More than 10 million Americans have osteoporosis—approximately 15% of women and 4% of men over the age of 50. Another 34 million or so have osteopenia—bone density that is below normal and may lead to osteoporosis. And every year, two million people with osteoporosis have a so-called osteoporotic fracture, usually of the hip, spine or wrist.

Osteoporosis or “porous bone” is a condition of the skeletal system characterized by low bone mass and deterioration of bone tissue. Osteoporosis leads to an increase risk of bone fractures typically in the wrist, hip, and spine. It’s estimated that 20% of people with osteoporosis who sustain a hip fracture die within one year, and 20% of those who survive end up in nursing homes.

And the risk of dying after a fracture is still elevated for five years. The Canadian Medical Association Journal’s results of the largest study to date on the risk dying after breaking a bone is frightening. They studied nearly 10,000 people across Canada over five years. Women and men 50 and older with osteoporosis who experienced a vertebral fracture were 270% more likely to die than those without fractures. And those with a hip fracture were 320% more likely to die. Additionally, the researchers observed that hip fractures “may have long-lasting effects that result in eventual death by signaling or actually inducing a progressive decline in health.” These findings add to at least six other studies that all confirm the same thing: breaking a hip or vertebrae increases your risk of dying.

Osteoporotic bone fractures can also cause chronic debilitating pain and loss of mobility. The goal then should be to prevent osteoporosis from occurring in the first place. The FDA has approved the health claim on calcium dietary supplements that calcium can “reduce osteoporosis risk.”

Bone Density Scans and Fracture Risk

Osteoporosis treatment and osteopenia treatment focus on increasing the amount of minerals in bone, called bone mineral density. That is why doctors prescribe osteoporosis medications and also frequently recommend a calcium supplement. Osteoporosis is diagnosed by a bone density scan, also called a DEXA scan. A DEXA scan gives you a T-score. A T-score of -1.0 to -2.5 is osteopenia (pre-osteoporosis). A T-score of less than -2.5 is osteoporosis.

However, since 1996 it has been documented that bone mineral density (BMD) predicts less than half the risk for hip fracture. In fact, only a bone density scan only predicts 44% of elderly (> 65 years old) women who eventually get a fracture and only 21% of elderly men who experience a bone fracture.

The problem with a bone loss treatment that just focuses on minerals is that it ignores the other vital component required for bone health and building bones; namely, collagen. Bone is a complex, living tissue that interacts with all other systems in the body. It continually rebuilds and remodels itself using two primary cells called osteoblasts and osteoclasts. The osteoblasts produce new bone while osteoclasts break down and recycles old bone. Building bones requires the proper functioning of both of these cell types.

Benefits and Risks of Bone Medications

The most commonly prescribed osteoporosis treatment and osteopenia treatment medications are a class of drugs called bisphosphonates. These include Fosamax, Boniva and Actonel.

The bisphosphonate category of medications reduce vertebral fractures an average of about 49%. While this is good, it’s important to note that vertebral fractures are not the most dangerous type of fracture. Hip fractures are.

Unfortunately, the medications aren’t very good at reducing hip fracture risk. A series of 2008 articles that reviewed the published studies that included more than 27,000 patients concluded that taking alendronate (Fosamax) risedronate (Actonel) or etidronate (Didronel) does not reduce hip fracture risk in people who had not previously suffered a hip fracture. And in the cases of Actonel and Didronel, they did not prevent a first vertebral fracture either.

Many people also can’t take these medications because of their side effects, which include esophageal bleeding, stomach ulcers, jaw bone death (osteonecrosis of the jaw), vomiting, bone pain, headaches, abdominal pain, nausea, constipation, acid reflux. In fact, an article in the Journal of the American Dental Association concluded that four percent of people taking these osteoporosis medications may be at risk for jaw bone death when they have just a simple procedure like a tooth extraction. What these medications all do is to promote bone health by increasing the minerals. They do not build bones by promoting connective tissue growth.

Questions are emerging also as to the long-term safety of these osteoporosis treatment medications. More than fifty percent of the side effects of all medications are not detected until after the drug is already on the market. Additionally, osteoporosis treatment medications were not studied for longer than five years, as is true for most medications. Several studies have been published recently and concluded that people taking Fosamax for more than five years may actually increase their fracture risk. That’s because while the minerals are increasing bone quantity they are not improving bone quality overall. The result may be more brittle bones than before, just as if your bones were columns of chalk.