Caution Urged in Osteoporosis Treatments

Calcium supplements, one of many health trends bursting onto the big-business scene, have become a popular item. With such a deluge from advertisers, it is important to separate sales pitches from sound medical advice.

Don’t get me wrong. I applaud efforts to inform women about preventing osteoporosis, a crippling ailment that runs up the national medical bill by billions of dollars every year. And calcium supplements do have their place. But I am disturbed by some misleading press reports and advertisements promoting calcium supplements and osteoporosis screening centers.

One particularly sensational commercial shows a middle-aged woman helping a stooped-over elderly lady onto a train. The older woman suffers from a fractured and curved vertebral column twisted by osteoporosis. The younger woman looks on with concern, wondering, “Is this my fate in life too?” The ad implies that if she takes calcium supplements, she can prevent osteoporosis.

Massive Doses

Let’s take a step back and look at the facts. The medical community’s latest research tells us that while women begin to lose calcium from the central portion of their bones at menopause, massive doses of calcium hardly reverse this process. Actually, calcium supplements won’t even halt bone loss.

In a study of post-menopausal women, “Does Calcium Supplementation Prevent Post-Menopausal Bone Loss?” (The New England Journal of Medicine, Jan. 22, 1987) participants were divided into three groups: women receiving estrogen-replacement therapy for osteoporosis; women getting 2,000 milligrams of calcium supplements daily, and the control group of women taking a placebo. The similarities among these women extended not only to their ages, but also to changes in their weight and the calcium content of their bones after the onset of menopause.

Researchers monitored changes in calcium content among the three groups over a two-year period. As expected, the women receiving estrogen did not lose calcium from the central portion of their bones. A surprising finding revealed that high-dose calcium supplements alone did not slow the loss of calcium from vital portions of major bones, particularly those of the hips and vertebral column--common sites of osteoporotic bone fractures.

Reasonable Benefits

Don’t assume from this study that calcium supplements are useless. Earlier in women’s lives, between puberty and age 45, calcium intake provides reasonable benefits. Dietary studies show that the average calcium intake for American women tends to be 500 milligrams daily, well below the recommended level of 1,000 milligrams. Pre-menopausal women who avoid high-fat dairy products and dislike yogurt and low-fat milk often find it hard to get enough calcium from foods. If you fit into that category, you might well take calcium supplements to obtain this essential mineral. Post-menopausal women should consult a physician about the pros and cons of estrogen-replacement therapy.

Another popular belief holds that exercise helps prevent osteoporosis. While we have no doubt that it strengthens bones in women younger than 35, experts at the USC School of Medicine have called into question whether exercise controls calcium loss in post-menopausal women. A yearlong pilot study of the effects of regular exercise on women’s risk of osteoporosis was conducted at the USC Clinical Research Center, directed by Dr. Robert K. Rude, associate professor of medicine.

Researchers found that among pre-menopausal women age 25 to 35, those who ran an average of 34 miles a week had a higher calcium content in their bones than those who did not exercise regularly. However, among post-menopausal women age 55 to 65, those running an average of 27 miles a week showed bone mass measurements similar to those who got little exercise.

I caution that one study is hardly conclusive, although these results are disconcerting. But I use them to show that medical science doesn’t fully understand the mechanism of osteoporosis. Until more concrete information emerges, women should use common sense when considering alarmist warnings.

Another call for caution applies to ads for osteoporosis screening clinics. Researchers hotly debate the methods used to measure the calcium content of bones. Screening women for osteoporosis is not a bad idea. My concern about these clinics is overtesting, especially in cases where the potential cost to the patient may outweigh the benefits.

Reliable Tests

Physicians use four reliable tests to measure the calcium content of bones. The CAT scan may provide the best measurement by determining the trabecular bone content of the lumbar spine. While this test seems to be the most accurate of the lot, it costs the patient about $145. When you add on the costs of additional tests, plus technicians’ fees, your bill at a screening clinic could easily total $300 or more.

Until the costs of these tests drop, you can achieve the end result--advice from your physician about how to cope with bone loss after menopause--simply with a doctor’s evaluation of your medical history. We do know some basic facts about osteoporosis that allow us to identify high-risk patients and prescribe preventive measures.

Threshold at 35

First, women begin to lose calcium from their bones by age 35. When you reach that threshold, it is important to watch your calcium intake. Second, professionals have found that the only effective treatment now available that will halt bone loss after menopause is estrogen replacement. If you are a candidate for this treatment, your physician may recommend an examination to determine the calcium content of your bones before prescribing estrogen. In that case, osteoporosis screening becomes a worthwhile investment.

So it is important to avoid overkill. In commenting on the calcium supplement study, editors of the New England Journal of Medicine wrote in the Jan. 22, 1987, issue that the time for mass screening for osteoporosis has not yet arrived. At this point, the tests are not cost effective, unlike the routine Pap test or annual mammogram. Osteoporosis screening methods serve us well in gathering data that shed new light on the process of bone loss. Perhaps in the future these tests will make practical sense as part of your routine medical care.