Some of my readers might be worried after hearing about a safety alert from the FDA regarding prunes and dried plums contaminated with lead. I want to reassure you that this warning does not concern the prunes from California found in most US supermarkets that we recommend for bone health; instead, it refers to candied, salted, or pickled prunes imported from Asia, products that are generally found in Asian and Hispanic specialty markets. A list of the affected brands can be found here. If you have any of the brands listed on this warning in your  pantry and you haven’t yet used them, discard them immediately; if you’ve already eaten prunes from the listed products, contact your healthcare provider about getting your blood lead levels tested. If you are a regular consumer of imported plum or prune products, be sure to check the above-linked website to ensure your favorite brands are not on the list. You may also want to wait to consume this type of product until the source of the lead contamination has been identified and the matter resolved.

Thankfully, the FDA has emphasized that domestic plums and prunes are not included in this warning, so you can continue to enjoy the bone-building power of domestic prunes in safety. But I’d also like to stress that the imported prune products are a different prune species than the prunes used in the clinical studies, and they may not have exactly the same bone health benefits as the California prunes used in the studies I've discussed in earlier blogs. So if you’re eating prunes for bone health, our recommendation at the Center for Better Bones is to stick with domestic California dried plums (prunes). (PS an excellent source of organic California prunes can be found at www.OrganicPrunes.com)

For years we have known that bone density does not itself predict fracture, yet how many women have been told, and continue to be told, that they should take osteoporosis drugs based on their bone density? So I was delighted to hear noted osteoporosis researcher Dr. Steven Cummings declare that bone density testing was never intended to serve as a guide to treatment. He made this statement on September 11, 2009 at the annual meeting of the American Society of Bone Mineral Research in Denver.

As Dr. Cummings detailed, the T score definitions of osteoporosis (defined as -2.5 T or more) and osteopenia (defined as -1 T or more) were developed by World Health Organization Committee in the face of expanding bone mineral density testing. Researchers felt the need to define what was “normal” bone density, so they developed the “T scores” rating system distinguish how similar one’s bone density was to that of a young person of the same sex. These definitions were supposed to be guidelines for establishing normal ranges, not signals of a need for treatment with bone drugs.

Dr. Cummings went on to suggest, as I have suggested before, that treatment guidelines should be based on an individual evaluation of multiple risk factors as is offered in the WHO's FRAX tool, or better yet, in a more comprehensive fracture risk assessment like the one available on this site.

He also reminded his colleagues that another valuable way to assess risk of future fracture is by detection of previous fractures. While you well know if you have had a hip or wrist fracture, you may not know if you have a deformity, or fracture, of a vertebral body in the spine. An important new tool for detection of vertebral fractures is the “Vertebral Fracture Assessment" also known as a “Vertebral Deformity Assessment.” These tests, using either a spinal x-ray or a special picture from the bone density test can reveal of you have “hidden” vertebral fractures. If no deformities are found, no treatment is needed, but if such hidden fractures are found, taking action to strengthen bone is necessary. Existing fracture is the ultimate proof of bone weakness, and having such a fracture puts you at higher risk for further fractures.

Here at the Center for Better Bones, we try to give clients a realistic understanding of their fracture risk so that they know whether they need to take steps to improve their bone health. And we have a complete program that we tailor to their individual needs to help them do exactly that, without resorting to expensive bone drugs with unpleasant and unhealthy side effects.

Reference:

Cumming, Steven, “Identifying People Who Should be Treated to Reduce Fractures”. Presented at the “Osteoporosis: Focus on Fracture Prevention” Symposium, ASBMR Annual Meeting, Denver, 9-11-09.

At the 2009 annual meeting of the American Society for Bone Mineral Research, I had the opportunity to chat with an NOF health educator and was pleased to hear that this powerful organization is coming the recognize the importance of acid-alkaline balance for bone health. As you know, our research suggests that pH balance and chronic, low-grade metabolic acidosis is a major cause of bone loss. Even though the NOF does not officially endorse the idea of metabolic acidosis as a preventable cause of bone loss, they strongly recommend increased intake of alkalizing vegetables and fruits and reduced use of acid-forming caffeine and alcohol. Also, if you are interested in simple, safe exercise suggestions for frail individuals, you might look into the NOF publication Boning Up on Osteoporosis. The booklet offers simple, safe exercises that are helpful for the frail in clear risk of fracture. You can purchase it for $6.50 from the NOF website's store.