Thomson Healthcare, Inc.
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 In a larger study, concurrent administration of oral vitamin D3 and calcium reduced the incidence of nonvertebral fractures and hip fractures and increased bone density of the total proximal femoral region in elderly women (mean age 84 years). Compared with the placebo group (n=888), the treated women (n=877) had 32% fewer nonvertebral fractures and 43% fewer hip fractures. Eighteen months of treatment resulted in an increase of 2.7% in bone density of the total proximal femoral region compared with a decrease of 4.6% in the placebo group (p<0.001). |
Bottom Line Health
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| While their rate of hip fractures is lower than in the US, the Japanese have twice the rate of vertebral fractures. The difference in hip fractures is probably due to a difference in anatomy, which makes the hip less likely to break on impact.
Other evidence suggests that isoflavones do promote bone strength. The US Department of Agriculture (USDA) and the National Institutes of Health (NIH) are currently allotting significant resources—approximately $10 million—for studies to determine whether isoflavones play a role in bone health.
•Breast cancer. |
Abram Hoffer, PhD, MD, FRCP(C) and Dr. Jonathan Prousjy, DPHE, DSC, ND, FRSH
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 In another study, these two supplements decreased non-vertebral fractures by 32% and hip fractures by 43%. A 20% reduction in hip fractures in United States would prevent about 45,000 hip fractures and save about $1.5 billion dollars in health costs.
Dr A.R. Gaby and Dr J.V. Wright, in their book Nutrients and Bone Health, describe the following compounds that can be used in treating osteoporosis:
1. Estrogens and calcium. These are only partially helpful. Estrogen in the context of hormone replacement therapy has been shown to have too many risks (e.g. |
Tori Hudson, N.D.
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 Osteoporosis-related fractures will develop in half of all women and one-fifth of all men older than 65 years.11 hip fractures, with a median age of 82, are particularly life altering. Within the first year following a hip fracture, the mortality rate is increased by up to 20 percent, as many as 25 percent of the survivors will be confined to long-term care facilities one year after the fracture, and 50 percent will have at least some long-term loss of mobility.12
Vertebral fractures (fractures of spinal vertebrae) occur a little younger, on average in a woman's mid-70s. |
| Women with a family history of osteoporosis, and especially hip fractures, are at the highest risk of developing the condition. Eighty to ninety percent of the determination of the development of osteoporosis is a family history of osteoporosis.
• Fracture risk can be determined from a medical history, physical exam, laboratory testing, and a DXA bone density test. or have eating disorders are susceptible to insufficient intake of vitamins and minerals and therefore may have insufficient bone mass. |
Mehmet C. Oz., M.D. and Michael F. Roizen, M.D.
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 Those who are deficient in vitamin K have been shown to have a 30 percent higher risk of hip fractures than those with higher intakes. A relative of coenzyme Q10, K2 can be found in something called natto-a Japanese fermented soybean dish. (Samurai warriors would eat natto to increase their strength and quicken their reflexes.) K2 can also be found in low-fat cottage cheese, chicken, and certain cheeses. It doesn't come from milk and isn't found in yogurt, as it's a waste product of bacteria that ferment milk into cheese.
YOU Tip: Beware of the Supermodel Diet. What's that? |
Michael Friedman, ND
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 In the United States, more than 300,000 hip fractures occur each year due to osteoporosis.72 Half of the patients with hip fractures cannot walk independently afterward, frequently developing other complications, such as pneumonia or blood clots. Other metabolic bone and joint diseases and disorders (osteoarthritis, rheumatoid arthritis, cancer, endocrine disorders, Paget's disease, and amenorrhea) account for an additional 12 million cases of accelerated bone loss per year. |
| They called gonadal deficiency "an important and heretofore understudied" factor predisposing men to increased hip fractures, and concluded that "prevention of hip fractures in men may involve early recognition and treatment of testosterone deficiency."24
Numerous studies consistently show that long-term testosterone replacement therapy to combat hypogonadism improves bone mineral density and reduces bone turnover. |
Tori Hudson, N.D.
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| So, when women choose not to take estrogen after menopause, they are more likely to lose trabecular bone and therefore may be at higher risk for vertebral and hip fractures. Cortical bone loss occurs with calcium and vitamin D abnormalities such as vitamin D deficiency and leads to an increased risk of extremity fractures. An extreme form of this is rickets, which presents with bowing of the femurs that results from small microfractures of those bones. |
Abram Hoffer, PhD, MD, FRCP(C) and Dr. Jonathan Prousjy, DPHE, DSC, ND, FRSH
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| A 20% reduction in hip fractures in United States would prevent about 45,000 hip fractures and save about $1.5 billion dollars in health costs.
Dr A.R. Gaby and Dr J.V. Wright, in their book Nutrients and Bone Health, describe the following compounds that can be used in treating osteoporosis:
1. Estrogens and calcium. These are only partially helpful. Estrogen in the context of hormone replacement therapy has been shown to have too many risks (e.g., stroke, blood clots, breast cancer) and is becoming a less than desirable option for post-menopausal women.
2. A naturopathic diet. |
Tori Hudson, N.D.
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| Vertebral fractures are twice as common as either hip fractures or distal radius (wrist) fractures. The incidence of wrist fractures starts to rise immediately after menopause, with an incidence of about 15 percent by age 80, but a peak incidence about 20 to 25 years sooner. Each year, 172,000 wrist fractures occur that are the result of moderate trauma and rapid postmenopausal bone loss. The female to male ratio is 5:1. Wrist fractures are rarely fatal and cause much less disability than do hip and spinal fractures. |
Abram Hoffer, PhD, MD, FRCP(C) and Dr. Jonathan Prousjy, DPHE, DSC, ND, FRSH
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| A 20% reduction in hip fractures in United States would prevent about 45,000 hip fractures and save about $1.5 billion dollars in health costs.
Dr A.R. Gaby and Dr J.V. Wright, in their book Nutrients and Bone Health, describe the following compounds that can be used in treating osteoporosis:
1. Estrogens and calcium. These are only partially helpful. Estrogen in the context of hormone replacement therapy has been shown to have too many risks (e.g., stroke, blood clots, breast cancer) and is becoming a less than desirable option for post-menopausal women.
2. A naturopathic diet. |
Andreas Moritz
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 Thus, these drugs can be considered a major risk of dizziness and falling, and therefore, bone and hip fractures among senior citizens. In 1994, the British Medical Journal published a study showing that diuretics (drugs used to lower blood pressure) cause an 11-fold increase in diabetes. As reported in the Journal of the American Medical Association in 1993, ACE inhibitors (a group of pharmaceuticals that are used primarily in treatment of hypertension and congestive heart failure) can cause potentially fatal kidney damage and even death, if they are given too soon after a heart attack. |
| The Bone-Building Power of Brussels Sprouts
By age 70, one of every two women in the United States will likely suffer a painful fracture due to weak bones. hip fractures are often fatal. But, a recent woman's study shows that by eating a 3-ounce serving of Brussels sprouts several times a week, women can slash the risk of a hip fracture by 30 percent. In addition, phytochemicals found in Brussels sprouts enhance the activity of the body's natural defense systems to protect against disease, including cancer. |
Bill Sardi
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 Osteoporosis International 16: 713-16, 2005] Intake of less than 800 IU vitamin D per day has never been shown to prevent hip fractures. [Annals Medicine 37:278-85, 2005]
1,000 IU (30-45 nanograms/liter blood concentration)
Minimum blood concentration required to prevent cancer
2,000 IU (50 micrograms/day)
Safe upper limit established by National Academy of Sciences. 2000 IU of vitamin D3 has been shown to reduce or stabilize PSA in some prostate cancer patients. |
Michael Friedman, ND
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| They called gonadal deficiency "an important and heretofore understudied" factor predisposing men to increased hip fractures, and concluded that "prevention of hip fractures in men may involve early recognition and treatment of testosterone deficiency."24
Numerous studies consistently show that long-term testosterone replacement therapy to combat hypogonadism improves bone mineral density and reduces bone turnover. |
Bottom Line Health
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| John Hathcock
The news did look slightly better for women older than 60, who had a 21% reduction in hip fractures. Calcium plus vitamin D "looked more effective in women over 60 who adhered to the study medication," LaCroix says.
LOOKING AT THE RESULTS
The results were not surprising, say some experts. "The study looked at a large number of postmenopausal women who weren't specifically selected to be at risk for fractures, so the deck was largely stacked against the study," says Dr. Joel Finkelstein, an endocrinologist at Massachusetts General Hospital in Boston. |
Tori Hudson, N.D.
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| More recently, the NoNOF study of survivors of hip fractures demonstrated that vitamin D supplementation, either orally or by injection, suppresses parathyroid hormone, increases bone mineral density, and reduces falls.82 The effects were more marked with cosupple-menting with 1,000 mg of calcium per day.
Perhaps the most compelling study is a metaanalysis of randomized clinical trials in postmenopausal women with a mean age of 71 to 85, which found that 700 to 800 IU per day of vitamin D was associated with significant reduction in hip and wrist fractures83; 400 IU per day had no effect. |
Abram Hoffer, PhD, MD, FRCP(C) and Dr. Jonathan Prousjy, DPHE, DSC, ND, FRSH
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| A 2004 report in Nutrition Reviews speculated that long-term consumption of diets high in vitamin A stimulates bone resorption and inhibits bone formation, and may contribute to osteoporosis and hip fractures. This report caused many patients to discontinue supplementation with vitamin A. These concerns turned out to be unfounded. In a very large 2004 cohort study published in Osteoporosis International, 34,703 postmenopausal women were followed prospectively to determine if their supplemental vitamin A and dietary intakes were associated with increased hip fractures or all fractures. |
Shannon Brownlee
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 Wennberg's group looked at rates of heart attacks, strokes, hip fractures, cancer, and bleeding in the stomach in order to measure whether level of illness could account for how much care people got. There were differences, but they were slight. The elderly in Birmingham, Alabama, for instance, were less healthy on average than those living in Palm Springs, California, largely because the residents of Birmingham were poorer. But rates of illness had little to do with rates of medical care in Palm Springs and Birmingham, or with how much Medicare spent. |
| White marbles, which represent the sickest patients, with conditions like heart attacks, strokes, and hip fractures, are always put on the shelf, which represents a hospital bed. Black marbles, which stand for the patients with mild complaints like colds and twisted ankles, are never put on the shelf. Gray marbles are the patients with serious but not necessarily life-threatening ailments, like pneumonia or gallstones, or chronic conditions like hernias, congestive heart failure, and angina. It is the decisions about these kinds of cases, the gray middle ground, that get doctors into trouble. |
| A study performed for the Medicare Payment Advisory Commission, for example, found that patients suffering from heart attacks, hip fractures, and colon cancer did not benefit from more imaging tests.
To make matters worse, simply tracking the spiraling bills we're paying for all that imaging fails to capture its true cost. Many imaging tests lead to further testing and treatment, whose price isn't included when economists look at the amount we spend on CT and other imaging. Take the sixty-four-slice scanners that hospitals are snapping up as fast as they can. |
| Remember back to chapter 2, where Elliott Fisher showed that hospitals with a high ratio of specialists to primary care physicians did more procedures and tests on his three groups of patients suffering from colon cancer, heart attacks, and hip fractures. And in chapter 4, dying patients who landed in hospitals in Los Angeles that invested in more specialists than primary care physicians, bought more CT scanners and MRI machines, and had more ICU beds, were no better off for all the unnecessary time spent in the hospital and all the extra specialists they saw. |
Thomson Healthcare, Inc.
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| Compared with the placebo group (n=888), the treated women (n=877) had 32% fewer nonvertebral fractures and 43% fewer hip fractures. Eighteen months of treatment resulted in an increase of 2.7% in bone density of the total proximal femoral region compared with a decrease of 4.6% in the placebo group (p<0.001). The dosage of vitamin D3 was 20 meg (800 IU)/day and elemental calcium was 1.2 g/day (Chapuy et al 1992). |
| Chapuy MC, Arlot ME, Duboeuf F et al: Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med; 327(23):1637-1642. 1992
Cher DJ: Dietary calcium and blood pressure (letter). JAMA; 126(6):492. 1997
Dawson-Hughes B, Harris SS, Krall EA et al: Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med; 337(10):670-676. 1997
Denke MA, Fox MM, Schulte MC: Short-term dietary calcium fortification increases fecal saturated fat content and reduces serum lipids in mm. J Nutr; 123(6): 1047-1053. |
John J. Ratey, MD
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 Although heart disease, cancer, stroke, and diabetes are the leading causes of death for Americans over age sixty-five, many of them live in fear of falling and breaking their brittle bones. hip fractures are particularly devastating because they require months to rehabilitate, and losing mobility in such a pivotal, weight-bearing joint can dramatically reduce a person's activity level. About 20 percent of older adults who break a hip die within a year. |
| More women every year die from hip fractures — a vulnerability of osteoporosis — than from breast cancer. Women reach peak bone mass at around thirty, and after that they lose about 1 percent a year until menopause, when the pace doubles. The result is that by age sixty, about 30 percent of a woman's bone mass has disappeared. Unless, that is, she takes calcium and vitamin D (which comes free with ten minutes of morning sun a day) and does some form of exercise or strength training to stress the bones. Walking doesn't quite do the job—save that for later in life. |
Steven V. Joyal
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 The WHI study results included evidence of an increase in the risk for breast cancer and heart disease, yet reduced the risk of hip fractures and colorectal cancer. One reason for the results in the WHI trial is the use of synthetic progestogens rather than natural progesterone.
LOW TESTOSTERONE IS COMMON IN DIABETIC MEN
A study in the November 2004 issue of the Journal of Clinical Endocrinology and Metabolism revealed that one out of three diabetic men have low testosterone levels. |
Jack Challem
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 People who use Prilosec, Nexium, and other types of acid-reducing drugs are more likely to experience hip fractures. The risk is significant—almost a 50 percent increase of hip fracture after one year, and two and one-half times greater risk of fracture after long-term use of the drug.
Normally, the acid environment of the stomach helps to break food down for further digestion. Throughout the digestive tract, hundreds of species of good bacteria also help to break down food, enhance immune function, and protect us from infection. |
Jonny Bowden, Ph.D., C.N.S.
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 The Framingham Heart Study, for example, found that people who consumed approximately 250 meg of vitamin K a day had a 35 percent lower risk of hip fractures compared to those who consumed just 50 meg a day. True, you'd have to consume 10 cups of arugula to get that much, but still, a few cups in a salad is a good start (33 mg).
And besides, that's hopefully not your only source of vitamin K.
The arugula plant, like many others in the cruciferous family, contains glucosinolates. |
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