V i v i a n  S o n g
Freelance writer
Freelance writer
Bone health issues get c

Published in The Toronto Star, September, 2009.

Photo by Vivian Song

When Salima Ladak-Kachra slipped and fell, striking the ceramic floor in her home, a searing pain shot up through her back, paralyzing h

er body and forcing uncontrollable sobs from her throat.

Somewhere between the fall and the impact with the floor, she heard a crunching noise. Ladak-Kachra almost wet herself from the blinding pain, and for a few terrifying moments lost feeling in her body. She was 25.

It was an insignificant fall, a slip the average 25-year-old can cushion with resilience. But Ladak-Kachra broke four bones in the middle of her back, shocking the emergency doctor who likened the damage to being thwacked repeatedly with a baseball bat.

She had been living with osteoporosis, a diagnosis that didn't surprise her given her family and lifestyle habits.

"I have a strong family history of osteoporosis on both sides," Ladak-Kachra, now 39, said. "I wasn't getting any dairy and was drinking too much caffeine. I didn't take care of myself."

At 5-foot-4, she weighed a scant 90 pounds, and was drinking six cups of coffee a day. Physicians dismissed complaints of nagging back pain prior to the fall to poor posture.

The accident caused her to lose two inches off her height. For the first six weeks she couldn't walk and had to be fed, showered, clothed and held in place. "Lifting a spoon felt like 20 pounds," she said.

The experience changed Ladak-Kachra's career path. The nuclear technologist switched from cardiac medicine to osteoporosis, and now heads The Bone Wellness Centre on Broadview Ave., which offers bone density testing and educates patients.

"It's a myth that osteoporosis is a silent thief," she said of the term used to describe a disease that's supposed to carry few symptoms. "It's very painful."

Other osteoporosis myths have become the subjects of heated, lively discussions online, becoming entangled in conspiracy theories and longstanding controversies, such as:

Does milk really do a body good?

Does fluoride in tap water weaken bone density?

Do drugs used to treat osteoporosis inhibit bone growth?

In her book, The Bone Health Revolution, Vivian Goldschmidt tackles these issues and advocates an all-natural way to treat osteoporosis. Her work is endorsed by Dr. Robert Salter, a world-renowned orthopedic surgeon in Toronto, and has gained an online following.

One of her biggest beefs, is milk. Goldschmidt, who holds a Masters in nutrition and biochemistry from New York University, said milk, an animal protein, makes blood and tissues more acidic. To neutralize this acid, the body actually pulls calcium from our bones to help restore our system's pH balance. Instead of being absorbed in our body, milk robs our bones of calcium.

Think antacid tablets, she said: The main ingredient in Tums or Rolaids is calcium, which we take to neutralize stomach acid.

It's a theory corroborated by a landmark study published in the American Journal of Clinical Nutrition, which followed 72,337 women over 18 years. The 2003 Harvard University study led by Diane Feskanich, concluded that milk intake was not associated with a lower risk of hip fracture. Nor did total calcium intake affect hip fracture risk.

Instead, the real agent for change was the unsung hero of vitamins: Vitamin D.

"Calcium has been overemphasized," said Dr. Aliya Khan, a professor of clinical medicine at McMaster University and a member of Osteoporosis Canada's scientific advisory council. "And the story around vitamin D hasn't been emphasized enough."

Vitamin D increases calcium absorption by as much as 30 to 80 per cent. It's essential for building healthy bones and muscles.

"If I could only choose one, my choice would be vitamin D," added Reinhold Vieth, director of the bone and mineral laboratory at Mt. Sinai hospital and a University of Toronto professor. "One way of preventing osteoporosis and sustaining your calcium intake, is to take more vitamin D."

But the majority of Canadians are vitamin D deficient. We live in a country with long sunless, winter months and getting vitamin D from food – eggs, salmon, sardines, herring and fish oils – can be more difficult than meeting our calcium requirements.

But it's a fallacy to depict dairy as a poor source of calcium, medical experts agreed.

"We need to demystify these concepts," said Dr. Angela Cheung, the director of the osteoporosis program at University Health Network, and vice-chair of Osteoporosis Canada's scientific advisory council.

Dairy is the most effective and natural way to get calcium, Vieth said. Besides, added Marc Grynas, director of U of T's bone and mineral group, our pH level is regulated by carbonate and bicarbonate, not calcium.

Goldschmidt also makes a case against fluoridated water. Fluoride is a pesticide used in rat poison and can lead to bone fractures. It accumulates in our joints and can be exacerbated through the consumption of other fluoride-rich drinks like green and black teas and concentrated fruit juices, she said.

But at the dose we consume in our tap water – one part per million – Grynas, who studied the effects of fluoride and bone health, said its effect is negligible.

His research compared bone samples from residents in Toronto – where the water supply has been fluoridated for 30 years – and from residents in Montreal where water is non-fluoridated. The study found no difference. "The problem is that fluoride has become and emotional subject, with people crusading against it," he said.

When the New York Times published the results of case studies that found prolonged use of the most commonly prescribed drug, bisphosphonates, actually weakened bone density, the online osteoporosis community was abuzz with confused chatter. Patients who had been using bisphosphonates like the drug Fosamax for five years or more were experiencing sudden, unprovoked snaps in their thigh bones.

Bisphosphonates work by slowing down resorption, a natural process where one type of cell chews up old bone and other cells lay down new ones. In post-menopausal women, more bone is lost than regained. But these incidents happened to a small number of women, Khan said.

New data presented at The American Bone and Mineral Research in Colorado this week showed that a follow-up study in 76,000 men found no evidence to link atypical or thigh fractures to bisphosphonates.

"The bottom line is these meds are a breakthrough in medicine," Khan said.

Goldschmidt's contention that bisphosphonates inhibit new bone growth is a misreading of biology, experts said.

If bisphosphonates slow down the process in which cells chew away at bone, then technically, the drug will also reduce the amount of new bone laid down to fill in the holes.

"It's just semantics," Vieth said.

Goldschmidt says she's not opposed to drug therapy. But she's working to give sufferers a choice. "Learn, educate yourself and then decide what you want to do," she advises. "Then make intelligent decisions based on what you found out."

Cheung, who studies complementary medicine and natural supplements, agreed that lifestyle changes like diet and exercise alone can reverse signs of osteoporosis, depending on factors like age and fracture risk.

"Should everyone be treated with drugs? No. Should a 40-year-old with osteoporosis be given bisphosphonates? No. We have to look at the whole picture."

For Ladak-Kachra all the proof she needs is in her recovery. She drinks a glass of milk, fortified orange juice and eats cheese everyday. Her bone density has increased and while she still refrains from heavy lifting – no laundry baskets for her, her energy level is higher.

"I take a balanced approach. You have to practise fall prevention, like removing clutter in the home, good posture, exercising and eating right," she said.

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