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Susan M. Love

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More Is Not Always Better

Posted: 02/ 2/2012 5:15 pm

When it comes to medicine, all too often we think, "Well, if a little is good for you then more must be better!" But three studies published this month alone underscore why, when it comes to our health, more may actually be more than we need.

The first study I want to tell you about was conducted by the Study of Osteoporotic Fractures Research Group, and was published in the current issue of the New England Journal of Medicine. Its focus was bone mineral density testing for older women.

Bone density tests are used to determine if a woman has osteoporosis -- thin bones that are at increased risk of fracture. It used to be that osteoporosis was only diagnosed after a woman had fractured or broken a bone. But then the dual-energy X-ray absorptiometry (DEXA or DXA) scan, a machine that measures bone density at the hip, spine and forearm -- where fractures are most likely to occur -- was introduced. Suddenly, everyone was being sent for DEXA scans, on the assumption that more screening would lead to better detection of osteoporosis and reduce the risk of fractures because doctors now had a new drug to prescribe, called a bisphosphonate, which could increase bone density.

Medicare covers a bone density test every two years, but it's never been clear how often women really should have this testing done, or even when they should start. (The National Osteoporosis Foundation suggests age 65.) To look into that question, researchers turned to "The Study of Osteoporotic Fractures," a national observational study of 10,000 older women. They looked at 4,957 women, 67 years of age or older, who had normal bone mineral density, had not had a fracture, and were not being treated for osteoporosis to see how quickly they lost bone over a 15-year time period.

They found that bone doesn't change very much and osteoporosis progresses very slowly -- so slowly in fact that a women who had a normal bone density or mild osteopenia at age 65 could actually be tested every 15 years, while women with moderate osteopenia could be tested at five-year intervals. The one group that the study showed would benefit from regular testing was women who had advanced osteopenia, who should be tested annually.

It's bad news for the companies that make DEXA scans and the hospitals that do the testing. But for the majority of women whose bones are just fine, it's another bi-annual test you can cross of your list.

The second study showed that you might not need to be taking a daily low-dose aspirin to protect your heart. A meta-analysis (an analysis of previous studies) of nine randomized, controlled studies that compared aspirin to a placebo that was published online in the Journal of Internal Medicine earlier this month found that people who didn't have heart problems took aspirin in hope of keeping things that way were not less likely to die from cardiovascular disease or cancer than someone taking a placebo. If you have had heart problems, and your doctor told you to take a low-dose aspirin, you should certainly keep on doing it. But if you have been taking it with the hopes it would keep you healthy, well, you might want to save your money.

The third study suggests you may want to stop buying mega-doses of vitamin D, too. This study, published in the Jan. 15 edition of The American Journal of Cardiology, found that too much vitamin D might also not be a good thing. Conducted by researchers at Johns Hopkins University, the study investigated the vitamin D use of 15,000 adults enrolled in the National Health and Nutrition Examination Survey. Previous studies have shown that vitamin D supplements reduce blood levels of C-reactive protein (CRP), which has been linked to inflammation and cardiovascular disease. But the Johns Hopkins researchers found that adults who had levels of vitamin D that were higher than what is considered normal actually had higher levels of CRP. This suggests that if you have low vitamin D levels to begin with, supplements can be good. But that if you start with already high levels, taking more might do more harm than good.

These three reports are great examples of why we need to demand research and not just assume that drugs that will make us stronger, smarter, and better. Drugs, vitamins and tests aren't always the best prevention! Exercise, a healthy weight and stress moderation are still the best recipe for all of us!

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