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With a new mandate of required payment of preventive testing, does the US Preventive Task Force miss the mark with women’s bone health recommendations?

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The government has estimated that as many as ten million Americans have osteoporosis. Half of all American women will, according to these government estimates, have a fracture related to osteoporosis during their lifetime. Men are by no means immune to bone thinning. While the experts term osteoporosis as a disease that necessitates the latest medication to address bone thinning, others including John Abramson, MD, author of Overdosed America, educate us that bone thinning is far better designated the culmination of unwise lifestyle choices, including but not limited to:

• lack of weight bearing exercise to build bone density
• a diet rich in foods that set the stage for an acidic pH (high in sugar, meats from conventional sources, low in fruits and vegetables)
• lack of a balance of essential fatty acids (Omega 3:Omega 6 fatty acids) essential for bone health
• the side effects of medications such as acid blocking drugs and steroids
• deficiency of nutrients key to bone health including vitamin D and vitamin K (K1 and K2)
• hormonal balance
• adequate sun exposure to optimize vitamin D production

In 2002 the US Preventive Task Force drafted guidelines that stated, in part, all women over the age of 65 should get a bone density test. Now, a new draft of the guidelines is pending that states all postmenopausal women should undergo bone density testing if their risk of fracture is the same or greater than the average 65 year old woman.
Part of the US Preventive Task Force’s effort is to educate American women that certain medications, smoking, heavy alcohol use, less than optimal weight, and family history of a parent with a hip fracture increase their risk of bone fracture.
The US Preventive Task Force has failed in several important respects. The most important is the failure to educate consumers that no less than 26 nutrients are essential for bone health. It is widely recognized in many medical circles that up to 85%+ of Americans are vitamin D deficient. Vitamin D is now recognized to be as important as calcium for bone health. Other key bone health nutrients including the essential Omega 3 fatty acids, magnesium, and other minerals are all-too-frequently deficient in the standard American diet that is rich in calories but less than optimal in nutrient density. Vitamin K1 and K2 have profound research that acknowledges their importance in bone nutrient and bone strength.
Important government aging research at Tufts University has revealed that those who ate a diet rich in fruit and vegetables had the strongest bones. Those who ate a diet richest in sugar had the weakest bones. One simple step every American can take daily is to increase their daily intake of fruit and vegetables.
Cutting back on sugar not only is important for dental health and to reduce the risk of obesity but also critical to keep our bones strong.

Another important failure of the draft guidelines posted for public comment is that many experts point to studies that show positive bone density tests often fail to be correlated with bone fractures. That is, bone density tests can demonstrate bone thinning but that does not translate to bone fractures. Experts including noted integrative medical practitioner Jonathan Wright, MD advise their patients to use tests that reveal bone loss as well as vitamin D sufficiency as better measures of bone health.
The US Preventive Task Force uses FRAX, a Web-based bone loss risk calculator, It is designed to estimate the odds of bone fracture within 10 years. However, the OR Health and Science University researcher, Dr. Heidi Nelson, who led the scientific review of how frequently bone mineral density x-rays should be repeated, “found no advantage to repeating the test (bone density testing) even after eight years.” In the words of Dr. Nelson, “so we can really lay off a lot of these repeat screening tests.”
How many bone fractures could be prevented if this government-appointed panel put its efforts towards science-based lifestyle factors including:
• vitamin D status
• regular weight bearing exercise
• optimal diet to maintain alkaline pH (fruits and vegetable rich)
• education about medications that promote bone thinning
• education about all the nutrients that are essential for bone health including vitamin K1 and K2, magnesium, the omega 3 fatty acids, among others?

As healthcare reform moves to mandate preventive screening, it is critical we examine the current effort of early detection that masquerades as prevention while lives are lost, quality of life suffers, and money and efforts are wasted by these action steps that miss the mark. American healthcare consumers deserve better.

Deborah Ray, MT (ASCP)

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