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Remember this woman?
We love to shill, shill, shill!
Well they pay her to be a fake, so I guess we can’t get worked up about it. But before you take this woman’s advice and go out and make yourself toxic on bisphonate drugs for the “prevention” of osteoporosis like Fosamax (alendronate), Actonel (risedronate), and Boniva (ibandronate), read some of the comments from readers, the first Gwinn “Junior” Dunham, from back home in Washington State, and the second from Jennifer Schneider MD PhD, who actually wrote a case report based on her own bisphosphonate induced fracture! Here is the email from Junior whose wife was taking Fosamax and who developed the beginning stages of erosive esophagitis, a potentially fatal condition that is a side effect of bisphosphonates [I think when he says calcium he is referring to a bisphosphonate]…
Hey DougHow kind of you to reply with an e-mail message.I am SO GLAD your father told me about your book some months back. I bought it but it just sat around not being read. I guess at age 75 it is not always easy to sit down and concentrate by reading technical information.I have always felt it is best NOT to take medicine unless it is really needed.Joy had been taking the calcium pill once a week for a couple years. I had concerns about it right from the start as she was NOT to lie down but stay upright for at least 30 minutes. I kept thinking that it cannot be good for the stomach if it is bad for the throat.
Then she started taking TOO MANY tums and I thought something was going on in her system. Seemed like she began to have trouble swallowing this past month.I told her it had to be related to the medication she was taking. That is when I got your book out and started doing some serious reading. The pieces of the puzzle really started coming together and what you wrote really made sense ! !She had a scheduled doctor appointment Wednesday afternoon. We BOTH went in and I think things are on the right track now.I plan to continue reading your book but will do it slowly, one chapter at a time.I might tell you that I ordered two more of your books today at a book store in Silverdale. Plan to give them to two of our daughters._______________________________________________________
I grew up across the street from your father. My family had the corner house at MAIN ST. & BENSON ROAD. My father was a Border Patrolman
Jim was just over a year older than me.I graduated from Western with a teaching degree. Did my first nine years at Clover Park District 1955 – 64. During 1963 – 64 I taught televised elementary school science on Ch. 56 My daily schedules were somewhat open as I did not have a class of children to look after. I had to be on hand to do the six televised lessons each week and prepare scripts for what the lessons would be.One day I decided to go to the barber shop in Lakewood to get a hair cut during my lunch break. While waiting in a chair (as were several others ) a fella said, “are you Junior Dunham”? It was your father and was I ever surprised! We got in a brief visit.That was the last time I saw him.A year or so ago I was doing some searching on my computer and I located a phone number for him. I called him and I am sure he was also amazed. We send e-mail back and forth now.It was on one of those e-mails that he told me about your book. I went right out and bought it and the rest is history.
And as if that is not enough, here is a case report on alendronate induced fracture written by Jennifer Schneider MD about herself. Yes she taking alendronate when her bone snapped. Here is her x ray and her (NOT ghost written!) case report.
A woman visiting New York City was riding a subway train one morning when the train jolted. She shifted all her weight to one leg, felt a bone snap, and fell to the floor of the train. A hip x-ray in a local emergency department revealed a comminuted spiral fracture involving the upper half of the right femur (see figure). The woman was transferred to an orthopedic hospital, where she was noted to be 5’9” tall, 155 pounds, and in a great deal of pain. She had no significant medical problems aside from osteoarthritis of the knees and thumbs. Her medications consisted of hormone replacement therapy and alendronate, 70 mg/week. She had been taking alendronate for approximately seven years.
- OUCH! That must have hurt!
In the most recent issue of the journal Geriatrics Jennifer has described several more cases. In addition she has this UNUSUAL DISCLOSURE that differs from those “other” kind we have been reading about so much lately.
Dr Schneider practices internal medicine and pain management in Tucson, Arizona. Disclosure: As she was the patient in a related 2006 Geriatrics case report, the author discloses that she has a personal interest in understanding the possible causative role of alendronate and atypical femoral fractures. She states that she has no financial interests in any pharmaceutical product used to treat osteoporosis.
Ha ha ha! That’s the best disclosure I have ever seen!
Anyhoo, I have written at length about the osteoporosis drugs and the rat maze of bone mineral density (BMD) and treatment. Bottom line is it doesn’t make any sense to take drugs to prevent osteoporosis. Remember that commercial where the graceful but aging woman is talking about how she got shorter? And that if you had the same problem you should ‘talk to your doctor’. Well I don’t recommend talking to your doctor for any reason unless you are really sick (and not just think that you are sick or might have undetected disease). Why? Well first of all most doctors are boring (yours truly included). Second of all, in spite of common beliefs to the contrary amongst both doctors and their patients, there is no evidence that going to the doctor if you aren’t sick is good for your health. In fact, both the American Medical Association (ever heard of them?) and the Canadian Medical Association recommend against the annual physical checkup for healthy people.
As for osteoporosis and bone mineral density (BMD) testing, the most disabling of fractures occurs in the elderly, in the hipbone, specifically the femoral neck, which is associated with considerable loss of mobility. The studies haven’t shown that for women without a history of osteoporotic fracture that these drugs can prevent hip fractures. According to the guidelines, half of postmenopausal women should be taking medication for osteoporosis. However, recommendations for so many women to take bone medications don’t make any sense. 
Most of the studies, including the the Alendronate Phase III Osteoporosis Treatment Study, the Fracture Intervention Trial (FIT), The FOSamax International Trial (FOSIT), and the Vertebral Efficacy with Risedronate Therapy (VERT)
study collectively performed in thousands of women with osteoporosis based on BMD, did not show a reduction in hip fractures, the kind of fracture most clearly associated with lasting disability.
In terms of fractures in other parts of the body, referred to collectively as nonvertebral fractures (in places like the clavicle or the wrist) the findings are more mixed, with differing findings depending on whether there is a prior history of fractures and other factors.
This study did not show impressive results for women with osteoporosis but no history of fracture
The Hip Intervention Program (HIP) Study assessed the effects of three years of risedronate or placebo in 9331 women over age 70 with dramatic losses of bone mineral density (t score less than -4), with -2.5 being regular osteoporosis) or t score less than -3 with a risk factor for hip fracture, like propensity to fall. Overall 2.8% of women on risedronate suffered hip fracture versus 3.9% on placebo, a difference of 1.1% that although statistically significant was not very impressive. In the only study of men to date, bishphosphonates did not prevent painful vertebral fractures or nonvertebral fractures, including fractures of the hip.
And what about treatment beyond three years? The implication of the educational campaigns about osteoporosis is that this is a disease for which you need to be treated for the rest of your life. But is there evidence of added benefit of long-term treatment, or perhaps harm? The studies I reviewed above showed that after five years there is no benefit. In other words after five years they seem to stop working. How could this be?
Again, bisphosphonates act by inhibiting osteoclasts, the cells that act to break down bone. So although they increase BMD for a few years, in the long run they decrease bone turnover. Animals treated with bisphosphonates have a decrease in bone turnover. Women on alendronate were found to take up to two years to heal after a fracture, and had markedly suppressed bone formation on biopsy. In the long run bisphosphonates may decrease the ability of bones to resist fracture, making bones more brittle. They also are not metabolized, meaning that they bisphosphonates you are taking now will be in your bones for life, resulting in a long term reduction in bone turnover.
This decrease in bone turnover underlies the scariest potential side effect of bisphosphonates: osteonecrosis. Osteonecrosis is a degeneration of the bone in the jaw that may require surgery. Osteonecrosis was seen in “Fossy Jaw” or “Phossy Jaw”, which developed in workers in 19th Century match making factories exposed to phosphorus. The phosphorus would get into the bone of the jaw, much like the bisphosphonates do, and stop bone turnover, leading to death of the bone tissue. The outcome was so painful and disfiguring that it sometimes led people to kill themselves.
Although most of the cases of osteonecrosis of the jaw have been reported in patients with bone metastases or myeloma treated with intravenous bisphosphonates, there are now emerging cases in patients who took the medication only for the “prevention of osteoporosis.”
This shows there are those out there for whom there is little potential benefit and unfortunately much to lose in taking bisphosphonates. A total of 15 cases of osteonecrosis have been reported with oral alendronate, one with oral risedronate and one with ibandronate, taken for the treatment of osteoporosis or Paget’s Disease (a disease of that makes bones weak and fragile).
Maybe the “Fossy Jaw” should refer to Fosamax, and not Phosphorus!
Marilyn Mann wrote on this topic on Gooznews here:
http://www.gooznews.com/archives/001116.html
Article on Sen Charles Grassley in today’s Philadelphia Inquirer
http://www.philly.com/inquirer/business/20090208_Charles_Grassley_and_the_FDA.html
If you enjoyed this article, please consider sharing it!
I don’t know if I’ve ever mentioned to you that my sister is a surgeon, and her husband a cardiologist.
My sister had children rather late. Her twins she had at age 43. She developed severe osteoporosis at that point. I knew even then that the drugs used to treat osteoperosis were nasty, but now I know a lot more…
unfortunately I can’t have that dialogue with my sister…
and oh boy!! my brother-in-law, good cardiologist that he has would have everyone on statins…oy!!
he’s also into devise making and owns a company that does such…I don’t really know what he’s up to in that department, but I’ve heard word that Grassley is after device makers next!
You might have me to thank for that. “Swing a cat by the tale and you will hit someone in the pharmaceutical industry.” This related article just in from Vera Sharav.
http://www.philly.com/inquirer/business/20090208_Charles_Grassley_and_the_FD
I wrote a post on this last summer here:
Doug,
that link didn’t work…
Marilyn,
I have got to go check out your work since I keep seeing your name on friends of friends on facebook…will make a jaunt to your piece now…
oh Doug,
I’m still not getting notifications of new comments in my email???
I put the link at the bottom of the post as well. I am stumped on the email thing but thanks for letting me know.
Okay, so I doubt it’s true that you’re boring, Dr. B, but I’m certain that you are inordinately more knowledgeable on this than most physicians. That has a certain entertainment value.
I can’t tell you the number of women I know who are taking Fosamax, etc. and still not getting better bone-density results. Moreover, they are experiencing more symptoms.
When I ask what their physicians suggested prior to resorting to those drugs, they typically said calcium — in the form of TUMS!
Why is that a problem? Because TUMS buffers the GI, lessening ability to uptake calcium! And none of them were advised to increase magnesium. Yet, we know that without enough magnesium, calcium sorts of wanders around looking for trouble, not being absorbed and doing what it’s supposed to do.
The trouble is, they want to trust their doctors. They are compliant and adherent — and IMHO it’s killing them.
My 80-year-old friend, in remarkably good health, signed up at one of the Women’s Health Study sites several years ago — for the free medical care. When I heard that they had her taking 1,000 mg of calcium, with no magnesium, I begged her to reconsider. That was just too dangerous, I felt. Six months after starting this, she developed congestive heart disease and died. I can’t help but think that calcium killed her.
The Mag Nag
I meant the link about Grassley…not Marilyn’s link…
Thanks, the corrected link to article on Sen. Grassley from today is at the bottom of the post now.
What is a woman at risk of osteoporosis supposed to do? My mother refused to take female hormones and felt she was protecting her bones by taking dolomite tablets (CaMg(CO3)2) – calcium magnesium carbonate which she thought was a good choice because it’s “natural”. My mother exercised regularly, and ate a healthy diet full of vegetables, fruits, homemade yogurt, whole grains, beans, legumes. In her late 70′s she developed a horrible dowager’s hump which, in addition to being cosmetically unsightly was actually a painful disability. She had terrible back pain and was no longer able to carry a camera bag or anything else of any weight. It changed her gait and gave her the appearance of a pooch belly despite her previous thin, flat stomach. AFTER she was deformed, her doctor put her on Fosamax plus a large daily dose of calcium. About a year after starting Fosamax my mother developed dementia. This was followed by a diagnosis of high blood pressure then congestive heart failure resulting in her death in March, 2008.
Already I have been told that I have osteopenia and I was instructed to take 1,000-1,500 mg calcium citrate. Perhaps luckily I am really irregular about taking it, but I take Citracal Calcium CITRATE which I was told by my doctor is a form of calcium more easily absorbed by the body. This formulation has 250 IU vitamin D and 80mg magnesium oxide for each 500mg calcium citrate plus zinc, copper, manganese, boron, vit. B6. I REALLY do NOT want osteoporosis because I have seen up close the devastation that it wreaked on my mother’s life. She went from vital, healthy and active hiking, yoga, swimming, and doing photography carrying her own bag to pain and disability. I was shocked hat how disabled she was. What steps does a post-menopausal woman take to prevent osteoporosis? I know from her example that a good diet and exercise don’t prevent it.
You have to do weight bearing exercise (e.g. weights), that builds up bone density, or prevents it from decreasing. The evidence for calcium supplementation is not that great. My osteoporosis MD expert friends use the dowagers hump as an argument against my line (they don’t dispute the results of the studies as I describe them in the literature, however). Although they agree that noone should take bisphosphonates for more than five years (they stop working, literature clearly shows that, not widely publicized of course).
I DO lift weights twice a week, so was surprised at the deterioration in my spinal vertebrae (but not my leg and arm bones) and was told that weight lifting only strengthens bone in the limbs, not the spine. I still do not know an exercise in which the individual vertebrae “bear weight”. My personal choice in an effort to combat osteoporosis in a different way is to take low dose estradiol (gel applied to skin 0.5mg) combined with the Citracal mixture, plus avoiding the known foods and beverages which deplete the body’s calcium like cola beverages and excess protein. There is no guarantee this will be enough, but supposedly female hormones help the body to utilize the calcium ingested.
Yes, female hormones definitely increase bone mineral density. Good question about exercise for vertebral bone density. I’ll repost if I find out anything new.:)
Jennifer’s articles are now available by clicking links; disclaimers are in the “about” section of this site.
GREAT article by cardiologist Barry Zaret MD. Myrna was lucky to be married to a cardiologist! I have been putting off taking a required CPR class for my teaching credential which I will put on the front burner.
Doug,
I recently stumbled upon this blog.
I just had one of those “freaky” moments when I realized that Benson and Main just so happened to be streets in a certain small town I was raised in near the border. Small world or am I imagining things?
Great work here, love reading it.
No you’re not, Lynden WA. Here’s a picture of Grandpa Bremner ).
outside his barn (no longer exist but the house does)
That house is less than 2 blocks away from mine and just around the corner from my grandparents on Pine street– I have been by that house on Benson more times than I can count. Small world indeed.
Just checked it out on google earth. Looks like the “farm” turned into a subdivision. They said they were going to call it “Bremner Acres” or some goofy thing like that but I bet they were liars.
Oh, Junior Gilham lived across the street when my father was growing up there back in the 30s
It wouldn’t surprise me if they “said” they would do something like that (a similar thing happened with my grandfather and his old raspberry farm that is now a subdivision)– next time I’m at home I’ll have to check and see if that happened.
LOL! They sent us up to Lynden one year when I was a kid to pick strawberries/blueberries/raspberries! I hated it! Maybe it was the same farm? I always felt humiliated cuz the Mexicans could pick so much faster than us. They even sent me to Lynden school for a week cuz my father thought it would build character. They said I was from the “city” (Olympia?) and beat me up. Har har har!