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Loren Fishman, MD

Loren Fishman, MD

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Osteoporosis Drugs: The Good, the Bad, the Natural Alternatives

Posted: 04/25/11 08:47 AM ET

Women (and men!) of a certain age who have been diagnosed with osteoporsis are frequently prescribed a bisphosphonate like Fosamax, Boniva, Actonel, Altevia or Reclast. In 2009 more than 5 million prescriptions for these drugs were written. But, as time has gone on, the dangers of long-term use of these drugs causing exactly fractures they were supposed to prevent -- and doing other damage -- have become well-known.

The FDA, which approved bisphosphonates in the first place has backpedaled a bit. Last October the government issued a warning about the increased risk of fractures of the femur -- the thigh bone -- for those who take these drugs for more than five years.

What a quandry for those who need to halt and reverse the bone loss that can lead to "dowager's hump," spinal compression fractures and fractures of the leg. And the number of people who suffer from bone loss is in the hundreds of millions.

Biphosphonates are popular among those whose doctors recommend a medication, possibly because they were the first drugs to be prescribed for building bone. But patients who have read about their drawbacks are afraid to take them for more than a short while, or afraid even to begin. And at the same time these patients are afraid not to take them!

What to do? Fortunately there are drugs other than bisphosphonates that can limit or reverse bone loss. The one I like the best is Evista, though it has side effects too. This drug is a SERM, selective estrogen receptor modulator, and is meant for post-menopausal women. Estrogen is crucial for keeping bone loss and regeneration in balance. SERMs bind to estrogen receptors on bone cells. The cells are fooled into thinking there is estrogen there, so they function like younger bones, keeping bone loss and replacement in balance. The same "trick" works on breast cells and other genital tissue, lowering the risk of breast and reproductive cancers.

Natural Osteoporosis Treatments

But drugs aren't the only answer. Medication or no medication, drinking alcohol and carbonated beverages and smoking aren't recommended, and a diet rich in calcium and Vitamin D is beneficial. Eat lots of vegetables and less red meat. Surprisingly the digestion of animal protein actually takes up some of the calcium bones need. Paradoxically that puts vegetarians and those who don't eat red meat in a good position with regard to bone health. We hear it again and again -- eat collard greens, bok choy and kale. And eat sardines and salmon. Vitamin D is important enough by itself and for calcium absorption that many of my patients take a supplement of 1000-2000 IU a day.

I believe yoga is another valuable tool for everyone's bone health. Not only is yoga weight-bearing. It's the far greater pressure created by one group of muscles opposing another that makes the difference. My clinical trial studying the benefits of yoga for osteoporosis and osteopenia has had significant early success, and it is ongoing now to test those initial results.

During the two-year study, participants added more than 3/4 of a point on the T scale in their DEXA bone density tests for the spine and 4/5 of a point for the hip, which is often the site of a fracture. They did this in one 10-minute yoga session a day. To explain this a little further, participants who had osteopenia improved enough to return to the normal bone density range. Some who had osteoporosis gained bone during the study and entered the osteopenia range.

The people in my study averaged 68 years of age, but yoga would have helped if they were much younger or much older to prevent, halt or reverse the process of bone loss. Eminently portable, quiet and just about free, yoga has few if any undesirable side-effects. Participants in my study did over 20,000 hours of yoga. There was not one injury! There is still room in the study, so if you're interested, you can sign up.

The bottom line

Whether you take medicines or not, you can improve your lifestyle by incorporating natural treatments. As for the medicines, ask questions and investigate, but if your doctor has a persuasive argument, follow his or her advice.

 
Women (and men!) of a certain age who have been diagnosed with osteoporsis are frequently prescribed a bisphosphonate like Fosamax, Boniva, Actonel, Altevia or Reclast. In 2009 more than 5 million pre...
Women (and men!) of a certain age who have been diagnosed with osteoporsis are frequently prescribed a bisphosphonate like Fosamax, Boniva, Actonel, Altevia or Reclast. In 2009 more than 5 million pre...
 
 
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04:23 PM on 06/08/2011
I have read about this Fosamax medicine, that it cause trouble to in-takers. Fosamax was supposed to strengthen your bones but a study from the Journal of the American Medical Associatio­n (JAMA) in its February 2011 issue, that Fosamax can cause atypical femur fractures. In that study, doctors surveyed 200,000 long-term female bisphospho­nate users over 68. The authors determined that Fosamax users are three times as likely to suffer a bone break after using the drug for a five-year period because bisphospho­nates make bones brittle as it hardens them.
Source:
http://www­.fosamaxfe­murfractur­elawsuit.c­om/updates­/physician­s-respond-­to-fosamax­-femur-fra­cture-stud­ies/
04:10 PM on 06/08/2011
I have read about this Fosamax medicine, that it cause trouble to in-takers. Fosamax was supposed to strengthen your bones but a study from the Journal of the American Medical Association (JAMA) in its February 2011 issue, that Fosamax can cause atypical femur fractures. In that study, doctors surveyed 200,000 long-term female bisphosphonate users over 68. The authors determined that Fosamax users are three times as likely to suffer a bone break after using the drug for a five-year period because bisphosphonates make bones brittle as it hardens them.
Source:
http://www.fosamaxfemurfracturelawsuit.com/updates/physicians-respond-to-fosamax-femur-fracture-studies/
04:38 PM on 04/27/2011
Tuffs did a study several years ago, that showed lifting weights decreased osteoporosis. The stronger your muscles are the more bone mass you will have.
11:22 AM on 04/26/2011
For years Doctors have routinely prescribed these drugs for osteopenia many still do .There is little evidence that this prevents fractures. Even the NOF guidelines which up until 2008 recommended treatment have had to be changed. Vitamin d ; vitamin k and other natural treatment seem the better option. Particularly in the treatment of osteopenia.. Interesting case study... "Rare Fractures Linked To Drugs For Weak Bones" http://www.npr.org/2011/02/28/134064950/rare-fractures-linked-to-drugs-for-weak-bones
11:01 AM on 04/26/2011
Here's an excellent interview with Dr. Fishman that gives a few more details about yoga's success in fighting bone loss. http://family.lifegoesstrong.com/can-yoga-cure-osteopenia
08:42 PM on 04/26/2011
Oops.The link doesn't seem to work. Try www.sciatica.org.
07:34 AM on 04/26/2011
In my web search a year or so ago, there was mention of Strontium as an alternative to Rx's. I've been using 2 caps of Strontium 227 mg. It has some Vit.C with it. I must take my Strontium, Magnesium and Calcium separate from each other. I'm interested to see if this has made a difference.
Any comments, Dr. Fishman?
01:19 AM on 04/26/2011
My situation is muddled, as is other's. I'm 59, obviously post-menopausal -- I had my uterus and one ovary removed in my 30's, so I'm not sure how well the one ovary I had left functioned because without a uterus I didn't have periods. I'm of the typical heritage that promotes osteoporosis. My maternal grandmother had it badly, but she also had lung disease and used steroids that contribute to bone loss. Then my mother was found to have it at a fairly young age, only to discover that, in addition to family history and slight build and all that, she had a parathyroid tumor which leached calcium from her bones like crazy. She spent years taking bisphosphonates, and ultimately suffered one of those mid-femur fractures that are being warned about now.

So I have family history, body type, and (unfortunately) years of cigarette smoking and alcohol drinking (not excessively, but I'm not a teetotaler), and because of illness, a number of years of physical inactivity over the last 10 years. Three years ago I was found to also have a parathyroid tumor, large, and I have full-blown osteoporosis in both spine and hip. Just to make matters worse, I have a major problem with GERD, have taken Prilosec for years now -- surgery hasn't been an option up to now -- and that's yet another risk factor.

I'm taking Fosamax, but feel doomed to suffer a fracture. I don't think I could ever eat enough kale to prevent it.
HUFFPOST COMMUNITY MODERATOR
midwesthousewife
03:59 PM on 04/25/2011
There is a Chinese herbal formula called Osteo 8 from Evergreen that is supposed to rebuild 3% of the bone in six months. Don't know if it is true, but the Chinese herbal formulas have been fine-tuned over millenia of use and western medicine is starting to pay attention to their effectiveness.
02:47 PM on 04/25/2011
Don't forget cannabis

"Cannabinoid receptor type 1 protects against age-related osteoporosis by regulating osteoblast and adipocyte differentiation in marrow stromal cells"
http://www.ncbi.nlm.nih.gov/pubmed/19656492
http://hmg.oxfordjournals.org/content/14/22/3389.full.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001217/
"This review summarises in vitro and in vivo findings relating to the influence of cannabinoid ligands on bone metabolism and argues in favour of the exploitation of cannabinoid receptors as targets for both anabolic and anti-resorptive therapy for treatment of complex multifaceted bone diseases such as osteoporosis. "
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03:35 PM on 04/25/2011
Why does nobody mention the most beneficial practice off all for staving off osteoporosis...lifting free-weights? Start with 1 lb and go up from there. http://www.webmd.com/osteoporosis/features/exercise-for-osteoporosis

http://www.livestrong.com/article/108545-exercises-osteoporosis-using-hand-weights/
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midwesthousewife
03:54 PM on 04/25/2011
I have done weight-lifting all my adult life--machines, not free weights. So I was aghast when my bone-density scan showed me on the edge of osteoporosis!
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Loren Fishman, MD
08:44 PM on 04/25/2011
You're right. Weight-lifting is good, but in older people it may lead to orthopedic injuries, and because of the dynamic pull of muscle groups, yoga actually puts more pressure on the bones than weight-lifting does.
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ddanimal
02:14 PM on 04/25/2011
This article is lacking.

Vitamin D is needed in doses quite a bit higher than 1000-2000 IU daily. Doses of about 5000 IU daily are required for most people t get vitamin D levels above 50ng/ml, which is ideal.

Also, there is no mention of vitamin K2 or magnesium.

Vitamin K2 is highly effective for bone mineralization, and preventing calcification of soft tissues. Life Extension foundation (lef.org) had some interesting articles last year reviewing scientific studies of K2 and bone mineralization , and other benefits of K2.

Finally, the statement about red meat causing osteoporosis is a myth. This is only a concern if vitamin D and vitamin K2 levels are inadequate.

Osteoporosis is easily prevented in most people by taking:

vitamin D3 5000IU
Vitamin K2 (from natto) 200mcg daily
magnesium 400mg daily.

Calcium is not necessary and can even be harmful if one is deficient in D or K2.
HUFFPOST COMMUNITY MODERATOR
midwesthousewife
03:55 PM on 04/25/2011
A recent report said that women taking calcium supplements had a substantially increased risk of heart attack and stroke. I wonder if that has been verified with other studies.
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Loren Fishman, MD
08:33 PM on 04/25/2011
A New Zealand study does confirm this, and several American studies suggest it. However, the FDA has explicitly stated that there is no connection. We are free to make up our own minds on this issue: my suggestion is below age 75 take 1500 mg and over 75 take 500.
04:49 AM on 04/26/2011
Great points - let's not forget about B12: http://saveourbones.com/low-levels-of-vitamin-b12-linked-to-osteoporosis/
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Halsey
"There is a price to pay for speaking the truth. T
01:30 PM on 04/25/2011
I had, for my age, great bone density. POW, chemo, in one year reduced it 14%. Of course, doc's now discussing a boniva type. All I had to hear was 'jaw pain' and KNEW I'd never, ever take it. I don't care if the jaw disorder is rare, I already fight almost daily tension headache, tied to severe TMJ and can't imagine the pain getting worse. Sadly the SERM..estrogen..No way. Again, after Chemo I lost a LOT of weight so was prescribed megase to increase appetite(sadly med. MJ didn't do it). Within 3 month, three massive pulmonary emboli (from the hormone in the liquid) almost killed me. OMG..anyone who's had a big PE KNOWS that pain!..I'm guessing it feels like a bad heart attack.

So..yoga and bok choy? better than emboli or jaw pain!..thanks for the article...good to have options.
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Loren Fishman, MD
08:37 PM on 04/25/2011
In my pilot study of yoga vs. osteoporosis, some people gained almost a whole point on the T Scale of bone density in 2 years. The side effects of yoga are better balance, improved strength and coordination and less depression. I invite you to join the study. Check it out at www.sciatica.org. And I hope you feel better!
05:57 PM on 04/27/2011
Dr. Fishman, please give your opinion regarding a product called "liquid calcium", apparently a sea byproduct from Australia. A friend found it in a store in Beijing and is taking one a day. His major concern is if the product contains harmful preservatives.
01:23 PM on 04/25/2011
Yes, most osteoporosis drugs do make the bones weaker and more brittle.
http://www.drugdanger.com/NEWS/20100914-ExpertsCallForChanges.htm and lots of others.
Also read about Calcitonin nasal spray, but really don't know much about it all. It's Rx drug made from salmon. Unlike bisphosphonates, it won’t make bones brittle.
Some key points to remember:
1. Take 500-1000 mg of magnesium a day and 500-800 mg of calcium – if you’re eating dairy every day, you may want to add more magnesium to your diet and supplements. But make sure to take the right kind of magnesium.
2. Strengthen your bones with bone-stressing exercise
3. Learn to balance. People break bones when they fall.
4. Reduce your stress. Stress hormones such as cortisol, pull calcium out of your bones.
A diet that's pH balanced - lots of greens and veggies - and less processed junk - helps also.
Milk is not good! Makes our bodies more acidic.
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01:14 PM on 04/25/2011
When it comes to drugs, I like to wait a long time to see outcomes of studies. As an example, 5 years into a 10 year study on hormone replacement, women started having heart attacks. Only 5 years in. I'll wait - take calcium - do weight bearing exercises - vitamin D. It will have to do.
12:46 PM on 04/25/2011
Alas it's the truth: most people would rather be medicated than make a tiniest change to their diet or exercise. If only yoga came as a pill!
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Loren Fishman, MD
08:39 PM on 04/25/2011
Are you listening, government officials? I hope so! As I heard on National Public Radio this morning, if there is a Fountain of Youth, it is exercise.
11:56 PM on 04/27/2011
From your lips to the nation's ears! Why is it that so many people are willing to swallow a ton of prescription meds, but when the "prescription" is to get up and move, they suddenly stop listening? I believe very strongly in the power of exercise to enhance the quality of our lives as we age. The benefits are many: higher energy level, better sleep, weight control, improved strength and balance (essential for fall prevention). Thank you, Dr. Fishman, for this excellent article.
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jacquelinenh
HuffPo Addict
12:43 PM on 04/25/2011
It is good to see a study finally being done on yoga and bone health. A few questions... Did the study participants previously practice yoga? Are there any yoga poses that seem particularly useful -- and likewise, are there any poses that are bad for someone with osteopenia? Looking forward to hearing more!!

As for a beneficial diet for bone health, Susan Brown (Better Bones) has put out a ton of information on the benefits of eating an alkaline diet, including doing an excellent job of highlighting the latest studies...
http://www.betterbones.com/blog/post/More-support-for-the-link-between-vegetables-and-good-bone-health.aspx
http://www.nature.com/ejcn/journal/v65/n3/abs/ejcn2010264a.html?WT.ec_id=EJCN-201103
http://www.betterbones.com/alkalinebalance/default.aspx

She also has suggestions for exercise too, including yoga: http://www.betterbones.com/healthylifestyle/exercise-bonesandosteoporosis.aspx
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Loren Fishman, MD
09:21 PM on 04/25/2011
My book, Yoga for Osteoporosis: The Complete Guide, is filled with poses. I am doing a clinical trial as well. Please feel free to sign up for the trial at www.sciatica.org. Hope this helps!
07:10 AM on 04/26/2011
Thank you for your great article on a topic that effects so many of us. I've been a yoga fan since 1971, but in the last few years, find I get distracted by garden work and hiking. Both excellent in many ways, but NOTHING keeps my body tuned up and allows me to stretch out visits to the chiropractor's office like yoga. I'm happy to read that a mere 10 min. of practice will do my bones a lot of good. I'm headed for my yoga mat right now!