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Is Osteoporosis Overtreated?

From eNewsletter 3/7/2022

DID YOU KNOW that new US Preventive Services Task Force draft guidance does not recommend statins for 75 and over? The evidence review on which the task force based the guidance lacked sufficient basis for determining statin benefit versus risk in adults older than 75 years without a history of CVD. "In the absence of this evidence, clinicians should use their judgment as to whether to offer a statin to a patient in this age group," says the press release.

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Osteoporosis Is Overtreated? In the longest study of bone loss in postmenopausal women to date, on average, bone mineral density (BMD) at the femoral neck (the most common location for a hip fracture) had dropped by 10% in 25 years - much less than expected based on shorter studies. Specifically, the authors of the Journal of Bone and Mineral Research study found the average BMD loss at the femoral neck was 0.4% per year during 25 years, compared with a drop of 1.6% per year over 15 years reported in other cohorts. This echo's what we have been saying about osteopenia and osteoporosis for decades: while it is a concern to be addressed, especially from a preventive perspective, it is overdiagnosed, overtreated, one-size-fits-all, does not address the crux of the issue (inflammation), and strikes unnecessary fear in women. A new study from Nutrients lays out the importance of nutrition, physical activity, and dietary supplementation to prevent bone density loss. This should be the first thing physicians speak to their patients about, yet is rarely discussed. Here's the highlights of the study. Nutrition Fiber-rich carbohydrates should be consumed every day, together with a minimum of five portions of fruit and vegetables of all colors (with an emphasis on orange fruit and vegetables, as well as green leafy vegetables). Extra virgin olive oil as a fat is strongly emphasized. Dairy products are recommended, but only if tolerated, which most do not. In this case, non-dairy enriched foods can be consumed. We are extremely pleased to see that naturally-occurring calcium water (one liter per day) was recommended, as we have done for many years. Gerolsteiner is our favorite brand. Protein consumption, mostly from animal protein, is critical, with most coming from fish, white meat, eggs, and some coming from cheese (if tolerated) and legumes. Red or processed meats should be consumed only once or twice weekly. Foods that are not recommended are added sugars, excess salt, and nitrates/nitrites/phosphate additives. Physical Activity Three to four times per week of 30-40 minutes of aerobic and resistance exercises must be performed. The rest of the week can be walking or other low impact activity. Add a walking vest if aerobic and resistance exercise are not possible physically. Dietary Supplements Absorbable calcium (200-800 mg.), vitamin D3, magnesium (2:1 ratio of calcium:magnesium), boron, EPA/DHA omega-3 fish oil, and isoflavones (if tolerated) were recommended. This is just what the study authors recommend based upon their findings and there is much more nuance of course. But if every physician could provide this information to their patients and tweak it based upon individual needs, we would be much better off physically as a society!