Osteoporosis: Are We Starting at the Wrong End?

Introduction

A few days ago, one of my clients sent me an email that finally persuaded me to write about a subject I have deliberately avoided for quite some time.

"Hi Gary I went to a yoga class this morning. After the class the teacher spoke about bone density and the importance of calcium intake and resistance training. With my recent diagnosis of osteoporosis and your interest in this subject I wanted to pass on the information shared. My teacher spoke about the importance of jumping, giving an impact of three times our body weight, and dropping onto the floor from a standing position. I remember from my HTMA I had high calcium levels, but I didn't think this could be calcium leaching from my bones."

Her email mirrors a discussion happening across New Zealand. A growing number of women are being diagnosed with osteopenia or osteoporosis, frequently after undergoing routine bone density scans. Rather than receiving excellent exercise guidance, like that provided by this yoga instructor, they are often being urged, firstly, to take medications intended to suppress normal bone remodeling. Although these drugs certainly have their place in specific situations, such as bone cancer, I am increasingly worried that, in many instances, we are starting treatment from the wrong perspective.

Over the past year, I've encountered a surprising number of women who have left their doctor's office feeling anxious about what lies ahead. Some have sat in front of me, tears streaming down their faces as they share this alarming diagnosis. They envision curved spines, fractured hips, reduced height, and a gradual loss of independence. This reaction is completely understandable. None of us wants to be told that our bones might be weakening, and they need regular infusions of a drug. My concern, however, is that the discussion often shifts too quickly to medication, without adequately addressing the underlying causes of the bone weakness.

Perhaps that reflects the way modern medicine works. We identify a problem, classify it, prescribe a treatment and then monitor the result. There is certainly logic in that approach, and it has produced extraordinary advances in many areas of medicine. However, when it comes to healthy ageing, I have always believed that our first responsibility is to understand why the body has changed before trying to override those changes with powerful pharmaceuticals, that come with a long list of side effects, often more terrifying than the condition it is intended to treat.

I remember the often-quoted humorous remark by medical conference presenters, meant to add some humor to an otherwise dull slide presentation I attended: "The treatment was a success; however, the patient died". This always drew laughter from the audience because of the uncomfortable truth it highlighted. Although her bone density might have improved, she ultimately succumbed to heart failure. I would like to point out that a scan showing low bone density is not a reliable predictor of fracture risk. More accurate predictors include assessments of strength, balance, and even the medications they may be taking, such as those for blood pressure.

The treatment was a success; however, the patient died

The Remarkable Dynamic Architecture of Living Bone

One of the greatest misunderstandings about osteoporosis is that bone is often thought of as a lifeless scaffold holding the body together. In reality, healthy bone is one of the most dynamic tissues in the human body. Every day of our lives it is quietly removing old material and replacing it with new. Every walk, every climb up the stairs, every shopping bag we carry, every session in the garden and every resistance exercise session sends messages to the skeleton about where reinforcement is needed.

Bone density is just one aspect to consider. Unlike a piece of classroom chalk, bone is a complex, living tissue. Simply taking medication that makes bone resemble chalk doesn't necessarily make it stronger. Bone has a triangulated structure and is continuously remodeled to adjust to the various stresses and strains of an active lifestyle.

This continual renewal and adaptation depends upon two remarkable groups of cells working together. The osteoclasts remove tiny areas of old or damaged bone that have reached the end of their useful life. Once their work is complete, another group of cells known as osteoblasts move in behind them, laying down fresh collagen before minerals are deposited to rebuild the internal structure. This process, known as bone remodelling, allows the skeleton to remain strong while continually adapting to the demands we place upon it.

Drugs used to treat osteoporosis work principally by suppressing the activity of the osteoclasts. Less old bone is removed, so bone mineral density often increases when measured by a DEXA scan. At first glance that sounds entirely sensible. The important question, however, is whether increasing bone density is necessarily the same as improving bone strength. Engineers have long understood that strength depends not simply on the amount of material in a structure but on the way that material is arranged. Healthy bone follows exactly the same engineering principles.

In this series of articles, I will publish one discussing the details of DEXA scans and share my perspective on their effectiveness in preventing bone loss.

One of the reasons I became interested in Hair Tissue Mineral Analysis more than thirty years ago is that it often encourages us to question convenient cookie-cutter - one-size-fits-all remedies that may not be the best for this, or that individual. I often say:

Although we are all alike, each of us is unique in our own special ways!

The chart from the female client who wrote the email above is typical of what I see in practice. Calcium is elevated compared with many of the other minerals, and magnesium is also relatively high. To many people this appears to suggest an abundance of calcium. My interpretation is often quite different.

When I observe this pattern, especially in conjunction with the individual's symptoms and health history, I start considering calcium metabolism rather than calcium intake. In my experience, this pattern appears in about eighty percent of the women I evaluate and in roughly sixty percent of the men. The HTMA chart does not diagnose osteoporosis, nor does it confirm that calcium has shifted from bone to soft tissues. Instead, it prompts me to question whether calcium is being effectively managed within the body or if its regulation has been disrupted over many years. After reviewing a thousand or more similar HTMA results and health histories, these patterns become compelling to me as an observer.

Bone is More Than Calcium - Chalk

Healthy bone requires much more than calcium alone. Bone is built upon a protein framework known as collagen. This is why we have additional collagen in my super smoothie formulation. Bone health relies on sufficient protein, healthy fats, and vitamins A, D, and K, along with magnesium, boron, zinc, manganese, and various other nutrients working in unison. Additionally, it needs muscles to consistently exert force on the bones and resistance to gravity to signal the skeleton's necessity. Without these components, merely boosting calcium intake is unlikely to address the root issue.

This is why I feel uneasy when the initial recommendation following an osteoporosis diagnosis is a medication designed to prevent normal bone remodeling. My inclination is to ask a different set of questions. Is this woman getting enough protein, fat, and collagen in her diet? What about her consumption of fat-soluble vitamins? Is she participating in regular resistance training? Has she experienced any muscle loss? Is she spending time outdoors in the sunlight? Could medications, hormonal changes, chronic inflammation, or nutritional deficiencies be contributing to the problem? Until we explore these questions, I believe we risk treating the symptom rather than the root cause. It is also crucial to examine her fracture history: does she have a history of fractures from minor incidents or spontaneous ones? I might ask a woman who tearfully tells me she has been diagnosed with osteoporosis, "Have you been breaking bones recently?"

That is not to suggest that these medicines have no place. They undoubtedly do. There are people with severe osteoporosis and exceptionally high fracture risk for whom they may represent an appropriate option after careful discussion of both benefits and risks. My concern is simply that treatments designed to suppress normal bone remodelling appear, in my opinion, to be moving closer to the beginning of the treatment pathway rather than remaining a carefully considered option after every reasonable effort has been made to strengthen the body naturally. I would add that what Natural Health Practitioners like myself are pushing back against is the pressure on us all to reach first for the easy, convenient, quick fix. Whereas degenerative diseases associated with diet, lifestyle, and aging, and also long-term use of medications such as for blood pressure or reflux, are quick fixes.

Bone-Sparing Drugs

Like every medicine, drugs that suppress bone remodelling are not without recognised risks. Over the years there have been reports of uncommon but serious complications, including unusual fractures of the thigh bone and osteonecrosis of the jaw, a condition in which areas of jaw bone fail to heal properly. These complications remind us that interfering with one of the body's natural repair systems deserves careful thought. Once treatment has begun, particularly with long-acting preparations, the biological effects may persist for years.

The half-life of these drugs is estimated to be five years, meaning it can take up to 10 years for them to be completely eliminated from one's body.

My own thinking on this subject has also been influenced by many years of correspondence with an American lawyer whose firm represented thousands of women alleging serious injuries associated with these medicines. A lawsuit is not proof that every allegation is correct, and court proceedings are no substitute for good science. Nevertheless, when large numbers of people independently report similar experiences, I believe they deserve to be listened to carefully rather than dismissed out of hand. History has taught us more than once that the full safety profile of a medicine often takes many years to emerge.

In Conculsion

Ultimately, my greatest concern is not the medicine itself. It is the possibility that we may overlook the remarkable capacity of the human body to repair and strengthen itself when given the opportunity. Good nutrition, adequate protein, progressive resistance exercise, healthy muscles, sensible sunlight exposure, good balance and an active lifestyle all contribute to stronger bones and, perhaps even more importantly, to stronger people. Preventing falls may save more lives than increasing bone density alone.

After more than fifty years working in rehabilitation and healthy ageing, I remain convinced that the first question should never be, "Which drug should we prescribe?" The first question should always be, "Why has this person's skeleton become weaker?" If we can answer that question, we have already taken the first step towards helping the body do what it has been doing remarkably well for millions of years: building and rebuilding healthy bone.

In my next article I will examine why so many women I test have elevated calcium on Hair Tissue Mineral Analysis and why this pattern may tell us much more about calcium metabolism than simply how much calcium they consume.

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Medical Disclaimer

The information in this article is provided for educational purposes only and is intended to encourage informed discussion about health, nutrition, exercise, and healthy ageing. It is not intended to diagnose, treat, cure, or prevent any disease, nor should it be regarded as a substitute for personalised medical advice.

The views expressed are based on current scientific evidence, professional training, clinical experience, and practical observation accumulated over many years. As research continues to evolve, recommendations and understanding may also change.

Every person is unique. Before making significant changes to your diet, exercise programme, medications, nutritional supplements, or other aspects of your healthcare, consult an appropriately qualified healthcare practitioner who is familiar with your individual circumstances.

If you have a medical condition, are pregnant or breastfeeding, are taking prescription medication, or are under the care of a healthcare professional, seek their advice before implementing any recommendations discussed in this article.

My aim is not to replace your healthcare team, but to help you ask better questions, make more informed decisions, and create the conditions that support lifelong health, resilience, and healthy ageing.