New York Times Highlights Necessity to Prevent Fractures

On November 7, 2008 the New York Times ran a story titled, Once Just an Aging Sign, Falls Merit Complex Care. This article highlights the dangers many people face with fractures as they age. I encourage everyone read this article and begin educating themselves about fragility fractures, which are fractures that occur as a result of fragile bones.

With the population aging rapidly, this issue will strain our healthcare system unless doctors and the general public embrace aggressive, preventative measures. There are two major factors that predispose people to fragility fractures. First, is bone health. The second is the risk of falls.

Currently bone health is only measured by a bone density scan, called a DEXA scan. DEXA scans, however, only measure the amount of minerals in bone, thus their "density." However, they do not measure bone quality. Yes, DEXA scans can be predictive of fracture risk, but relying only on bone mineral density is a grave mistake that literally can kill, because it alone does not predict well enough the risk for fractures. In fact, the World Health Organization (WHO) is recommending doctors and patients begin taking a more comprehensive view of osteoporosis, and move away from the narrow view of looking just at bone mineral density, to evaluating fracture risk as a whole.

As discussed in our article, Osteoporosis: Beyond Bone Mineral Density (Part 1), which was the cover article for the journal Integrative Medicine, 12-40% of the elderly who sustain a hip fracture die within six months. The cost for treating the more than 2 million osteoporotic fractures that occurred in 2005 was nearly $17 billion.

The standard of care for osteoporosis is drug therapy with medications such as Fosamax and Actonel. However, many people are unable to take these medications due to their side effects they can create, such as ulcers. And even if they were to take these medications, they decrease fracture risk by less than 50%.

Research now shows that the best way to reduce fracture risk is to take high doses of vitamin K2, along with supporting nutrients such as vitamin D and calcium. There have been many clinical trials using vitamin K2. So many, in fact, that the esteemed Archives of Internal Medicine published a review of all the clinical trials for osteoporosis that used vitamin K2. The researchers concluded that 45 mg of vitamin K2 (as MK-4) decreases the risk of vertebral fractures by 60%, hip fractures by 71% and all nonvertebral fractures by 81%.

The research on 45 mg daily of vitamin K2 (MK4) points to it being better than Fosamax without any of the Fosamax side effects. Additionally, evidence is accumulating that taking Fosamax for five years or more may actually increase your risk of fracture because Fosamax increases bone density without enhancing bone quality. Bone quality refers to the complex mixture of minerals and connective tissue that help bone absorb an impact from a fall without breaking. Vitamin K2 (MK-4), on the other hand, works by promoting formation of the connectivce tissue in bone, thereby allowing bone to better absorb the impact from a fall without breaking.

There are several different forms of vitamin K--K1, K2 and K3. And even within these forms, such as vitamin K2, there are different sub-forms (eg, vitamin K2 as MK-7 or MK-4). And readers must understand the only form and dose shown in clinical trials to reduce fracture risk is 45 mg of vitamin K2 as MK-4. When trying to promote bone health naturally, it's crucial that people only take dietary supplements with the amount and form of nutrients shown in clinical trials to protect them.

The only bone formula currently on the market that contains this amount of vitamin K2, plus calcium and vitamin D is Osteo-K, which I formulated with my partner, Dr. Steve Pieczenik, who has a MD from Cornell Medical College, a PhD from MIT, and who was a board examiner in both Neurology and Psychiatry. We created this product for two reasons. In searching for ways to help my patients in my clinic, Montana Integrative Medicine, I was unable to find a dietary supplement that contained the dose and form of nutrients shown in clinical trials to reduce fracture risk. We created this product also because Dr. Pieczenik's wife was unable to take Fosamax due to its side effects.

Some people ask if vitamin K2 increases clotting risk because they've heard that people taking blood thinners such as warfarin (eg, coumadin) shouldn't take extra vitamin K. Clinical trials that used vitamin K2 evaluated this question and showed no increase in the tendency to clot. However, people taking coumadin should absolutely not take extra vitamin K as a dietary supplement unless they speak with their healthcare provider first.

In addition to prescribing Osteo-K to my patients to help them prevent fractures, I also discuss other ways in which they can decrease their risk. A major factor for fractures is the risk for falling. The North American Menopasue Society (NAMS) has published very practical recommendations for decreasing this risk, which include ensuring optimal lighting, removing clutter and low-lying objects from the environment and providing non-skid rugs, among others. The complete table of recommendations can be viewed in our Osteoporosis patient handout, Preventing Osteoporosis and Modifying Fracture Risk, which accompanied our Osteoporosis: Beyond Bone Mineral Density (Part 1) article in the journal Integrative Medicine.

The bottom line is this: the best evidence-based medical research points to the powerful role vitamin K2 (MK-4) can play in reducing fractures. The only dietary supplement that contains the form and amount of this nutrient is Osteo-K.

More Bad News for The Pharmaceutical Industry--A Broken Paradigm

Note: This blog is a reprint of a Guest Opinion piece written in August 2007 by Drs. John Neustadt and Steve Pieczenik, and published in the Bozeman Daily Chronicle.

The news for the pharmaceutical industry has been very bad lately. A study published in the August 2007 issue of the Journal of the American Geriatrics Society conclude that people who use the histamine-2 receptor antagonists (“H2 blockers”) medications that block stomach acid, which include Zantac, Prilosec and Tagamet, have a nearly 250% increased risk of dementia.

Just a few months earlier, in May 2007, the US Food and Drug Administration (FDA) issued a warning for the diabetes medication, Avandia, which was shown to increase the risk of heart attacks by 30-40 percent, and last year the Journal of the American Medical Association (JAMA) reported that the risk of hip fracture increases by 22% after one year and nearly 60% after four years in people taking proton-pump inhibitors, another class of stomach acid blocking medications that includes Prilosec, Nexium, Prevacid. These revelations are just the surface of a very serious problem in the American healthcare system that are putting millions of people at risk.

This story of medications causing dangerous, sometimes fatal, adverse effects is not new. Another JAMA study in 1998 concluded that fatal drug reactions for hospital patients “appear to be between the fourth and sixth leading cause of death,” and that the rate of fatal drug reactions had been stable for the past 30 years, killing more than 100,000 people annually. We don’t want to give the impression that we condemn pharmaceuticals; however, the data are clear, medications can be very dangerous as well as very helpful. One has to always balance out the potential risks with the potential benefits, and that discussion should always be between you and your physician.

It’s not even that pharmaceuticals per se are the culprit, but it’s the underlying paradigm in medicine that needs to be changed. The current philosophy underlying medicine today is that diagnoses are based on symptoms and treated with medications to simply suppress the symptoms instead of identifying and treating the underlying causes of disease. For example, depression is treated conventionally by prescribing antidepressant medications, which, while they may be very helpful, do nothing to correct the underlying biochemical causes of the depression. Taking Prozac may lift someone’s mood and help them through a difficult period, but no one has a deficiency in Prozac.

In contrast, a medical system that approaches diseases by first evaluating the underlying biochemical causes of the disease and then correcting them using targeted biochemical therapies, can correct the underlying causes. The biochemical pathways for depression are well documented. Without being too complicated, the mood-lifting hormone serotonin is produced in the body by transforming the amino acid tryptophan into serotonin, and requires vitamin B6 and magnesium to do so. There are other relevant pathways for generating mood and energy, but this simple example illustrates a central point about the underlying biochemical dynamics of depression.

The concept of causality versus symptoms is a major shift in paradigm, which the pharmaceutical companies and the medical profession in general have not accepted. The premises for this new biochemical medicine are simple:

• Premise 1: health and disease are biochemical;
• Premise 2: if someone was healthy and they’re not now, something’s changed in their biochemistry;
• Premise 3: if you identify and treat the underlying biochemical dysfunction(s), disease may be prevented and cured.

Dr. Pieczenik’s case is a perfect example. Several years ago he was diagnosed with mature-onset asthma, for which he was prescribed steroids and an inhaler. He refused to take these medications because he knew that they would cause their own adverse effects. Instead, he made an appointment with Dr. Neustadt, who ordered a comprehensive biochemical screen that tested more than 450 variables of biochemical function. Biochemical testing revealed the underlying cause for Dr. Pieczenik’s asthma. His symptoms resulted from an inability to produce the hormone epinephrine, which is a bronchodilator, because he became deficient in copper, which is required to convert the amino acid tyrosine to epinephrine. Within two weeks of starting the therapy to realign his copper, all of his breathing difficulties stopped and he has had no breathing problem since then.

The problems with the pharmaceutical industry and our current medical system stem from an inherently incorrect philosophy where symptoms are treated and not their causes, and medical testing does not evaluate the underlying biochemical causes of disease.

These revolutionary concepts in medicine and how they can help you are described in great detail in the book, A Revolution in Health through Nutritional Biochemistry, written by Drs. Neustadt and Pieczenik. It is available on Amazon.com.

About Drs. Neustadt and Pieczenik
John Neustadt ND studied naturopathic medicine at Bastyr University, is clinic director of Montana Integrative Medicine (www.montanaim.com) and president of NBI Testing and Consulting Corp (NBITC, www.nbitesting.com) and Nutritional Biochemistry, Inc. (NBI, www.nbihealth.com) in Bozeman, Mont. He is an editor of the next edition of the textbook, Laboratory Evaluations for Integrative and Functional Medicine, and the author of the books, Thriving through Dialysis with Jonathan Wright, MD and A Revolution in Health through Nutritional Biochemistry with Steve Pieczenik, MD, PhD.

Steve Pieczenik MD, PhD, trained at Cornell, Harvard and MIT. He is a board certified psychiatrist, was a board examiner in neurology and psychiatry and is chairman of NBITC and NBI.