With Brenda Hutchins
Edited by Lou Gardner
In the lead article for my Substack, Doctors Don’t Know Shit from Shinola, I blasted the medical community for a long list of missteps, definitional inconsistencies, embarrassing ignorance, and outright fraud and deceit. The list was far from complete. And I doubt that I could ever make that list complete. I did, later, post articles about the miscarriage of Type-II diabetes treatment.
Trapped in the System
This post explains my refusal to get another DEXA® scan (or just DEXA) to check for bone loss due to my recent course of Prednisone®. A concern for possible osteoporosis is deserved for long-term use of high-dose Prednisone, but since, as yet, I’ve been on the drug for less than two weeks (and recently reduced the dosage to moderate-dose—and tapering off) and the standard arbitrary guideline designating long-term is three months, I hardly see any urgency about this. Besides, I have already betrayed my philosophy about this once, and the results (about two years ago) should have sufficed to allay my rheumatologist’s concerns for the moment.
I believe that my rheumatologist sincerely cares about my medical concerns. But she has no way of knowing or appreciating—nor is it fair for me to expect her to—in any sense our experience (Brenda’s and mine) with bone densitometry and that we don’t trust it. [I doubt if any doctor can, other than an extreme outlier such as Doug McGuff.] And I doubt I will ever get the chance to school her on what the medical establishment can never teach her. Nor could she ever identify with the fact that both SuperSlow exercise protocol (SS) and Timed Static Contraction exercise protocol (TSC) were developed by us as the most advanced approaches for osteoporosis (as well as for many other maladies) prevention and rehabilitation.
[Another factor that affects my reluctance to submit to the DEXA (and other tests) is that I am terrified of Orlando traffic. I am risk adverse. And I suspect that my doctors are unable to empathize with my evaluation that the risk to my limb and life (as well as to our 25-year-old car) far exceeds any benefit to learning the status of my bone density. Risk assessment has been an integral part of my career with exercise protocol development and I have long noted that few people—including many doctors—have the ability to appreciate the dangers of their everyday behavior.
I regard the DEXA scanning procedure, per se, to be relatively safe, but the medical community does not factor into its risk assessment the requirement for an impaired patient like me to travel to and from the test site.]
Our Experience with Densitometry
At the Nautilus-funded osteoporosis research project (wherein SS was developed… not TSC) in which Brenda and I worked for over three years (late 1982 to early 1986), we had experience with the prototype densitometry machines that led directly or indirectly to the present-day DEXA. They were called the DP-4 (dual photon absorptiometer) and the SPA (single photon absorptiometer).
The DP-4 (the much better of the two) had an error larger than the changes being recorded by the scans of our subjects in the study.
We saw blatant fraud with the researcher’s application of both machines, their reporting, and the statistical controls (as is often the case in medical papers) were sophomoric. We had first-hand experience with many kinds of corner cutting (corruption) to publish academic papers within a moderate-size company that ran “controlled studies” with new medications for various pharmaceutical companies.
[Note: The Nautilus osteoporosis project was predicated on the existence of these prototype densitometers.]
And with the bone densitometry prototypes, we observed unbridled greed to commercialize these products within the medical industry well before they were proven reliable.
The SPA was applied as a single linear scan (trace) across the distal forearm and its measurement was used to extrapolate the density of the entire skeleton… fantasy land. As the SPA was small, portable, and relatively inexpensive, the researchers figuratively salivated about mass marketing it in clinics until it was revealed at a major symposium (the 1984 International Congress of the Menopause) that its reliability was no better than a coin toss.
The concept of the SPA was also flawed with regard to its lack of repeatable positioning. The trace across the forearm could not be standardized. And attempts to manage this defect were ridiculous. When the problem was first revealed to me, I was shocked at the inherent stupidity involving these researchers sporting PhDs and MDs. For a while, they envisioned tattooing the women subjects to provide the technicians with a permanent positioning reference. Obvious to me, this was a mark, albeit tiny, on the soft tissues that was grossly mobile over the bone.
[Similarly, for over three decades, we observed the rampant fraud within the exercise physiology, orthopedic, and physical therapy communities to measure muscular strength with tools that we characterized as “rubber rulers.” Eventually, we came to realize that many of the researchers and doctors involved in this dangerous and expensive nonsense were actually honest and sincere, but incredibly stupid.]
Photos by Ken and Brenda Hutchins (1983): The SPA:
The DP-4 provided a whole-body scan. And its radioactive source depleted during the study. This, alone, would have (should have) terminated the study if the technicians had not otherwise opted to move the source away from the patient to “spread the cone of coverage.” This, of course, was both a scientifically invalid solution as well as dishonest.
Photo by Ken and Brenda Hutchins (1983): The DP-4:
I’m not against greed. It is naïve to hype the negatives of the concept. It drives our capitalist system. But it must be balanced with honesty.
[By the way, the late Arthur Jones—who as CEO of Nautilus Sports/Medical Industries, INC funded the osteoporosis research study with a pledge of $3 million over a term of nine years—simultaneously sold Nautilus in June 1986 and terminated the study. The research investigator(s) then sued Arthur for breach of contract (I suppose). About a year later, associated with this suit, Brenda and I were deposed to confirm that we had indeed authored the several reports to Arthur over the course of our stint with the study in which we expressed our opinions that the investigator(s) had been committing misconduct in the process of the study.
About 15 years later, Arthur and I were altercating about exercise protocol. Amidst this, he blurted to a common friend, “Well Ken and Brenda did save me $4 million in that lawsuit.”]
I don’t know if the DEXA is a reliable tool. It might be. I suppose that the technology has greatly exceeded the faulty prototypes. So what? Even if the tool is reliable, I don’t trust the people writing its software, running the machines, or interpreting the results of the measurements.
The system that the DEXA undergirds is fraught with even more corruption: arbitrary norms for comparison, definitional drift, and the blind assumption that the medical industry has anything to offer (other than fear) for osteoporosis if such is really confirmed in me or in any other patient.
Fear and Artful Terrorism
The Ratio of Fear
Arthur Jones asserted that fear is the most powerful motivator, but that it also often produces irrational behavior. Arthur also understood how to use terrorism.
A playground bully is a kind of terrorist. He applies fear and intimidation to achieve his ends.
In a lesser sense, perhaps, doctors often do the same thing. They attempt to raise concern—a euphemism for fear—while trying to temper unbridled fear in a patient. Unbridled fear is not a healthy condition, but the patient with a serious condition must be moved along what I see as a continuum: apathy… complacency… concern… fear… terror. Doctors struggle to strike a balanced psyche with the patient’s appreciation for their health status and appropriate measures to deal with it. I term this artful terrorism.
Also, there is what I call the ratio of fear. Using my personal potential for osteoporosis as an example: I fear the bone drugs far more than I do the osteoporosis. If I was an elderly woman with a small frame and a family history of osteoporosis, my ratio of fear might be reversed. Indeed, I might fear the osteoporosis far more than the bone drugs, especially if I did not know of the problems inherent with the bone drugs and if my doctor recommends them and if I am ignorant of the alternative treatments for osteoporosis that my doctor will not mention (discussed in later sections).
[The doctors don’t know the problems inherent with the bone drugs so how would many of their patients?]
As you read the following sections, please remain cognizant of the fact that osteoporosis is a life-threatening condition. It can produce sheer terror in its victims.
But let’s also admit that the DEXA is the tool of a terrorist.
[Ha! I suppose that a cynic might conclude—especially in light of the draconian measures imposed during both the 1918 Spanish Flu Pandemic and the 2020 Covid Pandemic—that medicine is a terroristic enterprise.]
The Bone Drugs
What is the next step for me if bone loss is indeed confirmed?… Any typical doctor’s answer: Of course… the bone drugs. And I regard the bone drugs as a one-way trip to more morbidity. I fear them almost as much as I do the Prednisone. And, depending on my Prednisone dosing, I fear the bone drugs much more than I do the Prednisone.
About twenty years ago (~2004), while I was openly sharing my distrust of the DEXA with Jeff Mueller, MD, I momentarily shocked him with:
But doctor, you forget the real purpose of the DEXA!... to scare the hell out of the women and to railroad them onto the Fosamax!
Mueller expressed doubt that any technician could place a patient in the DEXA twice in a reasonably repeatable position for comparison.
Michael Fulton, former orthopedic consultant for Nautilus Sports/ Medical Industries, stated that he does not believe that doctors know how to interpret the DEXA printouts.
I have personally observed the anxiety of patients who were told by their doctor that they had significant bone loss when, upon my close examination of the fine print at the bottom of the DEXA printout, the supposed loss was well below the minimum value (tolerance) for the machine’s accurate measuring capability. If I remember correctly, I later saw that this fine print was removed from the printouts from some of the DEXA testing sites.
In the early 2000s, I believe that there was only the Fosamax, and perhaps the Actonel, another bisphosphonate (BPN)-based drug treatment.
From what I can glean, all of the bone drugs listed in my subtitle (I suppose there are others) are BPN-based except for Prolia and Xgeva. But the effect of all of them (BPN-based or not) is the same. They are purposed to extinguish or diminish the osteoclasts. [Note that clast is part of the Reclast’s name.]
[Evenity® is a new bone drug by Amgen®. It works with a completely different mechanism than the other bone drugs mentioned herein—apparently not by hobbling the osteoclasts (see next section).
Osteoporosis is a serious, expensive, and prevalent condition; Perhaps Evenity is worth a try for some patients, but its side effects (one of which is balance impairment thus leading to more falls and more exposure to fractures and brain bleeds) seem daunting. The jury is still out. And can we trust the drug pushers who have moved on from their previous disasters to play with fire again? And how many times must we learn and relearn the lesson that the onerous side effects of new drugs are not realized until years after their introduction?]
Hobbling the Osteoclasts
All premed students, I believe, are required to take a course in histology, the study of tissues. I excelled in this particular coursework.
As part of this coursework, one learns that there are three types of bone cells. The osteocytes are your regular bone guys. When they age to the point of being decrepit, they are identified and removed by the osteoclasts, the bone demolition guys. And the worn-out osteocytes are replaced with new osteocytes by the osteoblasts, the bone reconstruction crew.
With current osteoporosis treatment philosophy, the prevailing notion is that the osteoblasts get behind in their work. They can’t keep up with the osteoclasts. And the wizards of smart have decreed that we must hold on to the existing osteocytes—even the decrepit ones—by hobbling the osteoclasts. This, on its face, seems a reckless course of action to me, but this is their treatment objective.
These people have no idea the downstream effect of these drugs. Just like with the statins (and other means to reduce serum cholesterol) these drugs cause mysterious havoc throughout the body that is ignored by the hubris of the medical community.
Perhaps sophomoric on my part, I envision the result of this hobbling of the osteoclasts as buying an old fixer-upper of a house that has rotting boards and merely painting over the rot. It’s a cosmetic fix and not an improvement in structural integrity. Note that this figuratively PhotoShop®ed image is registered in the lens of the DEXA. Pretty from the curb does not equate with structural soundness.
If one considers it further, it’s expected and natural that the osteoclasts stay somewhat ahead of the osteoblasts. Why would any reconstruction crew commence operation before the demolition of a condemned building? Essentially, the prevailing treatment objective is to do exactly that—to go about demolition and reconstruction in reverse order… In this case, skipping the demolition altogether.
Of course, the medical community has no idea of the exercise protocols I’ve developed—nor will they ever—nor do they consider bolstering the osteoblasts with vitamin D3 , vitamin K2 , strontium, and progesterone (or pregnenolone—precursor to progesterone).
[To her credit, my rheumatologist has occasionally mentioned vitamin D3 and gone so far as to measure it, but none of my other 10 current doctors have. Nor did anyone provide me with D3 during my long hospitalizations—a probable factor leading to my present condition. And my rheumatologist has said nothing about vitamin K2 which is important for the vitamin D3 to be effective and to ensure that the calcium remains in the bones and is not leached out to be deposited as calcifications in the heart, the vessels, and the kidneys (kidney stones). No doctor has advised me on phosphorous consumption, either for my kidneys or for my bones.]
[As I berated the docs in my lead article, few docs remember pregnenolone from the steroid hormone cascade and they are completely misinformed about progesterone—eternally confusing it with any one of the many disastrous progestins that are often prescribed to women by the gynecologists—example: Provera®. The progestin in Provera (actually contraindicated for osteoporosis) is not progesterone no matter the lie perpetrated on the doctors for the last 50 years! The progesterone is concealed from the doctors behind the veil of the progestins (substances synthesized from progesterone that have some progesterone-like effects). Progesterone is cheap, natural, and there is only one; however, there are many progestins. More are synthesized as PHARMA needs more patentable products. Ironically, I believe that I read that Prednisone is synthesized from progesterone.
A quote from the late John Lee, MD:
Doctor, you are giving this woman Provera. You are ordering tests for serum progesterone. Provera is not progesterone!]
And note that the treatments I suggest are not patentable, hence not substantially profitable. The involved substances are naturally occurring and of no interest to medical researchers and Big Pharma.
[25 years ago—in my naiveté—I mentioned to Doug McGuff, MD my dream to have SuperSlow exercise become accepted in the medical field with its own insurance codes and acceptance by the major medical insurance carriers. I believed that this would have given it the clout and recognition among the doctors and the medical schools. Horrified at my remarks, Doug responded, in effect,
Are you out of your mind? The medical and insurance industries will ruin SuperSlow. They will dilute it, will marginalize it, and make it unprofitable to administer as it needs to be applied.
Doug was both right and correct.]
Killing the Macrophages
The late Byron Richards wrote about another grave concern—and this one directly affects my defective immune system. He claimed that by killing off the precursor to the osteoclasts, we are doing the same to the precursor of our macrophages as the precursor is common to both cell lines… YIKES! I admit that I do not know of his references on this, and I do not have the wherewithal to chase them down.
[As I write this, a new observation arises, although it might be too alluring and convenient. Richards’ assertion makes sense in that both the macrophages and the osteoclasts are search-and-destroy entities. Both are specialized to identify and to dispatch foreign and/or defective residents in the body.]
Part of my immune system is crippled (the humoral side), but I have no reason to believe that that part involving the macrophages (the cell-mediated side) is deficient although it might indeed be. Even if I cannot substantiate Richards’ assertions about this issue, this causes me great concern… much more concern than osteoporosis at this moment.
[Perhaps Richards’ references can be found in his 2006 book, Fight for Your Health: Exposing the FDA's Betrayal of America.]
Inflame the Bone to Skew the DEXA Readings
Richards also suggested that the apparent improvements in the DEXA scans—ostensibly due to the bone drugs—were merely increased measurements of newly inflamed bone and that this inflammation was caused by the bisphosphonates, [Again, I doubt that Prolia and Xgeva were contemporaneous with Richards’ writings.], thus they registered false readings. This sounds reasonable (especially in light of fossy jaw—explained later), but again, I cannot provide a reference.
Fracture Rate
But the real bottom line—besides the questionable safety of the bone drugs—is this: Do they prevent or reduce fractures?
I don’t know the answer to this. Yes, I read papers claiming that they do lower fracture rates. But then I reflect on all the BS claims about the statins and myriad other medical products. I know what goes on in medical research and in the publish-or-perish mania.
Medicine is broken. Don’t expect it to get repaired.
Phosphorous
Another angle that I believe should be considered is phosphorous (P). P is essential for life. Consider its foundational role in ADP and ATP, the basic energy currency of the body. But P can have deleterious consequences when in excess [I suppose that excess P (P poisoning) could be regarded as kind of inflation of the body’s energy currency… Ha].
Consider the destruction of the kidneys by the P (in various iterations) added to soft drinks merely to give them a dark color. Chronic kidney disease (CKD) patients must restrict P whenever possible.
And can BPN break down to expose the body to additional P? [I don’t know the answer to this.] Is this another concern that I should have for my CKD? I suppose that my fear about the BPN is justified since the non-BPN bone drugs are recommended for patients with CKD.
And note that IF the BPN breaks down—it exposes the body to additional P—and leads to more osteoporosis, NOT less! Excess P upsets the P/Ca ratio to leach calcium from the bones!
The Twins: Fossy and Phossy
Phosphorous (P) is the foundation for two stories in medical history. Phonetically, they are identical. One is fossy jaw and the other is phossy jaw.
Fossy jaw gets its name from Fos-a-max in regard to the inflammation of the jaw by the bisphosphonates. This medically caused malady is screened for by dentists who are reluctant to perform dental work on patients treated with the bisphosphonates. The affected jaws tend to crumble as the dentists perform their work. [However, the Fos actually derives from the phos of phosphorous.]
And if fossy jaw occurs in the mandible, why would it not occur in other areas of the body? Hence, Richards’ assertion of improved DEXA data merely due to bone inflammation has some corroboration.
Phossy jaw is the 19th-century affliction of the so-called match-stick girls. Here, the Phossy is derived from phos-phorous. These women, and others who worked with P without protection, sometimes developed jaws that glowed in the dark. Enjoy the linked story.
https://allthatsinteresting.com/phossy-jaw
The Lipid Drugs: A Different Perspective on Osteoporosis
With lipid drugs, I am both referring to the statins as well as the new family of LDL lowering drugs represented by Repatha®.
With osteoporosis, we are also obliged to consider the lipid drugs with respect to the steroid hormone cascade. I have mentioned the cascade before, but I do not believe that have previously presented it. Please study its flow chart. Note that some of the arrows are one-way and others are two-way. [It is unfortunate that many representations of the flow chart do not show the two-way arrows. The two-way arrows are important, especially with regard to the so-called sex hormones.]
The objective of administering the lipid drugs is not to lower all cholesterol, but only to decrease the LDL (low-density lipoprotein) portion. But does this portion affect the downstream hormones in the cascade? We should first assume—until proven otherwise—that it does. And how in never-never land can anyone prove this?
The non-statin lipid drug, Repatha, was strongly promoted to me as not associated with the side effects associated with the statins. Authorities that I respect tell me that this is incorrect. If true, the statins—as well as perhaps the non-statin lipid drugs—cause rhabdomyolysis—a crippling condition that can be permanent even after cessation of the lipid drugs. We now know that at least the statins cause diabetes—a looming factor for both heart disease as well as CKD (while the prevention of heart disease is the stated objective of the lipid drugs). Also on the side effect list are ALS, cancer, and Alzheimer’s. The lipid drugs represent profound foolishness.
More particularly, how might the diminution of cholesterol—in whole or in part—affect or effect osteoporosis? As John Lee taught us: As we age—especially with women going post-menopausal—progesterone levels fall precipitously more than estrogen to present us (both men and women) with estrogen dominance. I submit that the estrogen dominance—greatly impacting osteoporosis—is exacerbated by the lipid drugs. Another measure to combat osteoporosis is to cease the lipid drugs! Another measure—as Lee championed—is to supplement progesterone (the real and only progesterone, NOT progestins!)
[Here are my private thoughts when my cardiologist enters the exam room and launches into his insistence that I take lipid drugs:
If you want to earn the right to preach to me about the lipid drugs, you first must prove to me that you can stand in front of me and draw the steroid cascade. Second, you must explain to me how you’re going to meddle with my cholesterol and not mess up all my steroid hormones. I am a dumb-ass with no college degree who can draw out the cascade amidst moderate Prednisone-induced brain fog. As my highly educated doctor, if you can’t do this for me, then shut up about the lipid drugs.]
So if I acquiesce to take the lipid drugs, will the cardiologist then follow up with tests regarding my progesterone and testosterone levels?… No.
Is this concern even in his mind?… No.
And if he performed these tests and these (and perhaps other) hormones were shown to be deficient subsequent to the lipid drugs, what then?
And would he know that the blood tests with which he checks all the other markers in my body with are worthless for estrogen, progesterone, and testosterone?… NO.
[Although it’s interesting to compare hormone tests via typical blood testing (drawn and centrifuged) to saliva testing, saliva testing and dried blood spot testing are the only methods to obtain accurate hormone testing. Many doctors don’t know that the active hormones residing on the red blood cells that are typically separated from the serum and disposed of to leave the inactive hormones (scheduled for excretion) in the serum are erroneously measured. (I’m not sure how this affecs measurements of all the hormones, for example, thyroid hormone.)
The dried blood spot testing is reliable as the dried blood from the patient’s pierced finger has not been centrifuged.
Another issue: While some doctors have become wary of the deficiencies of the standard blood draw for hormone measuring with labs like LabCorp® and Quest® recently offering saliva testing, I am advised that these labs do not have the necessary protocols in place to control contamination and timing of the collections.
If you’re serious about accurate testing for your hormones, seek ZRT Labs in Beaverton, Oregon. The ZRT people know what they are doing.]
So with deficient markers from a standard blood draw, my cardiologist might then send me to an endocrinologist, who in the case of deficient testosterone, would prescribe testostine (my coinage for a non-bioidentical testosterone). And if I want bioidentical testosterone, the endocrinologist would likely wash his hands of me and leave me to find an alternative care doctor who will cost me out-of-pocket money to prescribe me out-of-pocket testosterone.
[Endocrinologists try to slam bioidentical hormones as somehow inferior. Jonathan Wright, MD completely shuts down their argument with (paraphrased):
If I could draw your testosterone out of your arm with a syringe and then immediately plunge it back in, what’s your problem?]
[Although I may be mistaken, I don’t believe that John Lee mentioned statins as a possible progesterone robber... hence a concern for osteoporosis.]
More About Estrogen and Progesterone Treatments for Osteoporosis
I regard estrogen-replacement therapy (ERT) as an obsession by the medical community. The doctors seem blinded to the existence of progesterone while they typically overdose women on estrogen that is derived from horses and not bioidentical. In essence, conventional ERT is not truly ERT. [Nor is conventional HRT (hormone replacement therapy) truly HRT.]
I rarely encounter mention of progesterone regarding osteoporosis treatment in the mainstream medical sources. The overwhelming emphasis—if hormones are discussed at all with regard to osteoporosis—is on estrogen. And while there are women who indeed need estrogen supplementation, the medical community seems to overlook the greater importance of progesterone.
Per John Lee: Roughly two-thirds of all post-menopausal women under the age of 80 produce plenty of estrogen from their fat stores.
Also, doctors ignorantly seek to measure active estrogen (as they do testosterone and progesterone) in the blood serum and don’t know that either a blood spot test or a saliva test is required—not a blood serum test.
Then they respond to the inappropriate blood serum measurements by treating the patient with typically eight times the required dose of the mare-derived estrogen (Premarin®) when the patient is most likely suffering from estrogen dominance and actually needs progesterone, NOT more estrogen and CERTAINLY NOT any of a non-bioidentical estrogen that will often promote breast cancer.
During the Nautilus Osteoporosis study, subjects were required to be either naturally or surgically menopausal. The surgically menopausal subjects were often younger women who had had hysterectomies to cure their endometriosis. As all subjects were required to be on opposed estrogen (PremPro® = Premarin plus Provera), some of these surgically menopausal subjects had a return of their invasive endometriosis although they had no functioning ovaries [Although the ovaries may not be removed with hysterectomy, such patients are effectively castrated while being led to believe that their ovaries remain intact and functional.] and no physically present uteri! [Unfortunately, this study occurred before information was available from Ray Peat and John Lee, although I doubt the gynecologists administering the study would have been receptive to their insights.]
[Note that progesterone supplementation is the ideal treatment for endometriosis and almost always completely obviates the need for hysterectomy when indicated purely for this malady.]
From John Lee:
For decades, the makers of Premarin and other estrogen manufacturers would have had us all believing that estrogen loss is the major hormonal factor in osteoporosis in women. Fortunately that myth is beginning to change [Lee now seems to have been mistaken about this.]. We know that significant bone loss occurs during the 10 to 15 years before menopause, when estrogen levels are still normal. In the United States, peak bone mass in women occurs in their mid-30s, and a good percentage of women arrive at menopause with osteoporosis well underway. The more important factor in osteoporosis is the lack of progesterone, which causes a decrease in new bone formation. In women with low bone density, adding progesterone can actively increase bone mass and density and may reverse [Lee’s emphasis] osteoporosis.
Note that Lee was promoting the bolstering of the osteoblasts in contrast to the hobbling of the osteoclasts—often the theme with the bone drugs!
Jerilynn Prior, MD has documented that the osteoblasts do indeed have receptors for progesterone!
Summary
What are we doing here with the bone drugs? I know that I’m not going to comply with my doctors regarding another DEXA as it is merely on a one-way track to an unpalatable destination—the bone drugs. And the bone-drug treatment plan is nuts.
I do take plenty of vitamin D3, vitamin K2, progesterone, and strontium. For now, however, exercise is not a reasonable option due to the status of my Still’s disease. [And restricting phosphorous is EXTREMELY important!] Notwithstanding the Still’s disease, TSC exercise is the most direct pathway to bone stimulation. UK biologist, Lance Lanyon, PhD confirmed this for us with his research involving turkeys.
Osteoporosis is more my domain than it is the doctors’. And the Standard of Care advocates who uphold the closed-minded treatment guidelines for osteoporosis do not care what I have to say about it.
Suggested Resources
As you might appreciate, there are many pitfalls regarding this subject that the typical doctor cannot protect you from. Your only recourse is to master the related subject matter beyond their competence.
For example, a close friend who was a urologist asked me why I did not go ahead and use a synthetic testosterone since it had the identical biological effect as the bioidentical version (a typical statement from an endocrinologist). As I suspected, he was completely misinformed about the subject.
Read (study) the following books in this sequence:
Books by John Lee, MD:
What Your Doctor May Not Tell You About Menopause
What Your Doctor May Not Tell You About PreMenopause
What Your Doctor May Not Tell You About Breast Cancer
If you can obtain videos of John Lee presentations, do so. Here is my favorite and it is available on YouTube:
Natural Progesterone: The Breakthrough Treatment for Menopause
Book by TS Wiley:
Sex, Lies and Menopause
[Note: Some may need to seek help with the Wiley Protocol. It is a protocol that oscillates hormone dosing with moon phase.]
Another excellent and important article.
The ideas make me think of some of the work of Ray Peat who has written on the role of steroid hormones with respect to bone density. Eg
“a deficiency of thyroid and progesterone can account for many of these changes. Nencioni and Polvani have observed the onset of progesterone deficiency coinciding with bone loss, and have emphasized the importance of progesterone's antagonism to cortisol.”
From https://raypeat.com/articles/articles/osteoporosis.shtml
These ideas make osteoporosis a metabolic issue to be addressed by looking more broadly than the crude drugs you mention.
Peat also calls attention to the need to reduce the phosphorus/calcium ratio as excess phosphorus has problematic effects as you note. Eg
“For about twenty years it has been clear that the metabolic problems that cause calcium to be lost from bones cause calcium to increase in the soft tissues, such as blood vessels. The role of phosphate in forming calcium phosphate crystals had until recently been assumed to be passive, but some specific "mechanistic" effects have been identified. For example, increased phosphate increases the inflammatory cytokine, osteopontin (Fatherazi, et al., 2009), which in bone is known to activate the process of decalcification, and in arteries is involved in calcification processes (Tousoulis, et al., 2012). In the kidneys, phosphate promotes calcification (Bois and Selye, 1956), and osteopontin, by its activation of inflammatory T-cells, is involved in the development of glomerulonephritis, as well as in inflammatory skin reactions (Yu, et al., 1998). High dietary phosphate increases serum osteopontin, as well as serum phosphate and parathyroid hormone, and increases the formation of tumors in skin (Camalier, et al., 2010). Besides the activation of cells and cell systems, phosphate (like other ions with a high ratio of charge to size, including citrate) can activate viruses (Yamanaka, et al., 1995; Gouvea, et al., 2006). Aromatase, the enzyme that synthesizes estrogen, is an enzyme that's sensitive to the concentration of phosphate (Bellino and Holben, 1989).”
https://raypeat.com/articles/articles/phosphate-activation-aging.shtml
Ray Peat was a fascinating thinker. Increasingly I find parallels with your work. Pear unfortunately didn’t give much attention to exercise - accurately defined or not - yet he certainly was no fan of stressful “aerobics”.
Well, I do care, Ken. Mom, in her 70’s, broke her hip and died within a year. I, now in my ‘70’s have had it bad since my ‘50’s (osteoporosis). I’ve been offered all the drugs, which I refuse. I’ve been doing SuperSlow training since 1999. Yes, I’ve fallen a few times, no, I don’t break anything. Thank you for the outstanding article, and for being a health advocate for us.