How accurate are bone density scans in predicting one’s risk of pathological fractures? It seems obvious that the less dense the bones are, the greater the risk of fracture.

Yet, in my medical practice, I’ve seen patients who have been diagnosed with severe osteoporosis based on their bone density scans, and yet they live their entire lives without having hip or wrist fractures, compression fractures of the spine, or any other problems with their bones.

And, conversely, there are patients who have normal bone scans who have suffered frequent fractures. These results suggest to me that there is no sure way to tell from the bone density scans alone what the risk is for having pathological fractures.

Some people have dense bones with good scores on the bone scans, but the bones are “brittle” and more at risk of fracture.

What makes bones brittle in the face of adequate density?

Bones are living structures that contain blood vessels and nerves. The cells that control the state of our bones are osteoblasts and osteoclasts.

Osteoblasts build new bones. They produce a protein called osteocalcin which strengthens the bones.

Osteoclasts remove the old bone that has become brittle and no longer useful.

When there is a balance between new bone formation and the removal of the old and brittle bone matter, the bones remain healthy.

Healthy bones are porous and soft. As you age, they become less dense and more brittle—especially if you don’t engage in regular weight-bearing exercise. When you jump, run, hike up a hill, or lift weights, the stress of your muscles and your tendons where they insert into the bones sends a signal to your body to add new cells to strengthen your bones.

When patients are diagnosed with osteoporosis, they are usually urged to take medication that will make their bones more dense.

The most commonly used class of osteoporosis medications, the bisphosphonate drugs like Fosamax and Actonel, can actually put you at a higher risk of bone fracture.

How is that possible?

This class of bone medications interferes with the normal repair process of the bones by poisoning the osteoclasts that remove old and brittle bones. Under these conditions, the osteoblasts continue building up the bones so that, on a bone scan, the density significantly increases. Most likely your doctor will be pleased and reassure you that your bones are becoming healthier and stronger.

In fact, the bones are at an increased risk of fracture because they become weak and brittle without the activity of the osteoclasts that remove the old bone. The bones become so brittle that random fractures can occur from insignificant movements of the body, like a slight twisting of the spine. There are cases of femur fractures on bisphosphonate drugs that occur even without a fall. The shaft of the femur is considered to be the strongest bone in the body.

To make matters worse, the pharmaceutical companies that make the bisphosphonate drugs have convinced medical professionals to recommend osteoporosis medication when patients merely have osteopenia, a mild loss of bone, which was rarely diagnosed or treated before the bisphosphonate drugs appeared on the market.

Normal bone loss accelerates around the time of menopause for about five years before returning to a slower rate of loss. Women sometimes are frightened by this sudden loss of bone and do not understand it is a normal process. They are frequently prescribed the osteoporosis drugs at the time of menopause.

While we’re on the subject of the bisphosphonate drugs for osteoporosis, it’s important for you to know that some of the potential side effects of these drugs include esophageal irritation and even esophageal cancer, along with a risk of necrosis (death) of the jaw bone.

In Part I of the Osteoporosis article, I wrote about different drugs that increase risk of bone loss with long-term use, such as steroids, certain anti-seizure medications and certain anti-depressant medications. There are two more drugs to add to the list of medications that can cause loss of calcium in the bones—the statins and the acid blockers.

Unfortunately, the use of statins is rapidly growing in the US. One of the many problems related to use of statins is interference with vitamin K metabolism. Vitamin K2 helps escort the calcium to the bones and away from the arteries and the joints. So, theoretically, there is an increased risk of bone loss and arterial calcification with use of statins if not supplemented with vitamin K.

When patients get their bone density reports back, the written recommendations in the report are to take calcium and vitamin D—with no mention of vitamin K. Vitamin K is essential for cementing the calcium to the bones.

When acid blockers are prescribed, such as proton pump inhibitors for GERDs (acid reflux), patients are rarely informed that long-term use will increase the risk of osteoporosis. The lack of acid in the stomach prevents the absorption of minerals from both food and supplements, including calcium. Minerals need acid in the stomach to dissolve and be utilized.

One last potential cause of bone loss I want to mention is gluten sensitivity. I have had patients with both osteoporosis AND low serum calcium on their blood panel. Often people with gluten sensitivity cannot absorb calcium and other minerals due to the disruption in the gut from the gluten.

In the face of low serum calcium on your blood results, your doctor might simply tell you to take extra calcium. But the low serum calcium raises a red flag.

Low serum calcium suggests you are not absorbing the calcium and other minerals—like magnesium, boron and other trace minerals—that are needed for strong bones. Try getting off gluten for a few months and see if your serum calcium normalizes. If it does improve, try staying off gluten for a year or two and see if your bone density improves.

Here’s a quick review:

• Some medications for osteoporosis increase the risk of fracture. Consider using natural alternatives for increasing the health of your bones.
• Weight bearing is essential to maintain strong bones. A sedentary life will cause rapid bone loss. One is never too old for bone strengthening.
• A healthy diet is essential for maintaining strong bones. Limit sugars, simple carbohydrates, alcohol, caffeine, carbonated drinks, and animal foods that cause acidification of the blood which, in turn, promotes calcium loss from the bones.
• A high vegetable, whole foods diet helps to keep the blood in the proper acid/base balance.
• Acidification of the blood must not be confused with acidification of the stomach which is vital for adequate digestion and for extraction and absorption of minerals.
• Bones need not just calcium, they need magnesium, vitamin C, trace minerals, vitamin D & vitamin K in order to have be strong and healthy.Be careful about any long-term medications that might be interfering with bone metabolism, like steroids, certain anti-seizure medications, certain anti-depressants, statins, and acid blockers. When you are prescribed any medication, do your homework and read up on the potential risks. Consider if there are more natural methods of treatment, or less harmful medications. If not, then do a risk/benefit assessment before you fill your prescription.

Just remember—you are never too old or too young to work on building strong bones.

If you think it would be helpful, please spread this information around to your friends and family. Anyone is welcome to subscribe to the blog posts.

Since my medical practice is full and I’m not able to take new patients at the moment, I want to help the public sort out some of the many confusing and controversial areas of medicine—especially when pharmaceutical drugs are involved. It is getting increasingly more challenging to find information from sources without vested financial interests.

I’m committed to protecting my patients from harm in any way I can; I want to give them the tools to keep themselves as healthy as possible. And I’m also committed to do my best to stay informed and avoid unwittingly causing harm to anyone. After all, the doctors’ credo is, “Primum non nocere.” Above all, do no harm.

Here’s to your good health!

Erica