The other day I received an email from my sister; she was telling me about the Reclast Infusion that her physician recommended for her. She read the list of side affects and because she feels fine, she’s a little ‘freaked out’ about the list. Note: If you don’t like to use a list published by the maker of the drug, you can go to WebMD’s list. That is a formidable list! Since October 2010, Canadian regulations required Novartis to warn physicians about the danger of kidney failure, dialysis and even death; but it was not required in the U.S.

If you’re like my sister, and me, you want to preserve whatever health you have. I feel entitled in being a little frightened – or at least cautious, before just saying ‘yes’ to using a fairly new drug without asking some serious questions.

One of the reasons that this new drug was developed was because of non- compliance or poor-compliance with dosages for current treatments. I admittedly am one of those patients. I was diagnosed with osteoporosis about 10 years ago. Genetically, I was dealt that problem. I’m not alone; osteoporosis is a huge problem in our country – small-boned white post-menopausal women are the number one afflicted group. My bone mass was actually improving using Fosamax for a few years, but then I had to go off Fosamax for 6 months for a dental procedure. That was where things turned around – I got out of the habit of taking the medication. This past fall I got the bad news – my osteoporosis had turned around in a negative direction.

I, too, was offered the annual dose, but because I have serious concerns about the medication, I choose not to take an annual dose. Now after reading more about it for my sister, I have even more serious ‘concerns’ – O.K. call them fears. I’m not a chemist or pharmacist, but it just seems logical to me that taking a small dose would be less challenging for the body than a big ol’ annual dose. So I’m back to taking my meds every other week – I’ll see the results in about 6 more months. (Please note: This information is intended as supplemental and is not intended to be substituted for the judgment of your physician. It is given in the spirit of the research that shows that patients who take charge of their own care, evaluating carefully what good physicians recommend, usually do better over time.)

My sister said that she is considering taking supplements of vitamin D and calcium. I reminded her of her 1982 week in an intensive care unit with pyelonephritis that almost took her life - resulting from taking calcium supplements. The calcium supplements caused kidney stones, which blocked ducts and caused a horrible septicemia. I, myself, have not forgotten the 6 hours of pain that I suffered in an intensive care unit, a few months before my sister’s ordeal. Finally, they found that it was kidney stones. One of my visiting professors in my master’s program suggested that because of my very small wrists, that I should take calcium supplements. It was only a few months later when the kidney stone/emergency room episode happened.

My sister’s note has reminded me that there is a serious problem of bone mass. Some of us are genetically pre-disposed and others make life-style errors that lead to the same outcome. Can we solve all our problems with one easy annual infusion? I really don’t know, but I do know that there are some things that can be done that are a little less risky.

First, let’s be clear about when to start. Most of the bone mass is laid down in the teen years. So if you are a teen (fairly unlikely that a teen would be reading a nutrition blog) or your daughter is a teen, be sure to realize that you acquire 85% of your bone mass by 18 years old. So the bottom line is: DON’T WAIT! Begin doing what you can as soon as you can. Thirty is better than 60 or 70.

Osteoporosis is not just the inconvenience of being stooped over – looking at the ground, instead of looking forward. It can be very painful and about a fourth of patients that break their hip, die within a year after the break. It’s a very serious problem. What can we do?

Sometimes we have to use supplements and strong medications to help us be well or to keep us as well as possible; but relying on medications and supplements as our first line of defense seems unwise. If there are kinder, gentler technique of getting our nutrients from food or eating, and doing adequate weight-bearing exercise in a manner that is protective of our bone mass, for example, it seem judicious to consider using these life-style techniques in the first place and then, if necessary, adding the powerful meds and supplements.

Include high calcium foods:

• Dairy products [yogurt (non-fat or low fat), milk (non-fat or low fat)]
• Canned fish like sardines and salmon (with bones)
• Soy foods like tofu
• High intake of fruits and vegetables is linked with bone health. Look especially for greens like collard greens, kale, Chinese cabbage, mustard greens, turnip greens, and broccoli.

Protein – get enough, but not too much

• Legumes and peas are good protein sources. Too much protein, especially animal protein in the diet can cause the body to lose calcium.

Alcohol

• Heavy drinking of alcohol can lead to bone loss. Two alcoholic drinks a day for a man or one for a woman should be the max to protect bone.

Coffee, tea and soft drinks (caffeine and phosphorus containing drinks)

• Caffeine may decrease calcium absorption. As related to soft drinks, the caffeine and phosphorous in cola drinks seem to be culprits in bone loss.

Salt/sodium

• Too much salt (sodium) causes your body to lose calcium and can contribute to bone loss.

Foods with vitamin D

• Fatty fish like salmon, mackerel, tuna and sardines; vitamin D is involved in putting calcium into your bone.

Smoking

• Smoking increases the rate of bone thinning after it starts – don’t smoke (ever).

Exercise

• Weight-bearing exercise (walking, gardening, lifting weights) helps the minerals be deposited in the bone.

Most of us now know that it is essential that we get enough calcium and vitamin D for bone health, if we want to avoid or slow osteoporosis. One of the ways to ‘accomplish the goal’ of getting enough calcium and vitamin D is to pop a daily supplement and call it good. But as the story of both my sister and me with calcium supplements, there may be serious side effects from supplements too.  It is often better to get calcium and other needed nutrients from real, whole foods rather than from taking supplements.

Be careful. Be aware of the research; also, realize that ‘more may not be better’

A report at the end of last year from the Institute of Medicine (IOM) on vitamin D and calcium and the new reference values were based upon on much more information and higher-quality studies than were available when the values were first set in 1997. The IOM report increased the vitamin D recommendation from 200 International Units to 600 IUs (for infants through adults) and 800 IUs after age 71. The IOM panel dismissed concerns that many Americans and Canadians are vitamin D deficient. The panel concluded that for 97% of the population, a blood level of 20 nanograms of vitamin D per milliliter is sufficient. The problem is that many physicians are prescribing far, far more that these recommended amounts. The IOM report shares evidence that suggests that high levels of vitamin D can increase the risks for fractures, overall death rate and can raise the risk for other diseases; the risks are important when there is no demonstrable benefit of taking extra. In addition to the risk of kidney and heart damage reported with the vitamin D levels of 10,000 IUs per day, Dr. Patsy Brannon of Cornell said the panel had seen higher death rates from pancreatic cancer, prostate cancer and other causes in men whose blood levels were above 50 ng/ml.

In addition to the new recommendations for vitamin D, the IOM panel also issued new recommendations for daily calcium intake – ranging from 700 mg for children aged 1 to 3 up to 1,200 mg for women 51 and older. The main change from the 1997 recommendations was to lower the recommended level for men 50 to 70 to 1,000 from 1,200. One group that is of special concern is teenage girls – they may not get enough calcium. But taking too much supplemental calcium may be putting persons at risk for kidney stones.

A Swedish study published in the British Medical Journal actually found that extra calcium did not reduce the risk of osteoporosis and did increase the rate of hip fracture – exactly the opposite of the ‘hoped for’ goal.

A study reported in the Journal of the American Medical Association was a comparison of those who took an annual high dose of vitamin D. The idea was to solve the problem of non-compliance in taking vitamin D. Unfortunately, those who were given the high dose vitamin D had a higher rate of falls and more fractures compared with the women who received a placebo. The researchers were perplexed; but Bess Dawson-Hughes, director of the Bone Metabolism Laboratory at the USDA nutrition Center at Tufts University, offered a possible explanation. She said that the body might have responded as if the dose was a toxicity threat. When the body responds in this way, it sets barriers up to avoid absorbing the supplement it regards as toxic. This could explain the higher rate of fractures.

Who should talk to the physicians about taking a vitamin D supplement?

• You should, if you always slather on the sunscreen, even if it’s only going to be 10 minutes in the sun or you cover up with sun protective wear or wear long robes and head coverings.
• You should, if you are homebound, live in a nursing home, or stay inside most of the time.
• If you live in the northern latitudes
• If you have inflammatory bowel disease -- Celiac disease which disturbs your ability to absorb vitamin D.
• If you have very dark skin and you immigrate to northern latitudes, you may not get enough sun, contributing to a diminished vitamin D in blood.
• If you are overweight or obese – about 67% of Americans.
• If you are 50 or older – our ability to make vitamin D is diminished with our aging skin and our kidney may be less able to convert it to the active hormone form.
• If you have osteoporosis or osteopenia.
• Vitamin D is a fat-soluble substance, if you have a medical problem that includes fat malabsorption (pancreatic enzyme deficiency, Crohn's disease, cystic fibrosis, celiac disease, surgical removal of part of the stomach or intestines and some forms of liver disease), you may need supplemental vitamin D.

These reports of risk are ‘challenging the concept that more is better.’ Let’s try a sensible approach. Begin by doing all the gentle suggestions first; beginning with a plant-based diet and weight-bearing exercise. Then, of course, if our situation calls for supplements or medication carefully consider what will support continued health.