Osteoporosis: The modern plague


First of three parts

When I was a medical student, the only treatment for a badly shattered hip was bed rest in some sort of traction. This futile therapy in an elderly patient -- almost always female -- nearly always resulted in wasting, pressure ulcers or bed sores with infection, severe muscle loss, generalized weakening, and, finally, pneumonia and death.

The development of surgery that at first inserted metal devices in the fracture area and, much later, replaced the entire hip joint, has reversed the situation entirely. The hip replacement operation ranks as the finest achievement of modern surgery. Other operations are more expensive, glamorous, and headline-grabbing, but none saves lives more effectively and consistently than modern hip replacement surgery.

Now, most of the victims of major hip fractures survive, whereas previously most died. But they survive at a great cost -- a cost to the country in dollars and a cost to the patient in suffering and debility.

Is osteoporosis the worst disease facing American women today? It just may be. It depends on how you do the figuring. If you count the total number of women involved, osteoporosis heads the list. There is no doubt about it. No other major disease can claim so many victims. Some researchers claim that half of all American women over 50 years of age have osteoporosis.

Osteoporosis produces a wide variety of disorders. They range from minor symptoms, such as mild backache, to more serious problems such as curvature of the spine with height loss, repeated fractures of the back bones (vertebrae) with additional loss of height, and, finally, that most devastating fracture -- fracture of the hip.

The conventional view of osteoporosis is that it is a disease of older women, usually white or Asian, who haven't taken in enough calcium, who are not exercising, and who have neglected their hormone replacement therapy. Current medical testing tells us that bone loss is the inevitable result of aging, that calcium intake (especially from dairy products) is critical, that estrogen is needed during and after menopause, and that weight-bearing exercise may be of use.

Of course, we all understand that the situation is much more complicated than this. Some 25 or 30 additional factors, ranging from aluminum ingestion to the phosphoric acid in soft drinks, play a role in the onset of osteoporosis, but none of these is of major importance when compared to the "big three": calcium, estrogen, and exercise.

Does this correspond to your understanding of the problem? If it does, you are in the good company of nearly all American women and their physicians.

I would like to challenge this belief by asserting that -- with the exception of exercise -- not much of the standard advice listed above is helpful. To be sure, calcium and estrogen deficiencies are not trivial matters. They are contributing factors in osteoporosis causation, but they are not the main determinants of the disease.

When we are confused about issues of human health, one useful approach is to consider the health of our ancient ancestors, and next to look at groups of contemporary humans in societies other than our own. This allows us to see where we came from, whether osteoporosis is part of our natural, biological inheritance, and to note what happens when humans live differently from ourselves.

Here is one thing that we know for sure about our distant ancestors: Paleolithic men and women had robust, strong bones. It is equally certain that they did not have estrogen supplements, calcium pills, or dairy products. Their :fossil remains clearly show strong teeth as well as strong bones. (Only 2 percent of fossil teeth from the Late Paleolithic period show evidence of tooth decay, and even this is minor. In the pre-modern dental era, the incidence of decay was 70 percent.)

More to the point, the skeletal remains of Paleolithic humans indicate great strength. This is deduced from the highly tufted and large bony insertions for the muscles. The bones themselves are sturdy and dense, showing no evidence of osteoporosis despite their antiquity. So much for osteoporosis in Paleolithic times. It didn't exist.

We don't have to go that far back in time to learn that the bones of English people living in the 1600s were also far stronger than the bones of contemporary English folk. Recently, when a certain church burial vault required relocating, the bones were studied for density before they were re-interred. it was found that the bones of persons who lived in that era were far stronger and denser than those of modern English folk.

Looking at cultures other than our own in today's world is even more instructive. Stated simply, there is very little serious osteoporosis in most of the world. It is found almost entirely in industrialized, Westernized societies, such as the United States, Canada, the United Kingdom, Australia, and Europe.

But most of the rest of the world is nearly devoid of widespread and serious osteoporosis. These are the areas with the largest populations, among them most of Asia, Africa, much of South America, and any other place with little modernization or Westernization. The only notable exception is in the Arctic, where the Eskimo has been plagued with severe osteoporosis for centuries.

An even simpler way to look at the situation is to imagine a map of the world with the low incidence areas for osteoporosis colored bright red. Then picture areas of the world where there is large scale usage of dairy products and estrogen therapy for women. Color these areas blue. You will find your map completely colored, red or blue, with no overlap. In other words, the extensive use of dairy products and estrogen supplementation in the world -- today -- does not prevent osteoporosis. One could logically wonder whether one or the other, or even both, could be involved in actually causing osteoporosis!

As it turns out, one is and the other isn't.

See the next issue of Nutrition Health Review for part 2 of Dr. Kradjian's series on osteoporosis: "Calcium Matters -- But How?"

PHOTO (BLACK & WHITE): Robert M. Kradjian



By Robert M. Kradjian, M.D.

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