMD for population or opportunistic screening of asymptomatic individuals.”
But in the face of widespread scientific agreement that BMD scanning is NOT an effective screening tool, it is still heavily promoted. Most of my post-menopausal clients – no matter how fit, strong and active they are, and despite never having had a low-trauma fracture (i.e. breaking a bone in circumstances where it wouldn’t be expected to break) – have been urged by their doctors to have a ‘baseline’ BMD scan. This use of BMD scanning is exactly what all the government bodies quoted above advise against: screening of healthy, asymptomatic individuals.
As a result of this initial scan, a number of my clients have been told they have ‘osteopenia’, are at increased risk of bone fracture in the future, and should immediately start taking calcium pills and consider taking bisphosphonate drugs such as Fosamax.
I have taken many calls from clients who previously thought of themselves as healthy and strong, and are now in tears as they describe how the doctor told them they have the bones of a 70-year-old, and could end up stooped over from vertebral fractures, or breaking a hip just by stepping off the kerb.
After this devastating news, these women are often afraid to take part in vigorous activity – when the scientific evidence shows that is exactly what they should keep on doing (or start doing), in order to maintain strong bones and avoid fracture!
Let’s explore the myths that make up the Great Osteoporosis Scam.
Myth # 1: Osteoporsis = low bone mineral density.
Fact: In the past, osteoporosis was defined as “an enlargement of the spaces of bone… whereby a porous appearance is produced” (4). Only a person who had already suffered a low-trauma fracture was diagnosed with osteoporosis – that is, it was a disease with definite symptoms.
The invention and proliferation of DXA (dual x-ray absorptiometry) machines, which allow doctors to measure the density of mineral content in their patients’ bones, completely changed the definition of osteoporosis.
Now osteoporosis is a condition (usually without any symptoms whatsoever) defined with reference to the bone mineral content of an ‘average’ healthy 25-year-old white woman. A person whose BMD is more than 2.5 ‘standard deviations’ (a statistical measure of variance) below this ‘average’ person is said to have osteoporosis, while being 1-2.5 standard deviations below that average earns you a diagnosis of osteopenia.
It is important to realise that DXA scans do not detect the enlarged spaces in bone that characterise osteoporosis; they merely measure your BMD and compare it to a ‘norm’ based on a 25-year-old white woman. This leads on to Myth # 2.
Myth # 2: The reference standards for osteoporosis and osteopenia are based on good science.
Fact: The diagnostic standards quoted above were set by a World Health Organization (WHO) working party which convened in Rome in 1992. A fascinating program made by US National Public Radio (5) describes the completely unscientific process they used:
“The question before the experts in Rome then was this: Since after the age of 30 all bones lose density, how much bone loss was normal? And, how much put women at risk and therefore should be considered a disease?
[Anna Tosteson, a professor of medicine, attended the meeting, and was quoted thus:] ‘Ultimately it was just a matter of, ‘Well … it has to be drawn somewhere,’ ” Tosteson says. “And as I recall, it was very hot in the meeting room, and people were in shirt sleeves and, you know, it was time to kind of move on, if you will. And, I can’t quite frankly remember who it was who stood up and drew the picture and said, ‘Well, let’s just do this.’ ”
So there in the hotel room someone literally stood up, drew a line through a graph depicting diminishing bone density and decreed: Every woman on one side of this line has a disease. Then a new question arose: How do you categorize the women who are just on the other side of that line?
To address this issue, Tosteson says, the experts — more or less off the cuff — decided to use the term osteopenia. Tosteson says they created the category mostly because they thought it might be useful for public health researchers who like clear categories for their studies. They never imagined, she says, that people would come to think of osteopenia as a disease in itself to be treated.
The chairman of the meeting, John Kanis, of the WHO Collaborating Centre for Metabolic Bone Diseases, says the same thing.”
Additionally, this WHO study group was funded by three major drug companies which produce drugs to treat osteoporosis. Obviously, it was in their interests to define osteopenia and osteoporosis in such a way that eventually, the majority of women (and a significant proportion of men) would fit the diagnosis.
The reference standard of the healthy 25-year-old does not take into account either build – people with a smaller build quite naturally have lower bone mineral density, and this does not increase their risk of fracture (6); or race – there are dramatic differences in average bone mass between ethnic groups. For example, a study of Hawaiian, Filipino, Japanese and Caucasian women found there was significant variance between different ethnicities, and up to 100% difference between the peak bone mass attained by different women of various ethnicities (7).
Myth # 3: if you have low BMD you are automatically at increased risk of fracture.
Fact: To quote S. Pors Nielsen, of the Department of Clinical Physiology and Nuclear Medicine, Hillerød Hospital, Denmark, “BMD is not an ideal measure of true bone density; it is not an ideal measure of bone strength; it does not predict fractures well; and it has inherent problems of accuracy” (8).
Many low-impact fractures occur in people with normal or high BMD, while many people with low BMD will never suffer a fracture.
Reduced bone mineral density is just one risk factor for low-trauma bone fracture. The undeniable fact is that most people who suffer such fractures have multiple risk factors, including:
- Being elderly (over 85);
- Being inactive (which reduces muscle strength, balance and co-ordination, thus increasing the risk of falling);
- Dementia (which also affects balance and co-ordination);
- Taking medications that affect balance, co-ordination or alertness such as sleeping pills and antidepressants; and/or
- Having failing vision (which increases the risk of tripping).
Myth # 4: A high intake of calcium, especially from dairy products, prevents osteoporosis.
Fact: There is no reliable evidence for the dairy industry’s claim that consuming dairy products is good for your bones. Most of the well-conducted studies examining this issue have found that dairy intake has no effect on bone density or fracture risk (9).
As for calcium, multiple large studies have shown that calcium intake does not affect fracture risk in either women or men; calcium supplementation does not reduce fracture risk; and calcium supplementation without vitamin D may actually increase hip fracture risk (10).
The Harvard School of Health publication ‘The Nutrition Source’ makes it clear that
“high calcium intake doesn’t actually appear to lower a person’s risk for osteoporosis”
and also points out that
“People typically lose bone as they age, despite consuming the recommended intake of calcium necessary to maintain optimal bone health.” (11)
Ok, so that’s the industry-sponsored myths dispatched with! Now for the most important part:
How to keep your bones strong and healthy – for life
Exercise regularly
When you do any kind of physical activity that puts some stress on your bones, cells within the bone sense this stress and respond by making the bone stronger and denser. Such weight-bearing exercise (including walking, dancing, jogging, weightlifting, stair-climbing and racquet sports) causes the bones to retain and possibly even gain density throughout life. You need a variety of exercises or activities that put stress on different parts of the body, to keep all your bones healthy.
Exercise also increases muscle strength and coordination, helping to maintain balance and avoid falls.
Get adequate vitamin D
The ‘sunshine vitamin’ reduces fracture risk by enhancing calcium absorption, increasing muscle strength and decreasing the risk of falls. In fact, one study found that supplementation with vitamin D reduced the risk of falls among older individuals by more than 20% (12).
Get adequate vitamin K
Vitamin K, which is found mainly in green, leafy vegetables, contributes significantly to calcium regulation and bone formation. The Nurses’ Health Study found that women who ate a serving of lettuce or other green, leafy vegetable every day had only half the risk of hip fracture compared with women who ate only serving a week (13).
Avoid excess animal protein
Animal protein foods such as meat, cheese, chicken and eggs cause increased loss of calcium in the urine. In the Nurses’ Health Study, women who ate more than 95 grams of protein a day were 20 percent more likely to have broken a wrist over a 12-year period than women who ate less than 68 grams a day (14).
Avoid excess calcium – and get your calcium from plant sources
The populations of countries such as India, Japan, and Peru have an average daily calcium intake as low as 300 milligrams per day (less than a third of the Australian RDI of 1000 mg per day for women aged 19-50), yet have a low incidence of bone fractures (15).
Getting your calcium from plants such as lettuce, parsley and kale will ensure you’re maximising your intake of other bone-healthy nutrients such as vitamin K, magnesium and potassium.
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