Living Well

Tired of the Flip-Flopping Medical Advice? Here's What You Need to Know...

It's hard to tell which medical studies to follow... especially when they contradict each other.

One day coffee is good for you... the next, someone claims it gives you cancer. The same with eggs, milk, and a number of other things. (For the record, coffee is good for you and protects against liver cancer.)

The latest flip-flop of advice involves osteoporosis medication. One headline from mid-August stated that these drugs might lead to a lower risk of early death. Then just a few days later, a new meta-analysis proclaimed there's no link between the drugs and longevity.

So what do we take away from this?

First, we have to understand what's going on here...

You might think bones are solid and stagnant. But that's just not true. Our bones go through balanced cycles of growth and resorption throughout our lifetimes. Resorption is the process of our bones breaking down to release nutrients to the body. The main nutrients involved are calcium and phosphorus.

Osteoporosis weakens the bone structure because we have too much resorption and not enough growth to balance it. That's why folks with the disease suffer from bone loss. Bone loss damages the bone, making it more fragile.

Popular types of drug for osteoporosis are bisphosphonates, which work by slowing the resorption process. Special bone cells called osteoclasts are responsible for resorption. The osteoclasts absorb the bisphosphates... but the drugs trigger apoptosis – the death of the osteoclast cells.

The meta-analysis that just published showed that these drugs don't lower your risk for premature death. The researchers looked at 38 different studies and concluded there's no solid evidence that they do. However, there were mixed results for one type of this drug, zoledronate...

Zoledronate is a nitrogen bisphosphonate. In other words, it's a sub-class of the osteoporosis drugs with a different chemical makeup that includes nitrogen.

The meta-analysis did not include the most recent paper from the Garvan Institute of Medical Research in Sydney. (It was the second paper from the institute that looked specifically at this sub-class.)

These researchers saw that people taking certain nitrogen bisphosphonate like risedronate or alendronate had a 34% lower risk of premature death.

But the researchers dug further... They focused primarily on women for the second paper. Focusing primarily on women for the second paper, the institute found that taking any nitrogen bisphosphonatenBP lowered risk of premature death by 39%.

So, do these drugs really lower risk of early death?

If they do, it's only the nitrogen bisphosphonates that are responsible. And of those, results are more or less mixed.

There are two ways they could lower your risk for early death. First, stronger bones mean fewer fractures from a fall. Remember, falls are a leading killer of folks over 65. They account for about 800,000 hospitalizations each year and more than 27,000 deaths.

But a more interesting theory is that the nitrogen bisphosphonates protect against heart disease, the top killer of Americans.

That's because other studies have looked at the connection between osteoarthritis, heart disease, and higher levels of calcium in your blood.

In fact, if your doctor suspects you have heart disease, he may order a calcium screening in your blood. Since some of the plaques that block your blood vessels are made of calcium, the idea is that if you have excess calcium in your blood, you have more of these plaques. (Remember, plaques are build-ups in your blood vessels that lead to heart attacks and stroke.)

The connection here is the resorption. As our bones break down and release calcium into our bodies, we wind up with too much calcium. That can lead to excess calcium-rich plaques in our blood vessels.

We believe it's likely a combination of these factors. But one thing is for certain – strong bones lead to a strong heart. If you work on improving one, you'll help the other. That's why I always recommend a healthy diet and regular exercise to combat chronic inflammation in your body, which is the real cause of heart disease. Sticking to these two principles will also help your bones.

But don't go popping the supplements yet... As we've said before, calcium supplements are useless at best and dangerous at worst.

The answer isn't in a pill. You don't need just calcium to keep your bones strong. Calcium needs vitamin D to help your body absorb it. You also need vitamins C, E, and K, as well as magnesium and boron to help absorb calcium and build bone strength.

If you take calcium supplements as a preventative measure for bone loss, consider a multivitamin instead or simply up your intake of nutrient-rich foods. Eat more calcium-rich foods, but also foods high in vitamins C, E, K, and magnesium and boron. Almonds, spinach, bananas, chard, pumpkin seeds, hazelnuts, honey, raisins, fish, berries, and Brussels sprouts are all great additions to your diet to get these needed nutrients.

As for exercise, regular movement exercises like tai chi and walking will help you work on your balance and build some muscle tone. Add in weight-bearing exercise to keep your bones strong as well. One study from American Family Physician introduced simple weight-bearing exercise to folks in various retirement villages. These simple exercises improved walking distance and resulted in an overall drop in number of falls compared with the control group.

We're still looking out for more cause-and-effect studies on these arthritis medications, but we're excited for a potential new way to treat the No. 1 killer in the U.S.

What We're Reading...

Here's to our health, wealth, and a great retirement,

Dr. David Eifrig and the Health & Wealth Bulletin Research Team
September 3, 2019