The American College of Physicians have new guidelines out for osteoporosis treatment. I believe these guidelines are flawed and do not deal with the real cause of osteoporosis. These guidelines basically promote using medications over anything else. The cause of osteoporosis is not a lack of bisphosphonate in our system it is largely due to the bodies natural physiological function. What stimulates bone to get stronger is the same stimulus that causes muscles to get stronger, loading. If you load your body regularly, through strength training, both your muscle and bone tissue will get stronger. If you fail to stimulate your body to build more muscles and bone these tissues will atrophy with time resulting in muscle and bone weakness. Now there are other pathological conditions that cause low bone mineral density but those are outliers and average patient with osteoporosis has it because they have not kept up with strength training.
These guidelines recommend the use of one of the three main bisphosphonate drugs on the market or denosumab for five years. They also recommend that no monitoring of bone density needs to be done for those five years of treatment. In other words take the drugs but don’t measure their effect on bone density. These guidelines do not recommend using hormone replacement therapy (HRT) medications to manage bone density due to the lack of evidence supporting their effectiveness. In reading a review of this guideline I noticed that researches in HRT actually say that HRT is safe and effective for osteoporosis in women under 60 or within ten years of menopause. These researchers agree that HRT is unsafe to treat osteoporosis for women over 60. The guidelines also say that there is not enough evidence to support the use of calcium, Vitamin D, and physical exercise alone to treat osteoporosis. WOW!!!!!
I’ve got many problems with these guidelines but lets start at what is probably my biggest problem. The author of these guidelines disclosed he receives research funding from Eli Lilly and Amgen and also consults for Eli Lilly, Merck, and Amgen. I know that we shouldn’t necessarily throw out the opinion and expertise of people with affiliations like this guy but with these guidelines I don’t think it is improper to question his motives. An author who receives funding from drug manufactures and consults for them, writes guidelines that promote drug therapies and downplays all other forms of treatment. These guidelines basically say only the drugs are appropriate treatment for osteoporosis, which is complete bull. This is what your doctor is hearing and probably why Sherry’s doctor was confused as to why she improved from osteoporosis to osteopenia, she was not taking the drugs but got better.
The recommendations for monitoring bone density are ridiculous. The DEXA scan is flawed but it is the best thing we have to measure bone mineral density at this moment. If that measurement was the basis for your physician to recommend drug therapy wouldn’t it be smart to measure how well that was working. To recommend to stop measuring bone density for the five years of treatment is ridiculous. How do you know if it is working or not? I have seen a lot of DEXA scans over the past years and what I noticed is that patients who are on these medications for osteoporosis don’t always show consistent gains in bone density. In fact a few years ago I heard a physician say that a positive outcome in treating bone density with medications is for the patient to have no change in bone density. That means that you are two years older but not getting any worse, that is a positive outcome. My guess is that the recommendation to discontinue DEXA scans is because they know the drug doesn’t show consistent gain and trying to explain that to a patient and then keep them on the drugs is hard to do. To avoid that discussion and keep the patient on the drug I guess their answer is to discontinue measuring bone density.
I can go on but what really made me angry was their recommendation that physical exercise was not effective. That is complete bull. The basic human physiology of bone is that bone tissue responds to loading by increasing it’s strength. This is called Wolf’s Law, a theory becomes scientific fact (a Law) through rigid scientific examination. These guidelines ignore the normal human physiology of bone, and they have to in order to claim physical exercise is not effective. The right amount of strength or resistance exercise will result in an increase in bone density as well as muscular strength. Our BStrong4Life program is the perfect program to get this done and we have the results to show for it.
These recommendations are complete crap and only promote the sale of medications not the health and welfare of the patient population at risk for a osteoporosis related fracture. They say nothing about taking into account the patients health history or FRAX score. The FRAX score takes into account the DEXA score along with other factors to come up with the patients fracture risk. This is what we treat for, the fracture risk not the DEXA score alone. As far as I am concerned this guideline appears to be an attempt by the drug manufactures to ensure their products continue to find a market. In some cases I do believe that drug therapy might be warranted but those patients are the outliers not the norm. The average patient would fare best with an effective physical exercise program that includes effective strength training like our BStrong4Life program. You beat osteoporosis by improving your strength, flexibility, and balance not by taking these medications.