Dr. Susan Brown’s 2020 Predictions For Bone Health

It's time to polish up my crystal ball and make my 2020 predictions for bone health! With so much new research to draw from, I see a year filled with bone health advancements. Take a look at what I think will become true in 2020 for osteoporosis, fracture risk assessment, bone health nutrition -- and much more.

Prediction: Osteoporosis will no longer be diagnosed through bone density testing. Thoughtful doctors will move away from using the infamous bone density -2.5 T score for deciding who has osteoporosis.  This change will stem from a growing awareness that most osteoporotic fractures occur in people who have osteopenia or even normal bone density.  Scientists will scramble to set new criteria for the diagnosis of fragile bones.  Caution alert: You will see a move toward using CT scans to assess bone strength and diagnosis osteoporosis.  Think twice about this as CT scans expose involve high levels of DNA damaging radiation.

Prediction: Osteoporosis stem cell therapy will surface. Stem cells are cells with the potential to develop into many different types of cells. Mesenchymal stem cells are important to bone as they can develop into bone-building osteoblasts (favoring development of bone strength) or bone marrow fat cells (which weaken bone). You will be hearing of important plant compounds which influence these mesenchymal stem cells to morph into bone- building osteoblasts rather than bone-damaging bone marrow fat.  Curcumin, quercetin, vitamin C (ascorbate), resveratrol, olive and green tea compounds will be used to favorably activate these stem cells. 

Prediction: Alterations in gut microbiome will be fully documented to enhance bone strength. Scientists have already documented that those with fragile bones have altered gut microflora. The next step will be to identify which type and what balance of microflora serve to reduce bone loss and strengthen the skeleton. 

Prediction: The Australian Bone Clinic will scientifically prove that older women can reverse osteoporosis. The myth that older women cannot regain lost bone mass is about to be busted in a big way by female scientists down-under.  The Australian Bone Clinic will lead the way documenting that with just 2 weekly sessions of well supervised high impact strength training older women can build bone strength and reverse osteoporosis. Keep an eye on the clinic's work. 

Prediction: Personalized multiple risk factor assessment will become the most accurate way to predict real fracture risk. The “one size fits all” approach to predicting fractures by T score is clearly ineffective.  In its place you will see individualized multiple risk factor assessment.  As osteoporosis authority Dr. Robert Cummings documented decades ago, the vast majority of osteoporotic fractures occur in a small percentage of individuals exhibiting a high number of bone-depleting risk factors. Interested in assessing your total load of fracture risk factors?  Consider taking the Better Bones quiz.

Prediction: Doctors will begin recommending their patients supplement with a wide range of bone building nutrients, not just calcium and vitamin D.  Daily we see new research detailing the vast nutrient influences on bone healthFor example, a recent scientific review article detailed 16 nutrients as key for bone health. One day soon mainstream researchers will catch up with us and recommend appropriate levels of all the 20 essential bone-building nutrients  we identified 2 decades ago. 

Prediction: China will be recognized as the world’s leader in osteoporosis research. China’s need to prevent fracture among its massive and ever-increasing aging population will stimulate an impressive burst of osteoporosis research. Their research will be all encompassing including validation of traditional Chinese herbal formulas and acupuncture for osteoporosis, Qi Gong and Tai Chi to reduce fracture risk, pulsed electromagnetic field therapy and vibration platform therapy for bone, as well as bone drug development. 

Prediction: The “redistribution of bone” phenomenon will see the light of day. Quite by chance a handful of researchers have detected a phenomenon by which both weight lifters and water polo athletes gain bone mass in many parts of the body but lose mass in other part of the skeleton.  They detected that with loading exercise bone can be redistributed. For example, both male and female weightlifters have been found to gain bone mass in hips and arms, but lose bone mass in the skull. Specifically, male weightlifters were found to have 3% higher bone density in the total body and 10% higher hip density, yet their skull bone was 10% less dense than that of non-athletes.

Female weight lifters also build substantial bone in the total body and hip yet had 7% less skull bone density than controls. Similarly, water polo athletes were found to undergo a redistribution of bone mass from the lower limbs to the upper limbsThe same redistribution of bone can occur when using bone drugs.  For example, it was recently reported that recombinant human parathyroid hormone drugs (Forteo®) increased bone density of the lumbar spine, but reduce bone density of the hip.

Prediction: Doctors will be required to tell patients of the Number Needed to Treat” when prescribing a bone drug.  The Number Needed to Treat” is a calculation that reveals how many people need to be treated with a particular drug to see the claimed benefit. Recently the Journal of the American Medical Association mentioned that the Number Needed to Treat” for bisphosphonate drugs like Fosamax and Reclast was 77Specifically, it was reported that 77 women had to be treated for 3 years with these bone drugs to prevent one single hip fracture. Even worse, an international study I reported on earlier found that 175 postmenopausal women with bone fragility had to be treated for 3 years with bisphosphonates to prevent one single hip fracture.  In other words, imagine you go to the dentist with a tooth ache, finding decay he says, I recommend this new dental filling, serious side effects have been reported, but I really like it, and one out of even just 77 people will find it stops future decay in this tooth. 

Tip: When bone drugs are recommended, ask your doctor to give you the “Number Needed to Treat” and to show you the research documenting this.  Remember that those with the most risk factors stand to benefit the most from bone drugs.

Prediction: Bone quality will be found more important than bone density. Realizing that bone density does not accurately predict fracture, scientists will expand their search for non-invasive ways to measure bone quality and strength. Muscle mass and strength will be proved to reflect bone strength better than current bone density testing. Also novel techniques will be developed to assess quality of the living bone protein matrix. Among other things, skin ultrasounds will be used as markers of bone collagen maturity and connective tissue health.  

Futuristic prediction for the new decade…   The 2020s will witness a mass awakening of human consciousness, creating an appreciation for the dignity and oneness of all humanity and a demand for protection for our natural environment, our Mother Earth.  

Let's see what comes true and please know that I am wishing you an abundance of peace, happiness and great blessing for improved bone health in 2020 -- and beyond!