BOOK REPORT: The Intelligent Patient Guide to... - Bone Health

Bone Health

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BOOK REPORT: The Intelligent Patient Guide to Osteoporosis, by Sutton & Josse, endorsed by Osteoporosis Canada 1st edn, 2009, 207pp


I finally received this book via my local library this weekend and came across several points of likely interest to readers here.

Calcium intake levels:

p. 54 "The UK recommendation is at least 700 mg of calcium per day for adults .... in North America, the recommended daily calcium intake is 1000 - 1500 mg/day."

I've found (from 1,000+ studies and reports on osteoporosis I've read), NO studies supporting that calcium supplementation by itself is helpful (there are plenty of studies where vitamin D, or vitamin D + calcium, is helpful). If anyone has come across a peer reviewed research study showing that calcium alone has any beneficial effect on patients, I'd appreciate their letting me know (by reply post or site message). To me it's clear the (North American) medical community is fixated on urging large calcium intakes, somewhat tempered lately by concerns about heart health, and are slow to recognize the direct connection between too high a calcium intake and osteoporosis.

600-900 mg/day of calcium intake appears to be safe (not too little, not too much). As in large studies, much more than that, or much less than that, is readily shown as related to people with osteoporosis. See this graphical study of 60,000+ subjects in three studies at the 30 minute point of this video (added Aug. 20th):

Osteoporosis medications: While bone mineral density (BMD) is a possible indicator of fracture risk, BMD by itself is not reliable when increased through using bone meds (which, is why studies of bone meds need to prove they reduce fracture risk, and not merely boost the BMD level; as there's a 'quality of bone structure' issue involved). :

eg. p. 121 (re. patients taking Actonel / risedronate) "...a greater magnitude of increase in bone mineral density was not associated with fewer fractures."

pre- and post- menopausal women:

p. 134-5 "For a given bone mineral density, a premenopausal woman has a much lower 10-year fracture risk than a postmenopausal woman, ... " "Osteoporosis should not be diagnosed in premenopausal women on the basis of T-scores that are used in postmenopausal women. Rather, it is recommended that Z-score ... be used."

ibid "A Z-score lower than -2.0 should be described as "low bone mineral density", avoiding the term osteoporosis in the premenopausal woman, except in the case of patients with a fragility fracture or secondary osteoporosis." (elsewhere the book similarly remarks on avoiding the use of the term osteopenia in such situations)

ibid "At present, the FRAX tool is only applicable to postmenopausal women and men aged over 50."

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The Osteoporosis Book 4th Edn 2016, by Ellert, Low & Wade 288pp

"... research shows that individuals 50 years of age and older generally have a dietary intake of only 300mg to 700mg of calcium, ..." p. 70

[I believe less than 600 mg/day, or more than 900 mg/day, risks osteoporosis development]

"... the X-ray absorptiometry (DXA) data from the lumbar spine can now be analyzed using software installed on a DXA scanner to provide a trabecular bone score (TBS). .... TBS measures the porosity of bone. A higher TBS value indicates the bone is less porous and therefore stronger. ... TBS is a better predictor of fracture risk than DXA alone..." p. 147

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