Reduce bone fracture risk without drug use

Breaking Up is Hard to Do

I’m not sure exactly what to make of this one. But it makes me very suspicious.

It’s called a “Fracture Protection Program.” But it doesn’t protect anyone from fractures – it actually exempts a health insurance company from covering medical costs associated with fractures in patients who take Actonel – an osteoporosis drug. Under this program, two drug companies (one is the maker of Actonel) will pay the costs the insurer would normally pay.

In some cases. Under certain circumstances.

This sounds like any Actonel user who attempts to make an insurance claim due to a fracture will have TWO layers of bureaucracy to cope with. Delightful!

Thing is, Actonel is a biophosphate drug, like Fosamax. It increases bone density. In theory, that’s good. In practice, not so good, because when density increases, bones may eventually become more likely to fracture. No kidding. You can read all about this insane “bone health” scheme in the e-Alert “Sinking Fast” (4/7/08).

Meanwhile, if you’d like to reduce fracture risk without risking fractures (I know – sounds crazy), there’s a way to do that without resorting to a prescription drug that might lead you into a nightmare maze of insurance red tape.

Dose dependence

Calcium intake supports bone health. That’s a given. And it’s also pretty widely known that vitamin D works with calcium to help keep bones in good shape.

But some recent trials have questioned the effectiveness of vitamin D to reduce fracture risk. So an international team – led by researchers at the University of Zurich’s Center on Aging and Mobility – analyzed a dozen double-blind, randomized controlled trials to assess the link between vitamin D intake and fracture risk.

The 12 studies included more than 42,000 subjects, all aged 65 or older.

Analysis results:

• Generally, intake of oral vitamin D supplements was linked to a nine percent reduction in hip fracture risk and a 14 percent reduction in non-vertebral fracture risk
• Nine of the trials tested vitamin D levels of 400 IU per day or higher. In these trials, D supplementation was linked to an 18 percent reduction of hip fracture risk, and a 20 percent reduction of non-vertebral fracture risk

These numbers were uniform, regardless of various levels of calcium supplements that were also taken.

Writing in the Archives of Internal Medicine, the authors concluded: “Nonvertebral fracture prevention with vitamin D is dose dependent, and a higher dose should reduce fractures by at least 20% for individuals aged 65 years or older.”

Higher and higher

It appears that most of the subjects in the Zurich study weren’t getting enough vitamin D – not even by the modest standards of U.S. health officials. According to the Food and Nutrition Board, everyone over age 70 should aim for a D intake of 600 IU.

Of course, we can’t extrapolate and assume that 600 IU per day would produce an even greater reduction of bone fracture risk, but in order for a vitamin D supplement to have a therapeutic effect (such as a fracture-preventive or a cancer-preventive), it’s important to take steps to avoid a deficiency.

In previous e-Alerts, HSI Panelist Allan Spreen, M.D., has stated that he would have no fear taking 2,000 IU of D3 daily. (D3 is the same form of the vitamin that’s produced in the skin after exposure to sunlight.)

And in the e-Alert “Sunny Side of the Street” (12/22/03), I told you about this recommendation from Jonathan V. Wright, M.D.: Between 1,600 and 2,000 IU of D3 daily, and as much as 4,000 IU for those over the age of 40.

Dr. Wright also recommends a consistent intake of dietary sources that contain vitamin D3, including salmon, sardines, and cod liver oil – in addition to moderate daily direct sunlight exposure. On a sunny, summer’s day you can pick up several thousand IU of vitamin D with just 10-15 minutes of exposure.

Talk to your doctor before adding vitamin D3 supplements to your daily regimen.

Sources:
“Health Alliance Announces First Fracture Protection Program for Actonel(R) (risedronate sodium) Tablets” Health Alliance Medical Plans, Inc., 4/14/09, prnewswire.com
“Prevention of Nonvertebral Fractures With Oral Vitamin D and Dose Dependency” Archives of Internal Medicine, Vol. 169, No. 6, 3/23/09, archinte.ama-assn.org