Estrogen On October 13, 1993, CNN broadcast a medical article regarding estrogen replacement therapy and osteoporosis. Although the presentation was upbeat to sound novel and progressive, the information seemed to be a rehash of the same notions present in 1982 at the Nautilus Osteoporosis Project. CNN interviewed Dr. Ettinger, MD, a familiar name to us as we attempted to unravel the mystery of osteoporosis ten years ago.
The Nautilus Osteoporosis Study Morris Notelovitz eventually published (Notelovitz M, Martin D, Tesan R, Khan FY, Probart C, Fields C, McKenzie L. Estrogen Therapy and Variable-Resistance Weight Training Increase Bone Mineral in Surgically Menopausal Women. Journal of Bone Mineral Research 1991; 6:583-590) data obtained from the Nautilus Osteoporosis Project. Based on what I heard, saw, and what I was advised by Keith Johnson, MD, regarding the reliability of the measuring tools; the Project was a washout. The data should not have been published. Perhaps the shortcomings of the study were highlighted in the publication -- as I have not read it -- to put its data in a proper context of suspicion.
Nevertheless, I, indeed, have read a review of the Notelovitz paper by Brian P. Conroy, MA, William J. Kraemer, PhD, Carl M. Maresh, PhD, and Gail P. Dalsky, PhD (Medicine, Exercise Nutrition, and Health). Conroy et al. reported: that the bone mineral increases of the exercise group were "large but nonsignificant. . . . However, modification of some key program variables may have led to much greater adaptation in bone." These authors go on to recommend:
At the Nautilus Osteoporosis Project, we devised a protocol -- SuperSlow -- specifically designed to meaningfully load the skeletal muscles in such a way as to avoid destroying the delicate skeletons of osteoporotic women. The involved slowness optimized muscular loading and minimized force, the objective of which Conroy et al. is embarassingly ignorant. The load synergist and stabilizers argument is common exercise physiology nonsense; as it is impossible to avoid synergy and stabilization in the most isolatory and supremely tracked movements in exercise machines.
Conroy et al. are also backwards and uninformed of our extreme and deliberate avoidance of exercises that applied longitudinal compression forces. This is exactly why the Nautilus Duo Squat was removed from the premises. Such longitudinal spinal compression forces applied to an elderly woman is malpractice.
Later in their review, the Conroy et al. recommended for structural exercise the application of such lifts as squat, bench press, dead lift, snatch, clean and jerk, and various pulling-type lifts performed by weight lifters.
That four supposed experts, three of which were Ph Ds, gave such recommendations is outrageous. Their beliefs are frightening. To appreciate that these nuts are authoritatively recommending exercise to doctors and other people gives me cause to support censorship. [And, for the record, I am opposed to censorship.] Well, don't they have a right to their own opinion? No! Not when they express it to innocent and equally ignorant people who will permanently injure themselves following their advice.
Osteoporosis Research from MedX At the 1993 Spine Symposium hosted by MedX in Orlando, Florida; Michael Pollock, PhD, reported a 14-15 percent increase (within six months) in spine bone mineral density among subjects ages 60-82. Eight male and nine female exercise subjects -- all who were nonosteoporotic, however several were considered to be osteopenic (lower than normal) -- exercised one time each week on the MedX Lumbar Extension machine. In all, 38 subjects were divided into three groups: a control group (6); aerobics training (15); and the MedX group who also trained on a treadmill. (Obviously, Pollock can not get the treadmill fetish out of his system either.) A larger, more significant study is planned.
This raises further questions: Is the densitometry used by Pollock reliable? I am told that it is by people that I respect, but I have heard this before a la the Nautilus Osteoporosis Study. This study was doomed, regardless of my intervention, because it was subsequently discovered that the bone measuring devices on which the study was based, were defective. If Pollock's findings are shown to be valid and repeatable, I foresee several changes looming on the horizon. They may never come to pass, but they appear probable.
Many women consider their OB/GYN doctor to be their primary care physician. Some OB/GYN's suspect that the estrogen replacement therapy may increase the chance of breast cancer. With little doubt at all is the consensus that such therapy gives much needed protection against osteoporosis. If Pollock's results prove out and are widely publicized, the OB/GYN may find himself at the center of medicine, not just gynecological medicine.
I believe -- and I do not intend this to be a derogatory observation -- that many OB/GYN's are weary of their major medical role. They are tired of the drudgery of delivering babies. They secretly dream about the prospects of doing something progressive. Some would like to be involved in physical fitness.
Most orthopedic surgeons and neurosurgeon are not actively interested in conservative treatment of back conditions. They make their money doing surgery and only a small percentage of their ranks are prime candidates to operate a MedX rehabilitation program or to focus on muscular strengthening for their patients.
To me, it appears natural that the OB/GYNs will either open gyms as part of their clinic operation or develop professional relationships with already-existing health clubs. In so doing, they will aggressively approach strength training on the MedX Lumbar Extension machine as osteoporosis prevention. Also, they will have the MedX equipment that is not presently appealing to the other doctors.
I further predict -- assuming Pollock's findings are repeatable and are well-publicized, and also assuming that the estrogen-cancer link is substantiated -- that SuperSlow Strength Training will largely replace estrogen replacement therapy as a hedge against osteoporosis. (Note that estrogen replacement therapy is prescribed for other menopausal complaints: vaginal dryness, hot flashes, etc.) Some previously-pharmaceutical dollars will flow directly to the OB/GYN and his clinic. Some of the present dollar flow that typically goes to the general surgeon for mastectomies will also go to the OB/GYN. And since the OB/GYN has the MedX that the Neurosurgeons and Orthopods shunned, the OB/GYN would be the expert on those back conditions that are candidates for conservative treatment. Therefore the OB/GYN gets much of the traditional neurosurgical and orthopedic dollars.