Posted on: Thursday, August 29th 2024 at 3:00 am
Are we sacrificing overall health in our misguided pursuit of denser bones?
A Decade Apart, Two Articles Shake the Foundations of Bone Health
In the ever-evolving landscape of medical understanding, few topics have sparked as much controversy and rethinking as osteoporosis. Two thought-provoking articles, separated by years but united in their challenge to conventional wisdom, are reigniting this crucial debate.
The first, a piece by Sayer Ji titled "The Manufacturing of Bone Diseases: The Story of Osteoporosis and Osteopenia," originally published on GreenMedInfo.com in 2012, questioned our approach to bone health.1 Now, a recent Substack article by A Midwestern Doctor, "The Great Osteoporosis Scam: How conventional osteoporosis care often makes things worse and the forgotten ways to regain bone health," builds upon this foundation, offering fresh insights and renewing the call for a paradigm shift in how we view and treat bone health.2
The Density Deception
Both articles converge on a critical point: our obsession with bone mineral density (BMD) as the primary indicator of bone health is fundamentally flawed. Ji's piece deconstructs the World Health Organization's definitions of osteopenia and osteoporosis, arguing that these classifications essentially pathologize the natural aging process. He states:
"The present-day definitions of osteopenia and osteoporosis were arbitrarily conceived by the World Health Organization (WHO) in the early '90s and then projected upon millions of women's bodies seemingly in order to convince them they had a drug-treatable, though symptomless, disease".1
A Midwestern Doctor echoes this sentiment, emphasizing that "the most important thing is not the bone's density, but rather its elasticity and mobility".2 This perspective challenges the very foundation of current osteoporosis diagnostics and treatments.
The Profit Motive: When Health Becomes Big Business
At the heart of both articles lies a disturbing truth: the current approach to osteoporosis diagnosis and treatment is deeply intertwined with profit-driven motives. This raises serious questions about whether patient health or financial gain is the primary driver of osteoporosis care.
Sayer Ji pointedly observes:
"One thing that cannot be debated, as it is now a matter of history, is that this sudden transformation of healthy women, who suffered no symptoms of 'low bone mineral density,' into an at-risk, treatment-appropriate group, served to generate billions of dollars of revenue for DXA device manufacturers, doctor visits and drug prescriptions around the world."1
This sentiment is echoed by A Midwestern Doctor, who notes:
"Anytime a large drug market exists (e.g., presently osteoporosis affects around 20% of women over 50), the medical industry will dismiss any approach to the condition which does not result in it being able to sell large amounts of lucrative medical services."2
The financial stakes are indeed high. The global osteoporosis drugs market was valued at $11.5 billion in 2021 and is projected to reach $16.3 billion by 2030.3 This creates a powerful incentive to diagnose and treat osteoporosis aggressively, potentially at the expense of more holistic and less profitable approaches to bone health.
Both authors argue that this profit-driven model has led to an over-reliance on pharmaceutical interventions, particularly bisphosphonates, despite their potential risks and limited efficacy. A Midwestern Doctor points out:
"Bisphosphonates in turn concentrate in the bone and work by disabling or killing osteoclasts. This thus leads to bone density increasing because the balance of bone production shifts towards building them up rather than breaking them down."2
However, this approach may not actually improve overall bone health or reduce fracture risk in a meaningful way.
The profit motive also extends to the diagnostic realm. The widespread use of DEXA scans, despite their limitations and potential for misdiagnosis, represents a significant revenue stream for healthcare providers. Ji notes that "these scans typically cost between $150 to $300, that quickly adds up."1
This focus on profitability may be diverting attention and resources away from more effective, but less lucrative, approaches to maintaining bone health, such as lifestyle interventions, nutritional strategies, and addressing underlying health issues.
As we continue to examine the osteoporosis debate, it's crucial to consider how financial incentives may be shaping our understanding and treatment of bone health, potentially at the expense of patient wellbeing.
The Arbitrary Nature of Diagnosis
Ji highlights the problematic nature of using T-scores for diagnosis:
"T-sores are based on the young adult standard (30-year-old) bone density as being normal for everyone, regardless of age, whereas the much more logical Z-score compares your bone mineral density to that of your age group, as well as sex and ethnic background."1
This arbitrary standard leads to a startling conclusion: "by age 65, 60% will be told they have either osteopenia (40%) or osteoporosis (20%)"1. A Midwestern Doctor further elaborates on this issue, noting that "there is actually a great deal of variance in DEXA scan results depending on which machine is used, how the operator performs the test and what bones are measured, with studies often finding a 5-6% difference in bone density depending on where the test was done".2
The Bisphosphonate Boondoggle
Both authors cast a critical eye on bisphosphonates, the most commonly prescribed class of drugs for osteoporosis. While these medications increase bone density, they may paradoxically increase fracture risk by creating more brittle bones. A Midwestern Doctor notes:
"Bisphosphonates in turn concentrate in the bone and work by disabling or killing osteoclasts. This thus leads to bone density increasing because the balance of bone production shifts towards building them up rather than breaking them down. Unfortunately, there are two problems with this approach".2
The article goes on to list numerous side effects of bisphosphonates, including osteonecrosis of the jaw, atypical fractures, and even an increased risk of certain types of fractures. Learn more about the harms of bisphosphonates here.
Beyond Density: A Holistic Approach to Bone Health
Both articles argue for a more nuanced, multifaceted approach to bone health. Ji highlights the importance of nutrients like vitamin K2 and soy isoflavones, which can reduce fracture rates without increasing bone density.1 A Midwestern Doctor expands on this, discussing several factors that contribute to bone health:
- Mobility: "since bone growth depends upon the signals generated from loading weight on the body, a good case can be made that our progressively increasing sedentary lifestyles is responsible for the continual increase in osteoporosis occurring in America".2
- Hormones: "The primary hormone which imparts elasticity to the bones (and induces osteoblast activity) is progesterone, and like estrogen, it declines with age--particularly after menopause".2
- Inflammation: "many of us have observed that patients with chronic inflammatory diseases tend to be at a greater risk of osteoporosis".2
- Minerals: "Our own experience has been that supplementing with the correct minerals is often what restores bone health, so I am inclined to believe this is indeed a critical point".2 Another unique perspective is that bone density and quality issues could be related to vitamin C deficiency (scurvy). Read the article by Dr. Suzanne Humphries titled "Osteoporosis Is Scurvy of the Bone, Not Calcium Deficiency."
The Hidden Dangers of High Bone Density
Perhaps most strikingly, both articles point out a rarely discussed fact: high bone mineral density in middle-aged and older women is associated with an increased risk of breast cancer. Ji cites multiple studies showing a 200% to 300% increased risk.1 He notes:
"One of the most important facts about bone mineral density, conspicuously absent from discussion, is that having higher-than-normal bone density in middle-aged and older women actually INCREASES their risk of breast cancer by 200% to 300%, and this is according to research published in some of the world's most well-respected and authoritative journals, e.g., Lancet, JAMA, NCI."1
This finding starkly contradicts the current push for ever-increasing bone density and raises serious questions about the potential unintended consequences of our current approach to osteoporosis prevention and treatment.
Rethinking Risk and Treatment
These articles challenge us to reconsider what truly constitutes bone health and how best to achieve it. They argue for a shift away from the simplistic "denser is better" model towards a more holistic understanding of bone strength, elasticity, and overall function.
A Midwestern Doctor suggests several alternative approaches to maintaining bone health, including:
- Focusing on mobility and weight-bearing exercise
- Balancing hormones, particularly progesterone
- Addressing chronic inflammation
- Ensuring adequate mineral intake and absorption
The Path Forward
As we digest the insights from these two articles, it becomes clear that our approach to bone health is due for a major overhaul. The authors call for more nuanced diagnostics, treatments that focus on bone quality rather than just density, and a greater emphasis on lifestyle factors that contribute to overall bone health.
A Midwestern Doctor concludes:
"In short I would argue that while bisphonates may be effective at improving a DEXA score, they aren't necessarily good at improving health".2
This sentiment encapsulates the core argument of both articles: that our current approach to osteoporosis may be misguided and potentially harmful.
Conclusion
The combined perspectives of these two articles provide a compelling case for reevaluating our approach to osteoporosis. As we move forward, it's crucial that we consider their warnings about the limitations and potential dangers of our current density-focused paradigm. By embracing a more holistic view of bone health, we may not only improve outcomes for those at risk of fractures but also protect against unintended consequences like increased cancer risk.
The debate these articles have rekindled is not merely academic--it has profound implications for millions of people, especially aging women. As we continue to unravel the complexities of bone health, one thing is clear: we need a more nuanced, multifaceted approach that considers bone quality, overall health, and long-term outcomes rather than simply chasing higher density numbers.
To learn more about natural approaches to osteoporosis, and problems associated with osteoporosis definitions, go to our database on the subject here.
References
1. Ji, Sayer. "The Manufacturing of Bone Diseases: The Story of Osteoporosis and Osteopenia." GreenMedInfo.com, August 3, 2012. https://greenmedinfo.com/blog/
2. A Midwestern Doctor. "The Great Osteoporosis Scam: How conventional osteoporosis care often makes things worse and the forgotten ways to regain bone health." The Forgotten Side of Medicine, March 24, 2024. https://www.midwesterndoctor.
3. Grand View Research. "Osteoporosis Drugs Market Size, Share & Trends Analysis Report By Drug Class (Bisphosphonates, SERM, Parathyroid Hormone Therapy), By Route Of Administration, By Region, And Segment Forecasts, 2022 - 2030." Published 2022. https://www.grandviewresearch.
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