Herbs / Vitamins / Drugs / Supplements

Analysis of Misleading Medical Study re Calcium and Osteoporosis

Are you as tired as I am of all these "scientific studies" designed to demonstrate that what you really need is drugs?

The latest in a long list of poorly designed -- or possibly, purposefully rigged -- studies is the latest, published in the New England Journal of Medicine, on February 16, 2006. The headline screams "Calcium, Vitamin D Won't Protect Older Women From Fracture." Let's analyze both the article on Forbes.com and the study that generated it.

The article is very biased. I believe the author reveals that bias by the way the article is structured. The lead sentence basically states that taking daily calcium and vitamin D do not provide significant health benefits.

Then, in the second paragraph, a positive finding is actually turned into a negative. It turns out that the calcium given to healthy postmenopausal women over the age of 50, even in the wrong form and at low dose (see more about this below), did increase hip bone density, ". . . but [they received] no significant reduction in their risk of hip fracture until . . . their. . . 60s." Hunh? "Nearly 50% of all hip fractures occur in adults older than 80 years. Hip fracture at a young age is not common and is usually the result of a major traumatic event or, rarely, is related to bone pathology." (emphasis added) This statement from a teaching article on Emergency Room medicine. http://www.emedicine.com/emerg/topic198.htm

Furthermore, the greatest at risk group from osteoporosis is elderly white women, who experience hip fracture. Black women, black men and white men are not among the at risk population. Pub Med has more than 175 articles on this topic. Here is the link to just one which contains this statistic. http://www.ncbi.nlm.nih.gov/entrez/query .fcgi?cmd=Retrieve&db=PubMed& list_uids=8651229&dopt=Abstract However, the study did not control for race.

The third paragraph unequivocally states that vitamin D had no effect on the risk for colorectal cancer. Given the recent information concerning serum vitamin D and incidence of cancer, this statement is simply abysmally ignorant. The truth is, study participants took 400 IUs of vitamin D, the current RDA. However, data has shown that many people suffer from a subclinical vitamin D deficiency and that, as their serum vitamin D concentration rises, their risk of colorectal cancer, as well as reproductive cancers, such as ovarian and breast, declines. This study was published in England, but didn't make much of a splash in the US. (See my last blog on this topic: www.drrichardstalksback.com) Dosages need to be in the 1,000 to 2,000 IUs per day range, which is the amount we use at the RFHC.

There are other problems with the study as well: the form of calcium used, the dosage given, a lack of screening of study participants for their actual risk for osteoporosis, and, lastly, the length of the study.

First, the form of the calcium: The study group took 1,000mgs of elemental calcium in the form of calcium carbonate. In other words, they were taking cement! Calcium carbonate is the most unabsorbable form of calcium you can consume. That's why it's so cheap. Do you remember the dolomite craze from the 70's and 80's? Dolomite is essentially rock that contains calcium carbonate and magnesium oxide. It was hyped as the answer to both your calcium and magnesium requirements. Only trouble was: It didn't work. You can't digest rock! Other calcium products that are essentially calcium carbonate include coral calcium and oyster shell calcium.

The dosage was also amazingly low and not adjusted for body weight. Body weight dosages of elemental calcium are as follows: 1,000 mg for a person under 120 pounds; 1,500 mg for a person 120 to 200 pounds; and 2,000 mg for people over 200 pounds. Given the increasing weight of the American population, I would venture that few of the study participants weighed less than 120 pounds. And, among the women who took the supplements, there was an average 12% reduction in their incidence of hip fracture, which increased to 21% in women over 60. It would be interesting to know which cohort experienced the reduction. The finding was not considered statistically significant, but it might have been if the researchers had controlled for body weight.

As you may be aware, at the RFHC, we use elemental calcium in the form of calcium citrate -- which is very absorbable -- adjusted for body weight. In Caucasian women (those most at risk for hip fracture) who are perimenopausal or postmenopausal, I add a product which contains bone matrix -- microcrystalline hydroxyapatite concentrate (MCHC). This provides all of the co-factors required to rebuild the bone structure into which the body deposits the elemental calcium. Osteoporosis is a degeneration of the bone matrix, as well as a calcium deficiency.

With regard to pre-screening for risk of osteoporosis, none was done. Why is this important? Remember, only about 15% of women over the age of 70 will experience a hip fracture. And, primarily Caucasian women are at risk for hip fracture from osteoporosis. Therefore, when you are doing a study with this many participants, any positive result can be washed away by the number of women who simply are not at risk. And, even under these unfavorable conditions, please remember that there was an average 12% reduction in the incidence of hip fracture in women in their 50s. It just wasn't "statistically significant" because the proper parameters were not applied to the analysis.

The length of the study is also an issue. It lasted seven years, which seems like a long time. But, please remember, both cancer and osteoporosis take 10 or even 20 years to develop. Therefore, the study really was short-term and inconclusive.

There is one more item of note in the article that I want to emphasize. It illustrates how important an understanding of physiology, rather than pharmacology, is to proper use of nutritional support. It was noted that some of the women taking calcium plus vitamin D experienced an increased risk of kidney stones. This is a direct function of urinary pH. Now, urinary pH is an intensely interesting and complicated topic. It has ramifications for everything from urinary tract infection, to degenerative diseases (i.e., cancer) -- to formation of kidney stones. At the RFHC, we routinely monitor urinary pH for anyone on calcium supplementation. The reason? To avoid kidney stones. Most Americans eat a diet heavy in grains and animal protein. That diet yields an acid urinary pH, and therefore, protects from kidney stones. However, if you eat a diet high in vegetables, with little protein and/or low in grains, you shift your urinary pH to the alkaline side. Voila! You are at risk for kidney stones. Therefore, being monitored while taking calcium supplements is extremely important.

Finally, I was unable to find out who funded this study, but I have my suspicions. All of the news reports (although not the article I read) concluded by recommending medication, instead of supplementation to reduce your risk. I find it offensive that such an ill-conceived and poorly executed "scientific study" is being used as an excuse to further medicate us, particularly in light of the severe side effects of the popular medications for osteoporosis. These side effects include erosion and perforation of the esophagus and internal bleeding. Some of the medications (Foxamax, e.g.) actually making the bones brittle -- which may actually increase the risk of fracture!

Once again, we are forced to read with a critical eye, to really understand the "rest of the story." So, take care of yourself, get your blood work done and obtain a customized nutritional program from the RFHC to optimize your overall health -- which includes reducing your osteoporosis risk!

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