Feeling Fragile?

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Osteoporosis is still thought of as an old lady’s disease, although statistics show one in five women over 50 have it. Yet screening guidelines recommend we get Dexa scans at age 65, meaning years of potential preventative care are often overlooked.

Longer life spans — and the introduction of GLP-1 medications — will cause more of us to be at risk, including men. Once you have osteoporosis, there are a few drugs available, but rare-yet-horrifying side effects (or other medical issues) can be an understandable deterrent. Hormone therapy can help, but not every woman is a good candidate. 

All of this to say that osteoporosis is a complicated topic, as most health issues are. 

That leads us to this week’s feature, and the humble – some might say maligned – prune. Can eating them really help prevent bone-density loss, or is this information all just the work of “Big Prune” aka the California Prune Board? Read on for answers, plus a few recommendations for your weekend.

Bye,
Your friends at Gloria

My friend DB bounded down the stairs carrying a huge bag of prunes. She was visiting for a few weeks and brought her own supply. "I eat five every day," she said, chewing. "For osteoporosis."

Results of a randomized controlled trial, published in 2022, suggest that eating prunes could help postmenopausal women prevent bone loss. Researchers measured the hip bone mineral density of a control group, who ate no prunes, and of a group that ate 50 grams of prunes per day. That's roughly five or six prunes, depending on size. After a year, the control group lost density while the prune-eaters did not.

Prunes came into the picture for DB after the American medical system left her in a holding pattern. In 2018, she was diagnosed with osteopenia, or bone density loss, often a precursor to osteoporosis. Six years later, her general practitioner ordered her a DEXA scan (also called a DXA scan), a type of bone density test, that landed her with an official osteoporosis diagnosis. After the scan, DB should have seen an endocrinologist with expertise in treating older women, but the only one nearby and in her insurance network had just retired. The hospital was searching for a replacement. "I was trying to find things that I could do in the interim," DB said.

Her general practitioner prescribed ibandronate, sold under the brand name Boniva, a medication for osteoporosis. DB took the oral version once and ended up passed out on the floor.

She returned to her GP and said she would not take ibandronate again. That's when she brought up "the prune study," as it's often called. "I told her, 'This is what I'm going to do.' And she said, 'Yeah, there's some evidence that it may or may not help.' I think she just wanted me to take the medicine," DB said.

Anyone can develop osteoporosis at any time, though risk increases with age. It's more common among women than men, and the risks for women start going up about one to two years before menopause due to a decrease in estrogen. Osteoporosis is more prevalent among non-Hispanic white women and Asian women than other ethnicities. People taking certain medications, such as cancer medications and glucocorticoid steroids, have a heightened risk of developing osteoporosis, as do people with a family history of the disease. It's more prevalent among people who have had food-restrictive eating disorders and those with a small body frame, possibly due to them having less bone mass to draw from, says the Mayo Clinic.

Because osteoporosis is typically symptomless, it can go undiagnosed unless patients are proactively assessed for it, usually with a DEXA scan. (See a video of a DEXA scan here.) These scans may be covered by insurance, and the age at which you need your first one is determined by your doctor, though 65 seems to be the recommended age for people without many risk factors. DB was advised to get all follow-up DEXA scans on the exact same machine where she had her first one to make the readouts as comparable as possible.

Ibandronate isn't the only pharmaceutical treatment for osteoporosis. There are monthly pills, quarterly injectables, and annual intravenous infusions. Some of the side effects are terrifying, like osteonecrosis ("bone death") of the jaw – a risk mostly limited to "people taking intravenous bisphosphonates [including ibandronate] to treat cancer that has spread to the bones, or in women who are on long-term, high-dose bisphosphonates," according to Harvard Health. Other drug options can't be used long-term or come with other side effects, such as hot flashes, muscle pain, hair loss, and increased risk of deep-vein thrombosis.

Prunes certainly are nutritious. They’re known for their fiber content, and they deliver vitamin K, potassium, and several B vitamins. But can they really stop osteoporosis in its tracks?

TO LISTEN Pop-dance music talent Robyn has an album out today, and it’s mostly about staying horny in her 40s. There are a lot of fun songs (“Dopamine” already ranks up there with “Dancing on My Own”), and one questionable rap track.

TO SHOP A beloved indie underwear brand has expanded into swim, and we're psyched. A few cool things: The size range goes from XS to 6X, they offer all sorts of coverage options (including sun tops, board shorts, tanks, and more), and the fabric is eco-friendly, fast-drying, and UPF 50. Every piece is comfortable and made for active days in the sun. Shop it all here. #partner

TO WATCH Finally, a rom-com to get excited about. Fantasy Life stars Amanda Peet as a mom of three whose sexless marriage is shaken up by the anxious law-school dropout she hires to mind her children. There’s also a new rom-com starring Marisa Tomei as a mom concerned that her daughter’s engaged to a narcissist, as well as a pretty imbecilic (but in a way that’s maybe watchable) new time travel-action movie streaming on Hulu.

TO READ We’ve started to notice an uptick in advice and guidance from dutiful millennial women about tackling their parents’ end-of-life/estate issues. There are a host of new startups, podcasts, and books to help us, such as My Parents Are Dead: What Now? You can read an excerpt here.

TO LISTEN When a The New York Times writer realizes that their first cousin is a criminal, they follow their reporterly instincts and turn that family drama into a podcast with Serial. It’s called The Idiot and it’s out now.

Gloria Steinem is 92 and has a memoir coming out this fall – here’s a preview. • This Amanda Peet piece is as good as everyone has been saying it is. • Not sure if we’re ready for the White House MMA fight and other celebratory events. • This is such a great grandma story.

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