Most of my patients initially refuse when told that they need to start medication for osteoporosis. Why such an overwhelming negative response? The ads soliciting supposed victims of anti-osteoporosis drugs such as Fosamax, have been so wide spread and convincing that the general population is now convinced that the treatment is worse than the disease.
The high level of fear among woman regarding treatment of osteoporosis worries my colleagues and I. Although it is likely that after many years taking drugs such as Fosamax can cause bones to become brittle, the type of fracture they may contribute to is less than one percent of all fractures related to osteoporosis. Some experts believe that for about every 300 osteoporotic fractures there may be one fracture related to treatment.
How dangerous are fractures related to osteoporosis? The rate of people dying within a year after suffering a hip fracture is almost double and the risk seems to be higher the younger you are when the fracture occurs.
The question in my mind then is, who will compensate woman who fracture due to osteoporosis after being frightened away from treatment by lawsuit ads? When pharmaceutical companies promote a drug treatment they must provide “fair balance” resulting in promotional drug ads which devote most of their time to the negative aspects of the drug. Not so with the “have you been injured by Fosamax?” ads. The scarier the ads the more effective they are, which serves their purpose very well.
I propose that a fund be set up by those broadcasting, “have you been injured” ads to compensate people who have been injured because of their scare tactics. My thought is that many people are hurt by these ads because of their unbalanced and purposefully frightening message. Why shouldn’t there be a way to provide the resources needed to help the victims of such propaganda?
Probably the major cause for concern regarding post menopausal HRT (hormone replacement therapy) highlighted by the WHI study was an increased risk for breast cancer. This finding applied to women in the WHI who were using combination estrogen and progesterone replacement. Progesterone is given to counteract the effect of estrogen to cause uterine (endometrial) cancer but is not crucial for relief of post-menopausal symptoms. Interestingly, women who used estrogen replacement alone (without the progesterone) actually showed no increase and possibly even a reduction in invasive breast cancer after 7 years on treatment. In the group of women who started “estrogen only†replacement more than 5 years after entering menopause, the reduction in breast cancer was even more pronounced. Experts therefore conclude that “estrogen only†HRT is likely to be considerably safer from a breast cancer point of view, and starting estrogen 5 years after menopause reduces the cancer risk even further.
The relationship between estrogen use and breast cancer risk is further complicated by the finding that post-menopausal women using HRT who develop breast cancer appear to have better survival and less aggressive tumors than post-menopausal women who are diagnosed with breast cancer who never used HRT. Breast cancer may not be caused by estrogen, but cancer may grow more rapidly in the presence of estrogen. This doesn’t sound like an advantage but small undetected cancers may grow rapidly with HRT so that they can be seen on mammography and removed before they can spread.
New drug combinations in development offer hope to women who are looking for HRT alternatives. A class of drugs known as SERMS of which Evista is a member, used in combination with estrogen has shown promising results in clinical studies. A SERM will protect against the uterine cancer causing effect of estrogen so progesterone is no longer needed with HRT. This immediately reduces many of the undesirable effects of HRT found in the WHI including breast cancer risk and producing better cholesterol effects. This combination of drugs is referred to as a tissue-selective estrogen complex (TSEC). Other advantages of TSEC treatment are improvement in bone density (lower osteoporosis risk) and possible reduction in coronary artery disease development. Although TSEC treatment is not yet FDA approved for treatment of post-menopausal symptoms, individual doctors can prescribe this if they feel the available information is favorable and the risk/benefit ratio is in favor of the patient’s well being.
Finally, there is the issue of blood clots associated with estrogen treatment. This is likely due to the effect of estrogen to alter the balance of certain blood proteins that favor blood clot development. My thought is that adding a simple baby aspirin daily may reverse or significantly reduce risks associated with increased blood clotting with estrogen, just as baby aspirin is now recommended for those at increased risk of heart attack. Aspirin is unlikely to be helpful to prevent blood clots in veins referred to as DVT but this is not completely certain. As with all medications there are downsides to aspirin such as gastric irritation and ulcer bleeding but these risks can be assessed by the individual and their doctor.
(This information is for educational purposes only and does not constitute medical advise or establish a doctor patient relationship)
Gary Pepper, M.D.
Editor-in-Chief, metabolism.com
As a clinical nutritionist and author, it can be difficult to prioritize issues and actions.  For several years, my number one concern is the fact that radioactive elements, known to cause childhood and adult cancer, osteoporosis, anemia and immune deficiency, are regularly released into our air and water.  I first learned of this iniquity in 1997 when I became involved in the RPHP “Tooth Fairy Project” at the suggestion of Dr. Ernest Sternglass.  Dr. Sternglass is an author, director of RPHP and professor emeritus of Radiological Physics at the University of Pittsburgh Medical School. CLICK HERE to learn more about the Tooth Fairy Project.
The study basically measures radioactive Strontium 90 (Sr90) in children’s teeth and in drinking water supplies.  Strontium is an essential nutrient important to bone structure and health.  The radioactive form, Sr90, can be taken up into teeth and bones where it basically radiates the bone marrow. This constant bombardment damages red  blood cells and white blood cells (the foundation of our immune system!).  Its breakdown products can also travel to other organs such as the brain, pancreas, breast and prostate.  The resulting anemia, immune deficiency, osteoporosis,  leukemia and other types of cancer can be easily predicted.
The cancer causing effects of radioactive nutrients is well known, and led the Nuclear Regulatory Commission to recommend that counties close to a nuclear power plant stock Potassium Iodide to be taken as a protective measure in the event of a nuclear accident. Â Saturating the thyroid with the natural element should prevent the radioactive iodine from doing as much damage.
Dr. Sternglass discussed the health effects of low level radiation in his article about childhood cancer in the June 1963 issue of the journal Science. CLICK HERE to link to the article abstract. Dr. Sternglass presented his paper and findings to President John F. Kennedy and Congress in 1963.  Awareness that Strontium 90 could cause cancer and other health anomalies contributed to a partial Nuclear Bomb Test Treaty between the USA and USSR.
I do hope that they stop releasing these harmful radioactive elements, but until they do, I recommend a few things to reduce your exposure.
First and foremost try to remove the Sr90. Dr. Sternglass told me that REVERSE OSMOSIS and DISTILLATION will both remove Sr90 from drinking water.  To replace any minerals, be sure to eat lots of mineral rich foods (grown from healthy, nutrient rich soil). I use Willard Water with Lignite for a trace mineral source.
Secondly, consume lots of antioxidants from FOOD SOURCES such as fresh, vine-ripened fruits and vegetables to protect against free radical damage from the radiation. Antioxidant superstars include pinto beans, blueberries, prunes, raisins, cranberries, pomegranates, kiwi fruit, red bell pepper, kale, spinach, Brussels sprouts, and broccoli just to name a few! CLICK HERE for a list of 277 foods analyzed by the USDA. See, they are paying attention! You can also get a pamphlet from the AICR on antioxidants. CLICK HERE to see the PDF or visit AICR.ORG.  Ingestion of seaweed such as kelp appears to be protective as well.
If you are not eating the MINIMUM 5 servings of fruits and vegetables per day or are still working toward the RECOMMENDED 9-12 servings per day, consider a personalized NUTRITION CONSULTATION with me!
Annette posts a question to metabolism.com since she is on a high dosage of vitamin D due to intestinal surgery. Is the dosage too much for her, she wonders?
When the intestines fail to absorb fats due to surgery or due to disease, Vitamin D which is a fat soluble vitamin, can see its levels fall dramatically. Otherwise healthy people in the U.S., however, are being found to have unacceptably low Vitamin D levels. Is it due to inadequate diet or is it a result of wide spread sunlight phobia?
Here is Annette’s post followed by my response to her question. Answers to these questions are contained in this exchange.
Annette writes:
I had a Bilio Pancreatic Diversion surgery done in 1990. My Vitamin D level is low, at 15.
My Dr. has me on 50,000 iu of Vit D every other day, 4,000 iu on the other days.
May I ask you, what is your opinion on this amount of Vit. D. The 50,000 iu capsules are by prescription.
Thanks so Much,
AS
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Metabolism.com responds:
Vitamin D deficiency is a serious problem and has been largely overlooked in the general population until recently. Vitamin D is not only important for bone health but we are learning it is important for the immune system and may help protect against certain cancers. In my medical practice in Florida I am finding an alarming number of my patients with very low and borderline low levels of Vitamin D that were totally unexpected. I assume it is because everyone knows that sunlight is bad because it causes wrinkles and skin cancer. The further north you live the weaker the sunlight so the incidence of vitamin D deficiency is higher.
Until recently the recommended daily Vitamin D allowance was 400 IU but recently this was increased to 800 IU and some authorities recommend higher amounts.
10,000 IU levels daily for the average normal person is thought to be an upper limit before toxicity can be seen. Vitamin D is a fat soluble vitamin so in people who have problems absorbing fat, such in your case after intestinal bypass surgery, higher amounts are needed. Vitamin D doses of 50,000 IU at a time are not unusual but are usually given only a few times weekly or monthly, depending on needs. A handy tip is that deficient Vitamin D causes serum calcium levels to be low, so many clinicians will monitor serum calcium levels to help adjust the prescription.
Although I can’t recommend medical therapy in this forum I have some thoughts I can share. Why not get another blood vitamin D level measured to see if the amount you are getting is okay? Calcium levels go up in vitamin D excess so a serum calcium level that is elevated can be an indication of too much vitamin D.
Hope that helps. Keep us posted.
The metabolism.com website disclaimer applies to this and all my posts.
Recent information published in the British medical journal Lancet, supports using calcium and vitamin D supplementation to prevent fractures and bone loss in older people. A 12% reduction in bone fractures linked to osteoporosis was seen in people aged 50 and older who used calcium and Vitamin D supplements. Osteoporotic fractures are common with one in six people over the age of 50 experiencing this type of fracture in their lifetime. In people over 70, the occurence of a bone fracture, particularly of the hip is associated with a very high risk of mortality. One study showed a one year mortality of about 33% in elderly people after hip fracture. To achieve the bone benefits from supplements the researchers recommend a daily dose of 1,200 mg of calcium and 800 IU of vitamin D for people over 50.
The staff of metabolism.com wants to add a warning to people shopping for calcium and vitamin D supplementation. When shopping for these items be aware that there is a great variation in price among the various brands of supplements. The higher price brands often claim to be significantly better than cheaper competitors in terms of absorption and results. Be aware that many of these claims are false or exaggerated. Why spend $12 for 50 coral calcium pills when 100 Tums (calcium carbonate) can be gotten for half the price? If coral calcium is actually 20% better absorbed then calcium carbonate then an extra Tums per day will more than balance off any difference.
Here’s more on the once yearly osteoporosis treatment. The drug is Zometa (zoledronic acid), marketed by Novartis and is sometimes referred to as Vitamin Z. It is given once a year intravenously by an office procedure taking only a few minutes. Side-effects are reported to be minimal but may include transient decrease in kidney function. In a three year study the effect of the drug was at least as good if not better than that seen with the oral medications such as Fosomax and Actonel. Fracture of the spine was reduced by 70% whereas the oral medications only achieve a 50% reduction.
One possible drawback was the occurrence of a non-fatal heart arrythmia which was more common with Vitamin Z than with placebo (the dummy medicine).
Don’t expect to find Vitamin Z in the pharmacy any time soon. It hasn’t been approved by the FDA for routine use in treatment of osteoporosis. Rumor has it that a yearly dose will cost around $1000, not including the doctor’s charge for giving it intravenously.
Only you and your doctor can decide the best treatment for you. Consult your physician before initiating any treatment program.
The mission of the The Thyroid Project is to encourage sharing of information and experience between the public and the medical community about the treatment of hypothyroidism (low thyroid function). For at least the past few decades there is a growing awareness of “something missing†in the way suffers of hypothyroidism are treated for their disease.
Too many patients, as documented in an on-line study of 12,000 individuals conducted by the American Thyroid Association published in June 2018, (https://doi.org/10.1089/thy.2017.0681) , complain of persistent symptoms of hypothyroidism despite what their doctors believe is successful treatment with levothyroxine (brands include Synthroid, Unithroid, Tirosent, Levoxl). We believe something needs to be done to resolve this conflict between patients and their doctors.
Without effective intervention the early stage of type 2 diabetes known as prediabetes carries a high risk of progressing to outright diabetes. Metabolism.com provides an up-to-date summary of recommendations from national authorities, for preventing and possibly reversing this life long affliction
Diabetes can be defined simply as elevated blood sugar levels. What exactly is high blood sugar and when should someone be concerned about their level? Does having prediabetes mean diabetes is around the corner? Metabolism.com tackles this tricky but important topic in this comprehensive review.
By Gary M. Pepper, M.D. Ozempic, Rybelsus, Trulicity, Wegovy, Saxenda are the central players in the weight loss craze sweeping across the globe. Metabolisim.com has been monitoring this phenomenon from its beginnings in 2008 with its report “Lizard Spit Reduces Blood Sugar and Appetite”, regarding the first drug in this class, Byetta (exenatide). Caught In the middle of the current chaos are the medical experts who treat diabetes and have been prescribing these medications for more than a decade. Here is a brief commentary from one such board certified endocrinologist; “I started treating Type 2 diabetics with GLP-1 agonists more than 10 years ago. In some respects, these medications have revolutionized the treatment of diabetes by lowering blood sugar effectively and promoting weight loss at the same time, a unique combination of benefits. Not everyone benefits from these drugs to the same degree unfortunately, and I have seen lots of patients experience unacceptable side effects from them. Nothing though, has prepared me for what is happening now. Too often, I find myself confronting someone who expects me to prescribe one of these drugs just so they can lose weight. Sadly, one extreme example was someone who, despite battling a life threatening medical condition, was insistent on getting a prescription. At the same time my diabetic patients are scrambling to find a place to buy their medications if they can even afford it. It is disheartening, to say the least, and I dread the negative interactions with some of my patients I now face almost daily.”
Off- Label Use
The FDA is the U.S. government’s department tasked with evaluating and approving drugs for specific medical conditions. When a new medication is approved for treating a medical condition by the FDA the agency will, at the same time, set strict guidelines for exactly which patients may use the newly approved drug. When a medication is used “off-label” it means that these limitations are being overridden by the provider for a potential benefit which outweighs the drugs risks. It is a general misconception that off-label means illegal; it does not. This practice has been going on for ages and more than 20% of prescriptions in the United States are prescribed off-label. A common example is the use of beta-blockers (approved for heart problems) for the treatment of performance anxiety.
GLP-1 agonist drugs, as discussed recently by metabolism.com. were originally approved for the treatment of Type 2 diabetes in adults. In the past few years most of these same medications have gained unprecedented popularity for their “off-label” weight loss benefit. Of the 5 GLP-1 agents presently in U.S. pharmacies only Wegovy (semaglutide) and Saxenda (liraglutide) are FDA approved for treating obesity. Of these two, Wegovy is the newer and had been much more popular that its sister drug Saxenda, probably due to being dosed only once weekly compared to daily for Saxenda and less likely to cause side effects. Due to Wegovy’s soaring popularity, its manufacturer, Novo Nordisk, increased the price of Wegovy two times since its initial release.
