This article is taken from Dr Vernon Coleman’s Health Letter. It gives general material and opinions for information only and is not to be considered an alternative to professional medical advice. Readers should consult their family doctors or other qualified medical advisers on any matter relating to their health and wellbeing.

Osteoporosis - A Special Report

Facts, Lies And Myths Every Man And Woman Should Know About Osteoporosis - and Hormome Replacement Therapy

Osteoporosis has become one of the most fashionable diseases of the late twentieth century. There are probably more misconceptions about it than about any other disease. (The biggest misconception – deliberately created – is that it is exclusively a female problem. It isn’t.)

In this article I intend to expose the myths and reveal the truths about a disease which has become a major source of income for three massive international industries.

More importantly, I will also explain how and why the solutions offered by these three industries often do more harm than good. And I will explain how every reader can protect themselves against osteoporosis simply by making lifestyle changes which cost nothing.

Profits From Hormones
The osteoporosis story really starts back in the early 1960s when the contraceptive pill was introduced and the international pharmaceutical industry first began to profit from the sale of female hormones.

After that it was only a few years before drug companies dramatically increased the potential number of consumers for hormones by offering oestrogen supplements to menopausal women.

For about ten years from the middle 1960s onwards oestrogen pills were heavily promoted as a ‘miracle’ solution for the many physical and mental problems which were widely described, by both doctors and journalists, as being an inevitable consequence of the menopause.

The symptoms of the menopause are known to be caused by a reduction in the body’s natural production of female hormones. When a woman goes past her days of potential motherhood those hormones are no longer required and so production falters. Suddenly, now that there was a ‘remedy’ available, the menopause began to merit much more serious attention from doctors.

Relatively minor symptoms which would, a few years earlier, have been ignored both by menopausal women themselves and by their medical advisers were now regarded as potentially life-threatening.

There had, of course, always been some women who had suffered serious and troublesome symptoms during the menopause. But the availability of a commercially profitable treatment for menopausal symptoms meant that all women reaching the menopause were now encouraged to regard themselves as ‘patients’ and to regard treatment with oestrogen not as a last resort but as a simple, safe and essential way to avoid potentially troublesome symptoms.

Early Fears About Oestrogen

Back in the late 1940s there had been some worrying early indications that treatment with oestrogen might not be entirely safe. Any concern that this might have raised was brushed aside in the enthusiasm for oestrogen.

The drug companies were enthusiastic about treating menopausal women because all women who live long enough eventually become menopausal – and that is a lot of business (particularly if women are encouraged to keep taking their hormone therapy for a decade or two after they reach the menopause).

Doctors were enthusiastic partly because oestrogen therapy gave them something positive to offer their patients and partly because doctors, on the whole, are now little more than a marketing arm of the pharmaceutical industry.

And many radical feminists were uncritically enthusiastic because here, at last, there seemed to be a solution to a problem (or potential problem) that only affected women.

Oestrogen And Endometrial Cancer

There was something of a hiccup in the ‘let’s stop all menopausal symptoms by automatically giving all women oestrogen therapy’ campaign in the mid 1970s when it was discovered that women using oestrogen had a dramatically increased chance of developing endometrial cancer. In an important article in the October/November 1998 issue of Nexus magazine Sherrill Sellman, who is the author of Hormone Heresy: What Women Must Know About Their Hormones and who has helped draw attention to the way osteoporosis is being used to ‘sell’ hormone replacement therapy points out that the figures showed that women who used oestrogen for seven years or more were 14 times as likely as other women to develop endometrial cancer. Cancer records in the US showed that there had been an 80% increase in the incidence of endometrial cancer among white women aged 50 or over during the late 1960s and early 1970s – the very years when women in that group were taking oestrogen therapy to prevent menopausal symptoms.

Soon, it seemed that endometrial cancer wasn’t the only problem associated with oestrogen. Evidence appeared suggesting that oestrogen therapy might also be linked to breast cancer, cancer of the ovary, diabetes, liver disease and gall bladder problems.

This news badly damaged public confidence in the idea of routine oestrogen therapy for women going through the menopause.

Hormone Replacement Therapy

Naturally, however, the drug companies were not going to be defeated by this. They added progesterone to the oestrogen and argued that the new addition would protect the uterus from the oestrogen. The new combined product was known as Hormone Replacement Therapy (HRT).

Alarmingly, it was apparently not considered necessary to perform long-term clinical trials to find out if the new twin hormone approach would prove to be safer, as safe as or less safe than the oestrogen-only approach. Such long term trials would, inevitably, have delayed the time when women would be able to ‘benefit’ from this new therapy. (There would, coincidentally of course, also have been a similar delay in the boost to drug company profits.)

Anxiety And Mistrust

There was, however, a snag affecting the launch of new, improved Hormone Replacement Therapy.

The problems associated with the use of oestrogen to treat and prevent menopausal symptoms had created considerable anxiety and mistrust among women. The drug companies knew that they had to find some way to make women believe that the menopause posed a real threat to their health and, indeed, to their lives.

In order to sell Hormone Replacement Therapy the drug companies had to find a way to convince women that any risks associated with this double hormone cocktail were worth taking. They had to find a disease that could be associated with the menopause, that could be described as deadly and dangerous and that, it could be argued, could be effectively treated with Hormone Replacement Therapy.

Osteoporosis: A Marketing Solution

They chose a disease called osteoporosis which fitted the requirements almost perfectly. However, one of the first things that had to be done was to redefine the disease.

Osteoporosis used to be a disease in which bones became thin and weak and fractured. But the number of people suffering from this condition was relatively small. And so in order to dramatically increase the target audience osteoporosis was redefined. It was now to be classified as a disease characterised by the fact that low bone mass and increased bone fragility increased the risk of bone fracture. (This is something of a nonsense since evidence from non Western countries shows that low bone mass does not necessarily increase the risk of bone fracture. Indeed, half the population in the West have thin bones which never fracture.)

According to the original definition of osteoporosis only around one million people a year developed osteoporosis in the US. But according to the new definition the number of people suffering from osteoporosis could be measured in tens of millions.

One expert has claimed that redefining osteoporosis in this way is rather like redefining heart disease in such a way that a man who has a high blood cholesterol level (but hasn’t actually had a heart attack) will be defined as a heart attack victim. There is no doubt that the new definition increases the commercial ‘scare’ value of osteoporosis by dramatically increasing the number of sufferers. But it is not justified for not all individuals with low bone density will develop fractures. In some countries low bone density is commonplace – but fractures are rare.

(Incidentally, osteoporosis is by no means the only disease to have become apparently much commoner as a direct result of a change in definition. Asthma, arthritis and depression are disorders which have become much ‘commoner’ in recent years because of definition changes. If everyone who ever wheezes is described as ‘asthmatic’ (as they are in some areas) then the incidence of asthma will obviously rise dramatically. If everyone who feels sad is diagnosed as being depressed then the incidence of depression will rise with equal rapidity.)

Osteoporosis Is Turned Into A Life Threatening Disorder

In order to balance the hazards known or suspected to be associated with Hormone Replacement Therapy it was also necessary to put a great deal of emphasis on the risks associated with osteoporosis.

The drug companies knew that if women perceived osteoporosis as offering only a modest danger to their health they would not be prepared to take HRT to prevent it. Osteoporosis had to be built up into a significant, life-threatening disorder. And so the lobbyists, public relations experts and industry spin doctors put a great deal of effort into turning osteoporosis from a relatively little known disorder into a scary and significant disease.

Enter The Spin Doctors

Women who were targeted as good HRT consumers were warned that hip fractures among women in the danger age group exceeded the incidence of cancer of the cervix, breast and uterus, and that half of all patients who have a hip fracture will need long term care with one in six dying within six months.

Pretty frightening stuff.

What the spin doctors didn’t tell women was that most of the women who have hip fractures are in their seventies, eighties and nineties – and are, therefore, likely to need long term care (or to die) because of other health problems totally unrelated to osteoporosis.

Women were also shown pictures of women with Dowager’s Hump – which is created when vertebrae collapse causing shrinkage and, eventually, a hump – and warned that this was what awaited them if they did not take immediate action to protect themselves.

This was scaremongering on a massive scale because only a tiny fraction of women with osteoporosis – perhaps around 5% of 70 year olds – ever develop collapsed vertebrae. And most of these never develop symptoms.

By the time they are 80 years old virtually all women in the US (and other Western nations) are officially suffering from osteoporosis. And yet only a tiny proportion of those women will suffer bone fractures.

Osteoporosis Becomes A Woman’s Disease

The other strange thing about choosing osteoporosis as a menopausal risk was that osteoporosis had never before been regarded as a disease of ‘women’ as opposed to a disease of ‘human beings’.

One man in three over the age of 60 gets osteoporosis and it can hardly be argued that this is because their circulating levels of female hormone have dropped. Men are more likely to die as a result of fractures which have developed because of osteoporosis than women are.

But as soon as the drug industry public relations people got to work osteoporosis was quickly redefined as a serious ‘menopausal’ (and therefore a women-only) problem.

Doctors were hired to spread the news about osteoporosis, the menopause and Hormone Replacement Therapy and journalists eagerly passed the news on to their readers. Television viewers, radio listeners and newspaper and magazine readers all learnt that Hormone Replacement Therapy is the best way to prevent osteoporosis – a disease which would, without the ‘miracle’ of HRT, be a major threat to the health of all menopausal women.

A Successful Campaign

By the early 1990s the campaign to link osteoporosis and the menopause had been completely successful. Women were by then so terrified of osteoporosis, the associated bone fractures and Dowager’s Hump, that they were pouring into their doctors’ surgeries and demanding HRT – regardless of the possible consequences.

The drug companies had once again succeeded in creating a disease, and a fear, that would enable them to market a potentially hazardous (but lucrative) product. The plain, unadulterated fact is that the alleged relationship between osteoporosis and the menopause is an entirely artificial one which was created for purely commercial reasons.

Turning A Treatment Into A Preventive Technique

Even more significantly, perhaps, the marketing of HRT to prevent osteoporosis developing had turned a product which had been originally designed, and thought of, as a treatment into a form of prevention.

In commercial terms this was, of course, a highly significant move and it is now a typical approach for the pharmaceutical industry to take.

The drug companies know, for example, that their profits will be far higher if they can sell drugs to ‘prevent’ heart disease, depression or asthma than if they can only sell drugs to treat heart disease, depression or asthma. The commercial potential for a drug which can be recommended as a preventative is infinitely greater than the potential for a drug which only has a therapeutic use. By no means all individuals actually develop heart disease, depression or asthma but most individuals are keen not to develop those problems.

Turning HRT from a specific treatment into a mass market form of prevention was, I believe, one of the first of many examples of this drug company trick.

The Dairy Industry Jumps On The Osteoporosis Bandwagon

Once the drug companies had established osteoporosis as a dangerous but avoidable consequence of the menopause a number of other groups jumped onto the rolling bandwagon.

Dairy farmers – and their marketing experts – quickly recognised that they could sell milk as a natural ‘medicine’ designed to help prevent osteoporosis.

The dairy industry was, of course, in a great deal of trouble at the time when osteoporosis was artificially linked with the menopause. Millions of people had cut down their milk consumption, or had stopped drinking milk completely, because they were worried about the associated fat consumption (not to mention the serious allergy problems known to be associated with milk).

But once they had realised the marketing potential of the fact that milk contains calcium – the most significant ingredient of bone – the dairy industry wasted no time at all in creating a new myth: that drinking milk leads to strong, healthy bones and a reduction in the risk of developing osteoporosis and bone fractures. Parts of the dairy industry even started to add extra calcium to milk to enhance its value as a preventative against osteoporosis and to substantiate the threat made to women that their bones would become frail and brittle and would fracture more easily if they didn’t drink milk.

Readers of VCHL will not be surprised to learn that there was no clinical evidence to support the claim that a diet rich in milk would help prevent osteoporosis or fractured bones. However, that small problem was not allowed to stand in the way and milk was vigorously promoted to women as an essential and healthy source of bone strengthening food.

And The Supplements Industry Joins In Too

The manufacturers, distributors and retailers of vitamin and mineral supplements also benefited from the drug industry’s success in scaring millions of women about the newly established link between osteoporosis, fractured bones and the menopause.

By the mid 1980s American women were spending over $150 million on calcium supplements which they believed would help prevent osteoporosis. Naturally, there was no clinical evidence to support the claim that taking calcium supplements does, or would, prevent bone loss, osteoporosis or bone fractures.

The Three Myths

The marketing programmes developed by the pharmaceutical industry, the dairy industry and the mineral supplement industry had, by the early 1990s, successfully established several important myths as fact.

Myth 1: Osteoporosis is a disease which exclusively or largely affects women.

Myth 2: Osteoporosis is directly caused by, or is an inevitable consequence of, menopausal changes in circulating hormone levels.

Myth 3: Osteoporosis (and the risk of developing bone fractures) can be safely prevented and/or cured by swallowing large quantities of calcium ideally either in the form of dairy produce or calcium tablets.

These myths are well established as apparent facts but are relatively easy to disprove.

Myth 1: Osteoporosis Is A Women’s Problem

Osteoporosis has only recently been described as a problem largely affecting women. It was traditionally simply a bone disorder which affected both men and women but was given its special status as a major menopausal symptom in order to counteract the risk known to be associated with Hormone Replacement Therapy. The fact that men are more likely to die of bone fractures than women are is ignored because it doesn’t fit into the scheme of things – and certainly doesn’t help drug companies sell HRT. Most men aged 75 and over have lost enough bone to put them within the definition of osteoporosis or to put them at significant risk of developing osteoporosis and the alleged sequelae. (The fact that most of those men never fracture any bones is proof that osteoporosis does not necessarily lead to fracture rather than that men don’t develop osteoporosis.)

Myth 2: Osteoporosis Is Caused By The Menopause

If osteoporosis really were caused by the menopause (or even associated with it directly) then it would be fair to assume that the incidence of the disease would be much the same among women everywhere.

But it isn’t.

There are many parts of the world where osteoporosis and bone fractures are almost unheard of among post menopausal women (and certainly little or no commoner than among pre menopausal women). Many women in Africa, Asia and South America live many years beyond the menopause without developing an increased tendency to bone fracture. Oestrogen levels among such women are not higher than among Western women – and bone density loss is comparable – but bone fracture rates are much lower.

Previous theories about bone density levels being linked to hormone levels have been disproved by studies which have shown that some women lose comparatively little bone when they go through the menopause while among other women bone loss actually starts before the menopause.

Particularly convincing is research which shows that sex hormone levels are more or less identical in women with and without osteoporosis. If bone loss was triggered by hormone loss one would rationally expect a dramatic fall in hormone levels to result in a big bone loss: that doesn’t happen.

It is also important to remember that bone density loss, osteoporosis and a tendency to bone fracture also occurs in white males – as well as white females. Once again this seems to provide convincing evidence that there is no link between the menopause and osteoporosis.

The truth is that all the evidence shows that the alleged link between the menopause and osteoporosis simply does not exist.

We do, however, have evidence showing that vegetarian and vegan women have higher bone density (and a smaller likelihood of developing fractures) than meat eating women. This is true for vegetarian women even when they have lower oestrogen levels than meat eating women.

The conclusion has to be that women who want stronger bones and a smaller fracture risk should give up eating meat.

This evidence has never been widely publicised. Readers with a slightly cynical or sceptical streak might ask themselves whether this could be because drug companies, doctors and the dairy industry could not possibly gain anything by encouraging patients to stop eating meat. And, of course, the meat industry has a huge interest in suppressing such evidence.

Myth 3: Osteoporosis Can Be Prevented By Taking Extra Calcium (As Milk Or As Supplements)

The fact that bone is largely made up of calcium has encouraged people to believe that a good calcium intake is essential for healthy bones.

However, although it is obviously true that some calcium is essential for healthy bones the evidence shows that a high calcium intake alone will not necessarily prevent osteoporosis or ensure strong bones.

Countries where people have a high calcium intake (such as Sweden or Finland) tend to have higher fracture rates than less well developed countries (such as those in Asia) where calcium intake is not high and dairy consumption is low or non existent.

According to the excellent article by Sherrill Sellman in the October/November 1998 issue of Nexus magazine there is no group of people in the world with a lower incidence of osteoporosis than the Bantu of Africa. But the average Bantu consumes less than a quarter of the amount of calcium consumed by the average Westerner. (Western women are encouraged to consume between 1,000 and 1,500 mg of calcium a day but the Bantu take in as little as 175 mg of calcium a day.)

Ms Sellman also points out that the Japanese daily intake of calcium is around 500 mg daily but fracture rates there are much lower than in the US and spinal fractures in women who have gone through the menopause are virtually unheard of in Japan.

I could go on almost indefinitely proving this point. People living as far apart as China and Peru have a low calcium intake and a low osteoporosis rate. It may seem surprising but there simply isn’t a link between calcium intake and bone loss. On the contrary, it now seems clear that bone loss and osteoporosis are problems which are much commoner in white women than in black women. And although there may be some genetic component in this, diet and lifestyle are probably most significant.

(In 1996 a study of over 500 women showed that white women are twice as likely to have fractures as are black women. This confirmed the results of a previous study, conducted in Texas, US, in 1988, which showed that hip fractures were much less common among African American women and Mexican American women than among white women. This strong racial difference was confirmed by a third study, conducted in 1992, which showed that black South African women, who have a low intake of calcium in their daily diet, have a fracture rate which is only about 5% that of white women.

Since black women are obviously just as likely to have a menopause as are white women it is perfectly clear from all this that there can be no direct relationship between the menopause and osteoporosis or bone fracture.)

The Milk Myth

It is a part of this myth that dairy products (such as milk) are a safe and vital source of calcium. But, a high intake of milk doesn’t appear to help avoid bone loss, osteoporosis or fractures.

The Harvard Nurses’ Study, which involved 77,761 women aged between 34 and 59, showed that women who drank three or more glasses of milk a day had no fewer hip or arm fractures than those who drank little or no milk.

The dairy industry must have been shocked by the results which showed that fracture rates for milk drinkers were significantly higher for those women who consumed three or more glasses of milk a day.

Those countries around the world where dairy produce is consumed most enthusiastically are also the countries where osteoporosis is at its commonest. Osteoporosis is at its rarest in countries where dairy produce consumption is low. The evidence points strongly to a vegan, rather than a vegetarian, diet being the healthiest option for anyone wanting strong bones in old age.

Dairy products (such as milk and cheese) are sometimes thought of as standard or irreplaceable sources of calcium. However, this isn’t true. For example, only about 30% of the calcium in milk is absorbed by the human body - possibly less than for typical green, leafy vegetables. Dark green leafy vegetables (such as kale and broccoli) are good plant sources of calcium and some experts believe that calcium is more readily absorbed from kale than it is from milk.

The main problem with milk seems to be that although it does contain calcium it also contains protein, and eating protein derived from animals results in an increased rate of calcium excretion. It is significant that osteoporosis is most common in countries (US, UK, Finland, Sweden) which have the largest consumption of dairy products.

Milk Is Not A Safe Drink

Human beings are, as far as I know, the only animals in the world who routinely drink milk obtained from another species. And it isn’t a wise thing to do. The first thing to remember about milk is that it is not the ‘safe’ food it is often made out to be. Even if milk were a good source of calcium (which, it is not) it would not be a safe source of calcium.

It has been known for some time that cow’s milk may cause a number of allergies and digestive troubles. Asthma, eczema, irritable bowel syndrome, migraine and sinus troubles are just five extremely common disorders which may be associated with drinking milk.

Clinical studies have also shown that there may be a link between cancer of the ovary and dairy products.

The original studies showed a higher than normal risk of ovarian cancer in women who consumed more lactose (foods which contain a lot of lactose include skimmed milk, ice cream, yoghurt and cottage cheese) and had less of an enzyme which helps to eliminate the galactose component of lactose.

Ovarian cancer is more common in Northern Europe than in Asia and the consumption of cow’s milk products may be one reason for this difference.

Dr Daniel Cramer, at Boston’s Brigham and Women’s Hospital has also recently reported evidence relating endometriosis and maldevelopment of the female tract to the fact that those women’s mothers had a high lactose diet and an enzyme deficiency.

And there has been a report suggesting that there may be a link between milk (even skimmed milk) and breast cancer. In a study published in Medical Hypotheses recently a researcher from Princeton University reported that cow’s milk is a cocktail of cancer-causing chemicals.

I have two other worries about milk.

First, I don’t think anyone knows the consequences of the fact that many farmers give their cows hormones in order to increase the milk yield. Inevitably, those hormones get into the cow’s milk and so anyone who drinks the milk is likely to getting an unwanted blast of hormones. Other drugs – such as antibiotics – which are routinely given to cattle are also likely to find their way into milk.

Second, I believe there is a very real risk that cow’s milk (and, quite possibly, the milk from other animals) could be contaminated with the factor which causes Mad Cow Disease.

None of this need be a problem since cow’s milk contains nothing that cannot be obtained in other foods and is nowhere near as good a source of calcium as the dairy industry would have us all believe.

Calcium Supplements Are No Use

Just as the theory about milk helping to prevent osteoporosis has been exposed for the sham it is, so the evidence also shows that calcium supplements do not provide protection, or help reduce the risk of fractures developing. On the contrary some studies have shown that calcium supplementation doesn’t lower the incidence of fractures. Indeed, there is evidence to show that individuals who take large quantities of calcium supplementation have a 50% increased risk of developing bone fractures.

A good calcium intake in childhood and during pre menopausal years will help build strong bones (and, therefore, help reduce the risk of thin, weak bones in later life) but that good calcium intake can best be obtained from a varied diet rather than from supplements. And cow’s milk is not a good source of bone strength at any age. Drinking cow’s milk during the teenage years does not provide protection against osteoporosis.

The real problem with calcium supplements is that some are not well absorbed while too much calcium supplementation can lead to calcification of the joints and kidney stones.

These Myths Did Not Develop By Accident

Clearly, there are a number of lessons to be learned from the way that the myths I have exposed have been deliberately created. And make no mistake about it: these myths did not develop by accident. The myths about osteoporosis, the menopause, milk and calcium supplements were manufactured, quite cold bloodedly, for very specific commercial purposes.

HRT Is Of Little Real Value

It is clear that without the link to osteoporosis the hazards posed by the menopause are considerably less significant. A US study which began in 1976 and which involves 122,000 nurses, suggests that any life extending qualities which HRT possesses depend largely upon the hormones helping to reduce a woman’s chances of developing heart disease. This survey suggests that HRT has little positive or useful effect on mortality rates when it is taken by women who have a low risk of heart disease.

The significance of this is, of course, the fact that if a woman wants to reduce her risk of developing heart disease she doesn’t have to take HRT; she can cut her risk of developing heart disease by avoiding tobacco, cutting down her fat consumption, learning how to relax, losing excess weight (preferably gradually through a change in diet rather than through an artificial dieting programme) and taking regular, gentle exercise.

The hazards associated with HRT are real, and I believe that for many women the disadvantages far outweigh the advantages. It is still not precisely clear exactly what the risks are of a woman on HRT developing cancer. But I don’t think anyone would disagree with the statement that a woman who takes HRT has a greater chance of developing cancer than a woman who doesn’t. Studies have shown that HRT increases the incidence of breast cancer by 10% a year for each year that the HRT is used. That is, surely, a significant level of hazard. And there are other risks too. According to a major study of 23,000 female nurses menopausal women who take HRT are 50% more likely to develop asthma.

It seems to me, therefore, that the evidence supports my contention that HRT should only ever be considered as a treatment and never as a preventative. If a woman has menopausal symptoms which are causing her great distress then she may consider that the largely undetermined risks associated with HRT may be worth taking. On the other hand, I don’t think that the mass- market, long-term prescribing of HRT for millions of healthy women can possibly be justified.

Other Safer Remedies For Menopausal Problems

Other, safer (and probably more effective) products are available to alleviate menopausal symptoms. For example, women who suffer psychological symptoms (such as irritability and a decline in sex drive) have been helped by taking St. John’s Wort (which should be available through good local health food stores but which should, like all remedies, only be taken under the advice and recommendation of a professionally trained health care professional). One trial showed that menopausal women taking St. John’s Wort were dramatically less likely to suffer from low self esteem, irritability and other associated problems. The same trial showed that most of the women who had complained of a lack of sexual desire recovered their enthusiasm for sex after taking St. John’s Wort.

Exposing The Conspiracy To Deceive

It should also now be clear that we all have to be constantly on the lookout for new myths and new attempts to manipulate our natural fears of ill health and death purely for profit.

Drug companies, doctors, the dairy industry and the supplements industry have conspired to encourage women to take HRT, to swallow calcium supplements and to drink vast quantities of milk when the evidence shows that all these alleged remedies are of far greater benefit to those who manufacture, sell or prescribe them than they are to women themselves. The sales of one HRT product alone have reached $1 billion a year. The potential profits are even higher for the postmenopausal women most at risk are those who are 70 years of age and older. Drug companies who claim that HRT provides protection can therefore argue that women need to continue taking their expensive (and profitable) products for several decades after they reach the menopause. Just imagine the potential profits to be made if every woman in the world took HRT for a quarter of a century.

The US dairy industry, once endangered, now has a $20 billion annual revenue. And the sale of calcium supplements is a billion dollar international industry.

Women want to trust doctors and still often tend to believe what they read in magazines and hear on television. But, sadly, women have been lied to, misled and deceived by doctors and journalists for years. HRT may cause cancer. Calcium supplements aren’t necessarily effective at helping to build bone but they may cause kidney stones and other health endangering problems. And drinking milk may actually cause bone loss and the development of bone fractures.

International pharmaceutical companies, and other exclusively profit orientated organisations, employ thousands of public relations executives, press officers, lobbyists, researchers, doctors and journalists who are paid to create new fears and to build up demands for products which might otherwise have a small or even non existent commercial value.

One of my main purposes in writing VCHL is to expose the myths and the manipulative techniques which are used to sell new products. For the one thing we can be certain of is that whenever one commercially inspired myth is successfully exposed another will be created to take its place.

Back in 1988, ten years ago, I remember feeling temporarily elated when I heard that the British Government had, at long last, responded to my lengthy campaign warning of the hazards associated with the benzodiazepine tranquillisers by issuing an official warning to doctors. My elation was short lived for within months, if not weeks, the pharmaceutical industry had created new products to take the place of the benzodiazepines.

The bottom line is that none of us can trust the pharmaceutical industry, the food industry, the politicians or the medical profession to tell us the truth about what is good or bad for our health, or to protect us from those who are inspired solely by greed.

The truth (and for many people it is an unacceptable and unwelcome truth) is that osteoporosis, loss of bone strength and an increased tendency to bone fracture are, like so many other health problems of the twentieth century, a result of our poor lifestyle and our poor dietary habits.

Attempting to combat these problems by taking hormones or drugs does not tackle the problem at source and is, indeed, likely to make matters worse by creating new health problems on top of the existing ones.

The great failing of our modern society is that we are constantly searching for the magic solution. Even when the answers to our problems are clear and simple we still prefer to look for solutions in a bottle.

Weak bones and bone fractures are, like cancer and heart disease, problems which we can have some control over. We cannot avoid them completely, of course, but we can dramatically improve our odds of avoiding them.

We are constantly encouraged to put our faith in drugs. But we are encouraged to do that because the people who make the drugs want to sell them to us – not because they want to make us well again.

Prescription Drugs To Halt Bone Loss

The big drug companies have, in recent years, discovered yet another way to try and make money out of osteoporosis. They have started selling specialist prescription drugs for patients with osteoporosis.

For example, the drug Fosamax is sold for the ‘treatment of osteoporosis in postmenopausal women’.

Here is just one of the warnings given by the company making Fosamax: ‘Fosamax can cause local irritation of the upper gastro-intestinal mucosa. Because there is a potential for worsening of the underlying disease, caution should be used when Fosamax is given to patients with active upper gastro-intestinal problems, such as dysphagia, oesophageal disease, gastritis, duodenitis, or ulcers...’

‘Oesophageal reactions (sometimes severe and requiring hospitalisation) such as oesophagitis, oesophageal ulcers and oesophageal erosions, have been reported in patients receiving Fosamax. Physicians should therefore be alert to any signs or symptoms signalling a possible oesophageal reaction, and patients should be instructed to discontinue Fosamax and seek medical attention if they develop symptoms of oesophageal irritation such as dysphagia, pain on swallowing, retrosternal pain or new or worsening heartburn.’

Bone, muscle or joint pain, headache, abdominal pain, constipation, diarrhoea and flatulence are other possible side effects which may occur with this drug.

The Truth About How To Build Strong Bones And Avoid Osteoporosis

The myths I have exposed above were, of course, developed quite deliberately for very specific commercial purposes. The truth about maintaining strong bones (and avoiding osteoporosis) is quite different to these myths.

One recent study has shown that vegetarians absorb and retain more calcium from foods than do non-vegetarians and other studies cite lower rates of osteoporosis in vegetarians than in non-vegetarians. Vegetarian and vegan diets may actually protect against osteoporosis. The wisest course is to obtain dietary calcium from a wide range of sources. Possible calcium sources include: broccoli, molasses, chick peas, dried figs, tofu, endive, cabbage, kale, turnip greens, spinach and many different types of beans (including soya beans and baked beans).

Probably the simplest way to make sure you get plenty of calcium is to eat plenty of dark green leafy vegetables.

Many factors in addition to, and other than, the consumption of calcium play a significant part in the development and maintenance of healthy bones. These factors have not been widely discussed or promoted in recent years and I find it difficult to avoid the conclusion that this has been because these other factors have not been promoted by individuals working for or on behalf of commercial organisations. Put quite simply, it is easy to make money out of selling calcium (either in the form of milk or calcium tablets) but not easy to make money out of offering good advice which does not involve the sale of a product.

It is, for example, vital to remember that there are, in addition to calcium, around twenty other essential nutrients – including a variety of vitamins and minerals – which are required before the body can build and maintain healthy bones. If the diet is deficient in any of these nutrients then the bones will become weak. You don’t need to take supplements to obtain these essential nutrients: all you need is a good, balanced diet that includes plenty of fresh fruit and vegetables (preferably organically grown and genetically unmodified). Buying locally-grown produce may help to ensure that it has not been kept in storage for months on end – with the inevitable loss of vitamins and minerals.

It is also important to remember that apart from ensuring a reasonable intake of calcium (best done without dairy produce) it is also necessary to reduce the loss of calcium from your body.

There are a number of things you can do to minimise calcium loss. 1. You should avoid tobacco (smokers have a hip fracture risk 40% higher than non smokers).

2. Don’t drink more than two cups of coffee or tea a day and keep your intake of alcohol down.

3. You should be aware that a sedentary lifestyle may lead to calcium losses so take regular, gentle exercise which you enjoy. Exercising just three times a week will help to strengthen bone density noticeably. The best forms of exercise for strengthening the bones include weight training and walking uphill or cycling uphill. (Remember that you should not exercise if it is painful and you should always consult your doctor before starting an exercise programme or altering your exercise habits).

4. You should keep down your intake of salt.

5. It is important to avoid constant dieting. The evidence shows that whenever someone diets and loses weight he or she will also lose bone. Since women tend to diet more than men this is a problem which affects women more than men. Clearly, therefore, women who have spent much of their lives dieting, regaining weight and dieting again will have lost a good deal of bone by the time they reach the menopause. (And, if they develop osteoporosis, the arrival of the menopause will be a mere coincidence).

6. It is also important to be aware that the human body also needs vitamin D to make healthy bones. Obtaining vitamin D is easy: ten or twenty minutes of sun on face, hands and arms, taken just three times a week, should produce all the vitamin D the body needs. People with dark skin, or those who live in cloudy or smoggy areas or in northern areas may need slightly more exposure.

7. Finally, and most importantly, you should be aware that eating animal protein results in withdrawal of calcium from the bones into the bloodstream. The calcium is then excreted in the urine and lost. Eating large amounts of animal protein can dramatically increase the rate at which the body loses calcium. This is probably the most important single secret in the battle against osteoporosis and bone fractures. It is a secret which has been deliberately suppressed and hidden by those industries which have a vested interest in selling their ‘solutions’ to this problem – and by the meat industry which is, not surprisingly, nervous about the long term consequences to its own profitability once the secret becomes widely known.

The truth is that meat consumption is one of the most important factors in the development of bone loss, osteoporosis and fractures.

(Incidentally, meat protein is a very poor source of calcium. Strawberries contain more calcium than rump steak or corned beef).

A report which was published in the American Journal of Clinical Nutrition in 1994 showed that when volunteers switch from a typical western diet to one which does not include animal protein calcium losses are halved. A study of the health of 85,900 women aged between 35 and 59 showed that an increase in consumption of animal protein was associated with an increased risk of forearm fracture. No such association was found for the consumption of vegetable protein. Women who consume five or more servings of red meat each week have a significantly increased risk of forearm fracture when compared with women who eat red meat less than once a week.

Moreover, there is strong evidence to suggest that in those countries where calcium consumption is low and bone fracture rates are also low the key factor may well be the level of animal protein consumption.

For example, according to a recent article in The Vegan magazine (published by the Vegan Society in Britain) hip fracture rates in Beijing (China) are among the lowest in the world despite the fact that the mean daily intake of calcium in China is only 540 mg per person per day. (In US the comparable figure is 1140 mg). The big nutritional difference between the two countries lies in the amount of animal protein which is consumed. A staggering 70% of the protein consumed in the US is from animals. In China just 7% of the protein consumed is from animals.

In addition to all this it is important to remember that environmental toxins and mental stresses can also interfere with the body’s ability to function effectively – and, therefore, its ability to build new bone. And the surgical removal of the ovaries can have a damaging effect on the body’s bone building ability.

The Bottom Line

Osteoporosis is a nasty disease. But it is a disease largely created and sustained by our way of life. As with so many other disorders our slick ‘in a bottle’ twentieth century solutions often simply add additional problems to existing ones. In my view the best way to avoid osteoporosis – and to deal with it – is to be aware of the real causes and to do something about them.

I believe that osteoporosis is yet another twentieth century lifestyle disease which can, not surprisingly perhaps, best be avoided (and conquered) through a change in lifestyle.


Dr Vernon Coleman’s Health Letter, Publishing House, Trinity Place, Barnstaple, Devon EX32 9HJ, England. No part of this article may be reproduced in whole or in part by any means without written permission, nor used for any form of advertising or promotion. Please note that Dr Vernon Colemancannot give individual replies to readers. Dr Coleman does not have a medical practice and his comments are only available through this Health Letter, his books and newspaper articles. Dr Vernon Coleman’s Health Letter gives general material and opinions for information only and is not to be considered an alternative to professional medical advice. Readers should consult their family doctors or other qualified medical advisers on any matter relating to their health and wellbeing.

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