With Saturn entering Pisces it seems appropriate to talk about dissolving bones and how I came to be diagnosed with osteoporosis. The saga begins a few years ago when I broke my wrist after being rugby-tackled to the ground by an overexcited dog. (Not much of an exaggeration!) Luckily this happened in 2019, just before the corona madness descended and the NHS imploded after decades of wilful neglect and mismanagement.

The doctors and nurses at the fracture clinic were great, although rushed off their feet, and the physiotherapists who helped to rehabilitate my wrist after the cast came off were fantastic.

That changed when I moved over to the disease side of the healthcare service, rather than the ‘patch it up and wait for it to heal itself’ side. The disease side is part of a whole industry dedicated to dodgy medications, suspicious diagnostic techniques, and even the wholesale redefinition of conditions in order to sell more drugs. And the attitude of my GP didn’t help.

With hindsight, I wish I’d kept my gob shut. Little did I know the power of the word: post-menopause. As soon as you pass that milestone, a whole world of diseases opens up to you! 🙄

The truth is that if I hadn’t mentioned that I was post-menopause at age 49 the doctors wouldn’t have considered my fracture unusual. The doctors at the fracture clinic didn’t and it certainly wouldn’t have been called a fragility fracture. If I’d fallen like that 10 years earlier my wrist would still have broken.

I didn’t believe that I had osteoporosis and, in my ignorance, suggested it might be a good idea to get myself checked out just in case. This was because my mum also broke her wrist in her early fifties and was subsequently diagnosed with osteoporosis. Her fall hadn’t been as bad and the doctors were concerned, especially since she had taken steroids in the past and these can thin your bones.

My health situation was obviously different and I assumed the diagnostic process would be able to discern that. I was wrong. I had strayed into the murky world of ‘risk factors.’

To diagnose osteoporosis various risk factors are taken into account, like family history, age, lifestyle (exercise and diet), previous fractures, and if you’re a woman whether you’ve been through the menopause. It’s more common in women than men because women tend to be smaller and lose bone more quickly at menopause because of the loss of oestrogen.

This means you’re at a higher risk of developing osteoporosis if you have an early menopause, i.e. before 45, and it’s even higher before 40. The average is age 51. Some medical conditions and certain drugs also make it more likely.

So my risk factors were starting to pile up: I had an early menopause at age 45 and I’d broken my wrist, my mum had osteoporosis and had broken her wrist, and there’s also a history of parathyroid and thyroid problems in the family. Almost a full osteoporosis bingo card.

The next step was to get a blood test to evaluate the levels of various factors and a bone density test called a DEXA scan. At the start of this process, my GP was thorough and reassuring. She did an online FRAX evaluation, which gave me a 7.5% risk of a major osteoporotic fracture in the next ten years and recommended my bone mineral density (BMD) be measured. Here’s the readout of the FRAX score:

You can see I’m just above the intervention threshold. The blood tests checked for anaemia, thyroid and malabsorption issues, inflammation markers, and vitamin levels, plus something called Beta Crosslaps for bone reabsorption levels. These came back fine and crucially, the Beta Crosslaps was normal so my bones weren’t turning over too fast.

The only problem was my vitamin D levels were low so the doctor advised me to get a supplement. I was already taking one but it obviously wasn’t enough – an easy thing to fix. (Interestingly, since increasing my vitamin D levels, I haven’t had a single cold or flu.)

At this point, I was confident that the bone mineral density test would turn out fine too. So off I went to the Rheumatology department at the local hospital to see the specialist and get a scan. The DEXA scan (or DXA) uses X-rays to scan your bones but they also input details of your risk factors so the machine can calculate your bone density.

The result was a shock. I had osteoporosis. The specialist explained the results and showed me the graph: both my spine and hip were in the red zone, although the spine was just on the edge of it. And a new FRAX score gave me a 12.2% risk of a major osteoporotic fracture in the next ten years – a jump of almost 5%.

She explained that my bones were turning over too fast and the new bone wasn’t being made fast enough to replace the old bone as it was destroyed. So I needed to take medication (Risedronate) to slow down the loss of bone – completely ignoring my normal Beta Crosslap blood test.

She didn’t believe I had no back pain and was annoyed that my early menopause had gone untreated. (I would’ve refused HRT if it had been offered anyway.) She asked how much exercise I did, but didn’t give any advice about what I should be doing or avoiding. Her only advice was to take the drugs. She explained how it worked and went through the long list of side-effects. I got the feeling she was trying to downplay them because she looked uncomfortable, but maybe I was projecting.

Most of the information went over my head because I was too busy scowling at the screen and thinking, “This is bullshit!” She interpreted this as me being cross with my family inheritance of bad bones.

But my instincts were kicking up a fuss and starting a mini war inside myself. I managed to ask a few questions and then stumbled out of the hospital to get the bus home.

I sat on the bus feeling old and frail, suddenly worried about knocking into things and accidentally breaking a bone. Was I an old biddy now? Destined to become stooped and crippled as I shrank closer to the grave. I began to beat myself up for not looking after myself properly.

Many years earlier I had suffered a bout of ulcerative colitis that had left me malnourished and made my hair fall out. Perhaps that had made the bone loss worse, as well as pushing me into an early menopause. I had healed my guts without using pharmaceuticals and was scared of taking anything that might make me ill again.

And now I was paranoid about falling over too. It was as if the doctor had put a spell on me, like a hex from the bad fairy.

Eventually I calmed down, got my fears under control and gave myself a stern talking to: I’m NOT old and I’m NOT frail!

Then I went looking for more information and got annoyed all over again because osteoporosis is generally presented as an old person disease. Much of the advice seems to be aimed at people over 65 and it made me feel old just looking at it!

But I was most alarmed by what I discovered about the medication that I’d been prescribed. Osteoporosis is treated using drugs called bisphosphonates which have a reputation for being incredibly toxic with side-effects like necrosis of the jaw, cancer of the oesophagus, and atypical femoral fractures. Those are the rare ones, but the common ones aren’t much better, including bone and back pain, gastrointestinal problems and bleeding guts, headaches, inflammation and blurred vision.

And for all this it’s not clear the medication even works. A study in 2015 found that these drugs were ineffective at reducing fractures and that the main culprit was falling over, not bone density.

You don’t say.

The same study suggests that improving diet and exercise routines can help to build stronger bones without the dreaded side-effects of the medication. So I decided to discuss this option with my GP to see if they were willing to work with me on this plan.

The appointment was in January 2020, the day after the Saturn Pluto conjunction which fell in my 12th house and was trine my natal Saturn. It didn’t go well.

After sharing my concerns about the medication and my worry that it would adversely affect my bowels, she said I should try it and see what happens rather than just assuming it would be bad. From her perspective this makes sense. But I know how my body reacts to toxic chemicals and wasn’t willing to take the risk – it took more than a year to heal my guts last time they flared up.

She tried to claim that the side-effects were limited to the oesophagus (throat) rather than the gut. But I knew this wasn’t true, and besides, how does the medication get into your bones? It has to go through your gut to be absorbed into the bloodstream. Even I know that and I’m not a doctor.

When I suggested tackling the osteoporosis using diet and exercise, she fixated on the fact that I would need to take supplements anyway and totally ignored the question of exercise. She seemed oblivious to the idea that exercise could help to build bones at all, which is odd considering that’s exactly how it works.

The medication slows down the breakdown of old bone which helps the bone building cells to catch up. I tried to suggest that this actually creates weaker bones in the long run because you’re building new bone on top of old dead bone. This means your bones appear to have more density (on a scan) but the quality of the bone isn’t necessarily stronger.

She breezed right past that using her best reassuring doctor’s voice. And then told me that people can break their vertebra over nothing – it just happens. I said surely that’s just older, frail people who can’t get out of a chair, and she denied this, saying it was across the board, and added:

“I’m not trying to scare you.”

This is classic gaslighting. She was definitely trying to scare me into thinking I could break my back. I haven’t been able to find evidence of her claim so I’m not sure it was a lie. But at the time, it certainly felt like one and I was furious. 😡

She must have realised that she’d overstepped a line because she told me I was entitled to a second opinion and started listing all the other doctors in the practice – which was a bit weird. I just wanted to get out of there.

In amongst all the scaremongering, my GP did mention the possibility that if you believe a medication is going to be harmful then it’s more likely to trigger side-effects. This is often called the nocebo effect where your negative expectations of treatment make it worse – the opposite of the placebo effect. So the fear that you might get ill can actually make you ill. Fear also causes tension and stress that can make you ill too.

However, there’s also something called iatrogenic injury or trauma, from iatros, the Greek for physician, where medical treatment or drugs cause harmful effects – otherwise known as side-effects. Medical treatment can also cause so much stress and anxiety that it makes your condition even worse.

I certainly experienced a low-grade version of the nocebo effect while receiving my diagnosis of osteoporosis. It must be much worse for those diagnosed with cancer and other equally nasty diseases. On the one hand, the fear of the disease could push you into accepting a treatment that might not be in your best interests. On the other hand, fear of the treatment may push you to reject an intervention that could help.

The nocebo effect has ethical implications for how doctors inform patients of the side-effects of a particular treatment. It complicates the need for informed consent and the language used when describing symptoms. Less harmful side-effects can be downplayed, like headaches or constipation, and alternative treatments can be given to deal with the side-effects – usually more drugs.

The trouble is, how do you tell the difference between a genuine iatrogenic injury or side-effect and one caused by the nocebo effect? It seems a convenient way for doctors and pharmaceutical companies to minimise the harms they may be responsible for – they can wave them away as being the patient’s fault. It’s all in your head – stop worrying and take the damn medicine!

All this presupposes that the disease being treated is even a real problem and not an artefact of dubious diagnostic practices. We’ll explore this possibility next by looking at how osteoporosis is diagnosed using the FRAX score and DEXA scan in Bone of Contention: Osteoporosis Scans and Statistics…

Obviously, nothing in this post should be taken as medical or health advice and you should always do your own research and talk to your doctor (if you can find a good one!).

Images: X-rays, Cobwebs; Skeleton; Blurred

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