Osteoporosis Treatment Paradox
by David Dunaief
Aug 14, 2019 | 1514 views | 0 0 comments | 151 151 recommendations | email to a friend | print
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
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Osteoporosis is a silent disease with bone loss, weakening of the bones and small changes in the bone’s architecture over time that may result in fractures with serious consequences. It affects millions of patients, most commonly postmenopausal women.

One way to measure osteoporosis is with a dual-energy X-ray absorptiometry (DXA) scan for bone mineral density. However, the Fracture Risk Assessment Tool (FRAX) is more thorough for determining 10-year fracture risk.

Those who have a risk of fracture that is three percent or more should consider treatment with medications. A link to the FRAX tool can be found at shef.ac.uk/FRAX.

The National Osteoporosis Foundation recommends 1,000 to 1,200 mg per day of calcium from diet and supplements if we are over age 50, although recommendations vary by sex and age. However, research suggests that calcium for osteoporosis prevention may not be as helpful as we thought.

Current treatment paradox

Depending on the population, we could be overtreating or undertreating osteoporosis. In the elderly population that has been diagnosed with osteoporosis, there is undertreatment.

One study showed that only 28 percent of candidates for osteoporosis drugs are taking the medication within the first year of diagnosis. The reason that most were reluctant was a fear of gastrointestinal side-effects.

On the other hand, as many as 66 percent of the women receiving osteoporosis medications may not have needed it, according to a retrospective study. This is the overtreatment population, with half these patients between the ages of 40 and 64 and without any risk factors.

Do we all need calcium?

Calcium has always been the forefront of prevention and treatment of osteoporosis. However, two studies would have us question this approach.

Results of one meta-analysis showed that dietary calcium and calcium supplements with or without vitamin D did increase bone density significantly in most places in the body, yet the changes were so small that they would not have much clinical benefit in terms of fracture prevention.

Another meta-analysis did not show a benefit with dietary or supplemental calcium with or without vitamin D. There was a slight reduction in nonsignificant vertebral fractures, but not in other places, such as the hip and forearm.

Does this mean calcium is not useful? Not so fast!

In some individual studies that were part of the meta-analyses, the researchers mentioned that dairy, specifically milk, was the dietary source, and we know milk is not necessarily good for bones. But in many of the studies, the researcher did not define the sources of dietary calcium.

This is a very important nuance. Calcium from animal products may increase inflammation and the acidity of the body and may leach calcium from the bone, while calcium from vegetable-rich, nutrient-dense sources may be better absorbed, providing more of an alkaline and anti-inflammatory approach.

What can be done?

Yoga may have a big impact on osteoporosis prevention and treatment. In a small pilot study, results showed that those who practiced yoga had an increase in their spine and hip bone density compared to those who did not.

In a follow-up study, results showed that 12 minutes of yoga daily or every other day significantly increased the bone density in both the spine and thigh bone. Prior to the study, participants had 109 fractures, but none had yoga-related fractures by the end of the trial.

The “side effects” of yoga included improved mobility, posture, strength and anxiety reduction. The researchers provided a road map of specific beneficial poses. Before starting any exercise program, consult your physician.

The moral of the story is that exercise is beneficial. Yoga may be another simple addition to this exercise regimen. Calcium may be good or bad, depending on its dietary source.

Be cautious with supplemental calcium; it does have side effects, including kidney stones, cardiovascular events and gastrointestinal symptoms, and consult with your doctor to assess whether you might be in an overtreatment or undertreatment group when it comes to medication.
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