QUESTION: I have been on heartburn medication (Actonel) for over 10 years and now have to have 2 teeth extracted. I discontinued the Actonel after I learned about possible osteonecrosis of the jaw problems. I want to know what to do for bone health instead.

LARRY's RESPONSE: You're wise to not be taking Actonel. Even though the reported incidence of osteonecrosis is low (reported by the makers of Actonel), I find the risks are far greater than the rewards. If you examine the studies that tout the benefits of bisphosphonates (Actonel is one of them) you would discover that the researchers actually looked at wrist fractures, not hip fractures.

Second, for example, they looked at a change in fracture rates. In a relative sense, 2% is half the incidence of 4%. They can report, then, a 50% reduction in fractures. The real incidence of hip fractures in the U.S. is actually less than 1% (about 300,000 per year). I always question anything that declares such a dramatic improvement rate. Using relative figures allows the drug makers to bombard us with wild claims. Even if their relative reduction is accurate at 50%, the actual incidence is only declining by a total of 0.5%.

Bone strength is not directly associated with bone density. Flexibility is vital. It is far easier to fracture a dense, inflexible bone than one that is young and supple. Drugs like Actonel impair the activity of osteoclasts (the cells that destroy bone). The drugs do this by interfering with the normal hormone balance in the body.

The osteoclasts make holes in the bone that is then filled in by the activity of osteoblasts. This is a quick description of the dynamics of bone growth and repair. If we didn't have both osteoclasts and osteoblasts working together, we could never heal a broken bone.

Osteoclasts are stimulated into action by estrogens and osteoblasts by progesterone. Blocking the activity of estrogen dampens the actions of the osteoclasts so there are no breakdowns. Without breakdown there is no new bone cells made to fill in. Over time, the bone looks more dense on a scan, but it is actually more like a piece of chalk. It is easy to break and almost impossible to heal.

ALTERNATIVES TO ACTONEL:

I suggest that the key to bone health requires that a person not use drugs. Mild weight-bearing exercise is very important, as is drinking enough water. When it comes to the hormone issue, I always suggest a modest amount of supplemental progesterone, usually in a topical cream. It stimulates the action of the osteoblasts and helps return hormone balance with the estrogens. This is particularly important for people in the U.S. who are under constant attack from environmental substances that mimic the actions of estrogens.

After more than a decade helping women with menopausal issues I conclude that a very small number need an estrogen supplement. The drug industry strongly disagrees. In our experience we see that MOST women (and men, too) would benefit from a supplemental dose of progesterone. It should be used correctly, according to a schedule that mimics the natural rise and fall of progesterone levels in the body.