Why I’m Not Liv Tyler’s Mother

Bell Bottom Blues

The main reason I did not manage to become a rock star was because I was just too practical. I blame my parents for this. People think we’re having an epic economic crisis now, but my parents were children during the Great Depression of 1929. There was no Social Security then, no unemployment, no social safety net of any kind. It was the Great Depression that prompted the creation of all those things in the 1930′s. Consequently, my parents, who were both the children of immigrants, clung to the lessons of thrift. I lived with that thrift every day of my life. It was not that they never spent money just to have fun, but they weren’t profligate, nor did they aspire to be. They fixed things themselves. They made do. When we were learning about the Depression in 5th grade, I pestered my mom into telling me about her experience. I suppose I thought there was something darkly romantic about my parents living through such historic drama. But hearing my mother impart details, with great reluctance, and realizing she was about my age at the time, dispelled those notions. Later on, I would find that it can be difficult to pursue the self-indulgent excesses associated with rock-n-roll stardom when you can picture your mom as a ten-year-old girl in a bread line.

On the other hand, I grew up in a music-loving household. My father was a musician who helped form a swing band in his youth that gigged off and on until I was six years old. I felt I owed it to this familial influence to do likewise. Plus, it was the thing to do back then. In the sixties and seventies, garage bands became as ubiquitous as blue jeans. Three or four teenagers, bored and desultory of an evening, might decide to form a band at the drop of a roach clip. Plus there was the feminist factor, the reborn women’s movement, which made it very cool as well as somewhat revolutionary for chicks to join rock bands. Like my dad, my best instrument was my voice, so I began to nurse an acute desire to front a band.

Like Father, Like Daughter?

I brought a lot of serious vocal experience to this endeavor. First of all, I could really sing. In Catholic grammar school, I learned to read music, and sang for years in the church choir, that cauldron of future vocal stardom. Later, I was a soloist in the high school glee club. My first serious boyfriend was in a rock band, and I would sing backup with them. And finally, there was the all-important crucible of belting out rock tunes in the car with my buds on a Saturday night, during which I would perfect my ability to howl like Grace Slick or warble like Joni Mitchell or croon like Nancy Wilson (both of them, the rocker and the jazz singer) or even wail like Robert Plant if I chose. I had a strong mezzo soprano range. I could sing harmony instinctively. I could still read music. And I had long hair and tight jeans, those prerequisites of rockers everywhere. All I needed was to find some rockers who weren’t too stoned, could actually play instruments, and whose ambitions extended a little further than making music as a precursor to getting wrecked and laid. A tall order, believe you me.

Dream On

But first, I wanted to go to college. This involved leaving home, at least temporarily, a prospect I felt was crucial to preparing myself for stardom. I was, as usual, a good student at college, but I was not a total dork about it. Those jeans up there had already attended a string of Boston rock concerts, and I continued to wear them as I strolled about the campus. In fact, it was during my first semester of freshman year that I embroidered that peacock on the leg. From then on, I was referred to on campus as “the girl with the peacock on her jeans.” Surely, I felt, learning how to stand out in a crowd was another step toward fame.

This was all taking place in Massachusetts in 1972/73, in suburban Boston. My dorm that year was still women-only, but we were for the first time allowed to sign in overnight guests as long as they signed out before they’d been on the premises for 24 hours straight. This led, naturally, to a lot of young men fulfilling their obligatory one-minute sabbaticals by the front entrance to the dorm each day. They’d all stand around on the sidewalk, rumpled and yawning, sucking cigarettes while their young women signed them out at the front desk before 23 hours and 59 minutes passed. Frequently, the person at the desk was a work-study student named Arthur, an obliging dude who was totally on our side. After chit-chat with Arthur ate up the requisite few minutes of non-residence, the women would sign the young men back in again, and everyone would return to their rooms, leaving a pile of crushed cigarettes butts in the sand-barrel just inside the door. Arthur and I became pretty good buddies. He and I were a lot alike, cool but a little nerdy, hip but geeky. But even then we clever, creative types knew we were the people who could do stuff like run the radio station and book the college concerts. Through him, I got involved with both activities. Thus, I got to meet the few musical luminaries that we were able, on our slender state college budget, to book for performances. Consequently, I met Tom Rush, who was handsome, polite, and very nice, and Richie Havens, who was phenomenally gifted and played his heart out. My hip stock multiplied while I learned that even famous musicians were just people, after all.

As luck would have it, in early 1973, during my second semester, the state of Massachusetts lowered the drinking age. For reasons which I’m sure must have seemed rational at the time, legislators finally caved to the argument that if, at age eighteen, we were old enough to vote and old enough to get shot in Viet Nam, we ought to be old enough to drink legally. Interestingly enough, this same argument has resurfaced in recent years as college administrators consider ways to deal with campus drinking. So far, though, statistics from our experiment in the seventies of youthful, alcohol-related accidents has kept the debate unresolved. However, from 1973 to 1979, the drinking age in Massachusetts was lowered from 21 to 18.

Thus it was that in March of 1973, I got to drink legally for the first time. The law took effect on a Tuesday. I remember this because a bunch of us went out that night to celebrate this momentous occasion, and I had a biology mid-term the next morning at 8:30. Yeah, I know. But honestly, I planned ahead and was already swotted up for my exam.

Two carloads of us descended upon the Steak ‘n’ Brew, a new pub-like establishment that served a decent meal with pitchers of draft beer or sangria. We took over two adjacent tables, one of which was the beer table, the other the sangria table. I occupied the latter. I was not unacquainted with drinking wine, and I attained perhaps a pleasant and rather mild inebriation during dinner. But the after-dinner activities put paid to my sobriety.

I don’t remember the name of the club, (it was not the Auditorium Theater where this photo was taken) but we ended up in the town of Hopkinton, a classic, old New England town, possibly most famous for being home to the start of the Boston Marathon. The club was, to the best of my recollection, housed in a large, barn-like structure. The walls inside were rough barn board, and an open mezzanine ran around the perimeter at about eight feet off the floor. Upon this mezzanine, a rock band was set up, comprised of five of the usual young, scruffy, long-haired, skinny dudes in tattered clothing that were the stock-in-trade of local garage bands. What set them apart was that they were getting enthusiastic airplay on the Boston rock radio stations for an original song that had not yet found national release. The song was called “Dream On.” The band was Aerosmith. Three months later, they had a big-time record contract. “Dream On” was released with their first album, and their fame shot to the top of the charts.

But that night, their national fame was yet to come. I wish I could recount lots of colorful, salient details from Aerosmith‘s performance that night, but I was too busy inhabiting my by-then thoroughly altered consciousness and dancing my ass off. Of course we all knew who Aerosmith was. They were already local heroes, we all loved “Dream On,” and I do recall Steven Tyler singing it that night, to the dissonant accompaniment of a few hundred blotto college students who knew all the words by heart. Other than that, the details are a little sketchy. I know I had a fabulous time. I do remember getting home in one piece. It was around 2:00 a.m., and Arthur, bless his heart, had agreed beforehand to snooze in the lobby so he could let me back in the dorm whenever I rolled in. I also remember, rather vividly, having to negotiate the long hallway to the corner room I shared with my roommate. This I accomplished by leaning against the wall and attempting to slide as quietly as possible to my door. My sainted roommate, normally in bed by ten each night, was waiting for me when I got there. She was opposite to me in every possible way. She was short, studious, well-behaved, and wore saddle shoes and plaid slacks to class. I, on the other hand, was your garden-variety hippie-chick, tall, Bohemian, occasionally contentious and gently rebellious. But despite all that, we had forged a bond, and I will never forget her tender ministrations that night, as she helped me into my nightgown, served me hot cocoa, set my alarm clock and tucked me in. It was a tad painful, but I made it to my biology exam in the morning and even got an A.


“The Hub of Boston’s Musical Universe”

Fast-forward to the latter years of the seventies. I’m living in Norwood now, a few miles south of Boston, in a great apartment in a triple decker house. One of my best gal pals lives nearby, on the shore of a small lake that she shares with a bunch of neighbors, some of whom happen to include a few members of Aerosmith. Soon, I come to take it in stride that my life included driving past them, now internationally famous rockers, in the car from time to time, like any other neighbor, in our mutual portion of town.

Eventually, a boyfriend moved in with me, an Army Vet who was attending art school on the G.I. bill. Meanwhile, I was a very busy girl. I worked at Boston University, running a word processing department for the Department of Admissions & Financial Assistance. I went to modeling school & even did a little modeling (‘though I can’t find my old contact sheets…). I took voice lessons. I took creative writing classes at B.U. with my tuition remission benefit. I wrote a lot, I drew a little, and I was actively trying to get a singing gig. I auditioned for four guys in need of a lead singer by singing “Jailhouse Rock.” Their idea. They liked the idea of a chick fronting the band, but they were skeptical of finding one who could sing the kind of stuff they liked to play, which was blues-rock of the Eric Clapton/Jeff Beck/Hendrix ilk. So, they figured they’d separate the wheat from the chaff by making everyone sing that old Elvis tune. So, I sang it, with gusto. I ripped it out, with a nice blues rasp, like Elvis’s contemporary, Wanda Jackson, the undisputed godmother of chick rock, who was voted into the Rock ‘n’ Roll Hall of Fame last year. The guys admitted later that when I arrived to audition, wearing a voile shirt with violets on it, tight jeans, long hair flowing, they figured I’d sound like Joan Baez. I didn’t. I got the gig.

Thus did I further my relationship with E. U. Wurlitzer, the Boston music equipment store pictured above as it looked in 1978. Among other things I purchased there was a Shure SM58 microphone. It was THE place to get gear, so it was not unusual to see famous rockers in there, trying out instruments or inspecting stacks of Marshalls. So, I got fairly nonchalant about spying people like Ric Ocasek of The Cars or John Geils, the “J” of the J. Geils Band while I was there. Hey, we were all doing the same thing, just at different levels. During one of my many expeditions, I spotted a small group of dudes in the back of the store who looked familiar in a more personal way. When I got a little closer, I realized they were my neighbors, Aerosmith. Huh. I wondered briefly what they were buying, then went back to browsing the rack of sheet music.

It was on the way out of the store that I experienced a kind of epiphany. Casual brushes with fame aside, I was back then, like a lot of performers, rather shy, particularly with the opposite sex. Once I got to know someone or was on stage, I was full of my usual piss and vinegar. But I was not then equal to striking up a conversation with perfect strangers, especially guys. At the same time, I had a lot of confidence in my own abilities for the most part. I knew I could do what I could do really well. Perhaps because of that, I was also not given to hero worship. I never really had a yen to get someone’s autograph, for instance. I mean, what for? And I was certainly not interested in being some rocker’s groupie, a designation on a par with slut-hood. Sure, I probably wouldn’t turn down a date, but it would have to be a real date, not some roll in the hay in some trashed out hotel room. But I didn’t think about such possibilities very much. I had a boyfriend, and I’d had enough experience with the opposite sex — and with rockers specifically — to know that a lot of them would probably not want a girlfriend who had her own career trajectory to nourish. And I was definitely not the keep-the-home-fires-burning type.

So, perhaps if I’d been a different kind of woman then, who knows what might have happened? But as I was leaving the store, my nose in some sheet music, and I literally bumped into all of the guys in Aerosmith at once, my first inclination was not to gush and bat my eyelashes. “Oh! Um, sorry,” I said, admittedly a little flustered. And they muttered something similar back. And then there was a bit of shuffling so that all six of us could get through the doorway. Once on the sidewalk, we went our separate ways. And that was that, until the next time I saw them driving around the lake or searching the aisles of E. U. Wurlitzer or playing a concert at Boston Garden.

A missed opportunity? Maybe. But after I got such a close look at them, there was another concrete reason, apart from being a non-gusher, why I didn’t try to flirt or ingratiate myself. None of them, not a one, was my type. In the first place, they were all basically shorter than I was. I’m just over 5’9″ and I don’t think I was wearing anything but low-heeled sandals at the time, but not a one of them was taller than I. Joe Perry was, I think, about my height, maybe 5’10″. Steven Tyler was most definitely shorter than I by at least a few inches. He was a skinny, little guy, like maybe he only weighed about 90 pounds soaking wet, someone I could probably take in an arm-wrestling contest. Plus, honest to god, up close like that, in regular clothes and not on stage, they looked like a bunch of lowlifes. I remember thinking it was a fortunate thing they had musical talent, because if they walked into the average employer to get a job, they’d be summarily turned away. Given their well-known lifestyle at the time, I was not surprised that they looked like they’d been ‘rode hard and put away wet.’ But it certainly did not make me want to get to know them better. I mean, I was adventurous and all, but I didn’t have a death wish.

I saw them all several more times after that, at the store, in the neighborhood, on stage. I bought their records because I liked their music. The band I was in broke up after the two guitarists had a huge fight and quit, taking all their equipment with them. The bass player and the drummer and I looked at each other and shrugged. We didn’t have the money, nor, after all the work we’d already put in, the inclination to look for someone to replace them. But we stayed friends. I looked for another gig, but after several auditions with a series of obnoxious, oversexed waste-brains, I’d had enough. My boyfriend and I broke up, and my creative ambitions took a different turn entirely. I still did some gigs now and then over the next decade, but they were mostly with other women musicians, and the music was mostly not rock ‘n’ roll.


Tyler’s Greatist Hits

Bebe Buell and Steven Tyler also broke up. She would give birth to their daughter Liv after the break-up, but kept Liv’s paternity a secret. Steven, for his part, was busy being a star and getting addicted to controlled substances. For years, Bebe Buell reportedly allowed Liv to think her father was Todd Rundgren, although I’m not sure how much of an improvement that was. However, DNA will out, and as Liv grew older, she looked so much like her father did in his youth that there was no denying it any longer. Aerosmith meanwhile went through their own sturm und drang, breaking up for while, leaving Joe Perry to start the Joe Perry Project. Eventually, everyone cleaned up his act and the band got back together to perform and recapture their former fame. Steven finally met his beautiful and talented daughter, who became a successful and well-known actor. Eventually, Liv got married and became a parent herself. Surely, in my humble opinion, Liv Tyler is one of Steven’s greatest hits.

After I related this entire tale to a musician friend of mine many moons ago, she shook her head in wonder and remarked, “You could have been Liv’s mother, you know. You’re a babe. They must have noticed that when you ran into them at the music store. And she even has blue eyes like yours.”

I smirked. “No. Never happen, not unless a whole bunch of things were very, very different. I’d have been very proud to have a daughter like her, though. She’s a lovely young woman. But the rest of it? Nah.”

We mused silently for a moment. “Well, you never know, do you?” my friend said.

“No,” I agreed. “You never do.” Pause. “I still have those jeans though.”

“Yeah?”

“Yeah. He would have brushed against them when we all squeezed through that door.”


Photos of Steven Tyler from the fansite, sexysteventyler.com.


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Bare Bones & Hormones — Part II

Inevitable or Avoidable?

It’s August. It’s hot. This has been one of the hottest summers on record here, not just locally in New England, but here in the United States. Maybe even here on the planet. So, I’m a little peaked. Now, I almost never drink carbonated soda. I mean never. I don’t buy it. I might order it at a restaurant. But that’s it. I know that the phosphates in soda can contribute to bone loss. So, it’s not my drink of choice. But, hey, once in a great while, what’s the harm? So, I bought some diet cola. And I’m sucking it back and it’s very refreshing, and I’m drinking it while sitting at the computer, doing research on calcium absorption for this post. And I read this:

“Over the long term the effects of colas are devastating to the body…. It would take 32 glasses of alkaline water at an alkaline pH of 9 to neutralize the acid from one 12 oz. cola or soda. Drinking a cola or soda, the body will use up reserves of its own stored alkaline buffers, mainly calcium from the bones and DNA….” — from Goldrust.net

All righty then! Guess this is the last time I drink soda. That sucking sound I hear must be my bones turning into dust. The good news is that if I go back to drinking my own low-cal, home-made lemonade instead, it turns out I will be helping the situation immeasurably. More on that later.

“Holy Porosity, Batgirl!”

When I started researching this follow-up to my last blog post, I had no idea what a can of worms I’d be opening up. That’s because a lot of what I thought I knew about bone loss and hormones was wrong or incomplete. Now, I could write a book, which means there isn’t enough room in one post to do justice to either subject. What I will do is focus more on bone loss in this post and more on its relationship to hormones and breast cancer in later ones.

Just trying to define the terms used in a discussion of bone loss is dicey. Physicians, physiologists and other experts disagree over what constitutes a disease or condition requiring treatment. So, even our own doctors may not know what they should or should not be advising us to do. Generally speaking, everyone seems to agree that we humans develop our peak bone mass somewhere between the ages of 20 and 30. The implication is that it’s all downhill after age 30, or that once we start to lose bone mass, the best we can hope for is to prevent the situation from getting worse. If that were strictly true, then none of us would ever recover from a fracture — or any other injury, for that matter — and there would be no point whatsoever in the entire industry of medications, supplements and exercises that has arisen out of trying to improve bone mass. Well, guess what? It’s not all downhill after age 30, at least as far as our bones are concerned. Bones are, in fact, a living tissue which is continuously breaking itself down and building itself up on a daily basis. The breaking down part is achieved by cells called osteoclasts, the building up part by osteoblasts. Bone loss occurs when there is more of the former than the latter.

  • There are a number of links referenced in this post that connect you to PDF’s you can download, by the way. So, do click on them for further information or to download something to pass on.

But why does that happen in the first place? What causes us to break down bone tissue faster than we can rebuild it? Turns out it’s not as straightforward as you might think. The villain that takes the heat most often is the estrogen loss that occurs around menopause. While it’s true that statistically, most of the people who develop osteoporosis in Western countries are women over 55, not all women over 55 develop osteoporosis, and not all folks who do develop it can attribute it to a lack of estrogen. Diseases, medications, poor nutrition, too much soda, not enough exercise, excessive alcohol and cigarette smoking all put someone at risk for bone loss. A parental or personal history of fractures puts you at risk. Stress, lack of sleep, not enough veggies, and too much caffeine can contribute. Frequent surgeries, gastrointestinal problems, long-term use of steroidal drugs and not enough vitamin D are also risk factors. The good news is that you can do something about quite a lot of these items and minimize the impact of the rest of them. For more information about risk factors, visit the National Osteoporosis Foundation website. You can also download their “Hormones and Healthy Bones” brochure for a more complete overview.

To Scan Or Not To Scan

If you ever calculated a mean or an average in math class, then you had a close encounter with a bell curve long before you ever had to think of having your first bone density scan. Trust me, getting a bone density scan is a lot easier than plotting a bell curve. But the T scores that get bandied about when you do get a bone density scan come from the data used to plot the bell curve to the left here. This bell curve represents normal female bone density between the ages of 20 and 29, which is that prime-time mentioned above when we have achieved maximum bone mass. The middle, or median, of this curve is represented by zero, meaning that half of all adult women under 30 have a bone density at or above the median, and the other half have a bone density at or below the median. Logical, right? When we get a bone density scan, our scores are plotted against this bell curve, and wherever our score falls is our T score, which is just a number indicating how far our score deviates from the median. If your bone density score is -2.5 or less, or 2.5 or more standard deviations below the median, then you are considered to have osteoporosis. That’s the left-most part of the bell curve in the bright aqua section. If your T score is between -2.5 and -1.0, then you have some bone loss, but you don’t yet have osteoporosis. This category of bone loss was given the name “osteopenia” in 1992 by the World Health Organization.

Having a low T score does not necessarily mean that you will fall and break your hip or that your spine will be riddled with compression fractures. To understand how your T score fits in with your overall fracture risk, the World Health Organization developed FRAX, which is a fracture risk assessment tool. You can find the tool here on this FRAX page; be sure you place your mouse over “calculation tool” at the top of the page and choose the appropriate continent and ethnicity.

Dr. Nelson B. Watts, Director of the University of Cincinnati Bone Health and Osteoporosis Center, does not like the term “osteopenia” [See "What is osteopenia....?"] and states that it is all too often used incorrectly and ineptly, needlessly scaring women and men who are fine, who have a normal amount of bone loss for their age or condition and who do not need treatment. His colleagues at the nearby Cleveland Clinic Foundation, Drs. Holly Thacker and Bradford Richmond, beg to differ. In their rebuttal to Dr. Watts, they assert that, “[o]steopenia describes the common finding on radiographs that should alert the clinician to an underlying bone pathology, whether it is osteoporosis or multiple myeloma. Understanding the technical factors that can produce the appearance of osteopenia is essential to the correct observation.” As the daughter of a woman whose osteoporosis killed her, I certainly feel that it is helpful for me personally to know whether or not I am osteopenic, so that I have time to do something to prevent my bones from developing osteoporosis. That prevention does not, however, have to be medication, and the treatment of osteopenia as a disease is what Dr. Watts objects to. As it happens, I agree with all three doctors. Osteopenia is at best just a reflection of a normal life process and at worst a helpful early warning to investigate further and, if need be, make some changes to prevent further bone loss. But osteopenia is not in and of itself a disease. And osteoporosis, as Dr. Watts points out, is only one item in the FRAX calculation of fragility which determines who is at risk for fractures.

What Does It All Mean?

First of all, it means that there will be a Part III, IV and probably V in this series. What it all means for now is that most of us are not in as much trouble as we might have thought. There are, in fact, ways to prevent, minimize or reverse bone loss that do not involve ingesting drugs or consuming vast quantities of broccoli and dairy foods. But the complete story will have to wait for Part III.

I won’t leave you hanging completely, however. Remember that lemonade I referred to earlier? Well, that lemonade leads to a few bits of information that can have a profoundly good affect on our bone heath.

Turns out that if you stopped drinking most if not all carbonated sodas and beverages, you’d be doing your bones a lot of good. ‘Carbonated’ is a misnomer, really. They should all, in fact, be called ‘overly-acidic, highly phosphorated’ beverages. The average 12-oz. can of cola has a pH of about 3.0 — neutral is 7.0. The body doesn’t like that much acid floating around. Our bodies like to be slightly alkaline or at least neutral. When we drink soda, however, we are sloshing a lot of acid liquid into our bodies that slides past our stomachs and gets taken up rapidly by our bloodstream. Our bodies then have to neutralize all that acid to restore our body’s pH balance. And the way they do that is by grabbing up calcium ions. And the handiest repository of calcium in our bodies is our skeletal bone. So, the more soda you drink, the more your body will be snatching calcium out of your bones to neutralize all that acid. It’s true that we do need some phosphorus to maintain our bones, but not that much. What phosphorus does is facilitate osteoclastic activity — remember osteoclasts? Those are the cells that break down our bones. And we’re trying to help our osteoblasts keep up, remember?

Meanwhile, we’re having a hellaciously hot summer and we need to drink something. It may seem counter-intuitive, but the juice of one lemon or lime is a wonderful substance for helping us maintain our bodies’ alkaline preferences, thus leaving our calcium where it belongs. That’s because lemons and limes, which we regard as acidic, contain citric acid, which — unlike the acids in soda — is converted to citrates in our digestive system before being turned loose in the blood. And the blood likes citrates because they help our bodies stay happily alkaline. We all know by now that berries are full of cancer-fighting anti-oxidants, so I’d say a nice pitcher of raspberry lime rickeys would be a perfectly acceptable substitute for a nasty ol’ six-pack of Mountain Dew.

See? Your momma was right: be good and eat your fruits and veggies.


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Bare Bones & Hormones — Part I

Hard Facts About Brittle Bones

Here’s a piece of information I’ll bet you didn’t know — osteoporosis can kill you. It killed my mother. It killed the mother of one of my oldest friends. My friend’s mother literally crumbled to death, in pain, in a hospital bed, when she couldn’t move anymore because her bones wouldn’t hold her up. My mother died because she had about twenty compression fractures in her spine from neck to hips, resulting in a spinal column that looked like the top of a coat hanger. Because of this deformity, her heart and lungs and intestinal organs were unable to work properly, thereby causing a lethal combination of poor nutritional absorption mixed with cardiac and respiratory distress. Half of all women and a quarter of all men over age 50 will experience a bone fracture due to osteoporosis, and of those who fracture a hip, one third of them will die within a few years of that fracture, fully one fifth within a year.

Here’s something else I’ll bet you didn’t know — for post-menopausal women, the risk of sustaining a fracture of the hip, wrist, pelvis, vertebra or other bone is far greater than the combined risk of having breast, ovarian and uterine cancer. A woman’s risk for a hip fracture alone is equal to her combined risk for breast, uterine and ovarian cancer. Even for breast cancer survivors, most of us are far more likely to develop osteoporosis and sustain a fracture than we are to have a cancer recurrence. Throw in the sudden loss of estrogen due to aromatase inhibitors and oophorectomies, and our risk for bone loss is even worse than average. As it is, it has been estimated that one in five of all U.S. Caucasian and Asian women over 50 have osteoporosis, and about half of all women over 50 have early, measurable bone loss, also known as osteopenia, which can lead to osteoporosis. I’m one of them. My recent bone density scan put my hip and lower back squarely in the osteopenia camp.

As a physical therapist, I can personally attest to the fact that an alarming percentage of women at risk for bone loss never have a bone density scan, even after they fracture something, even though the occurrence of a fracture, any fracture, at any age, is considered an indicative risk factor for osteoporosis. Other risk factors that predispose men and women to osteoporosis include a family history of fractures or osteoporosis, natural or surgically-induced menopause, disease, alcohol use, medication side effects, hyperthyroidism, cancer, and simply growing older. Even when a radiologist can see and thus report a finding of osteoporosis on a regular X-ray that may be taken to confirm a fracture, all too often there is still no follow-up bone density scan, no treatment offered for the osteoporosis, nothing beyond treatment of the fracture itself. And when osteoporosis treatment is offered, it is often inadequate or just plain wrong. I wish I had $5 for every time a patient of mine who has a history of gastric reflux or some other intestinal disorder is prescribed Fosamax or Boniva, which are both bisphosphonates, even though bisphosphonates are clearly identified as inappropriate for folks with gastro-intestinal problems. And because bisphosphonates make their heartburn or ulcers worse, my patients will stop taking them, never getting some other kind of treatment to replace them. It’s enough to make a PT completely insane.

Estrogen — Friend or Foe?

Naturally, when you throw breast or ovarian cancer into the equation, it makes things more complicated. Most of us are aware of the big hormone replacement study that was suspended in 2002 because of the increases in heart disease and blood clots among the subjects. I could go on at some length about how the actual statistical significance of these increases was taken out of context and thereby inflated by the media, but I’ll spare you. And many of us know that after the suspension of this study, when droves of women on any kind of HRT suddenly stopped it, reports eventually came out crediting cessation of HRT for a decreased incidence of breast cancer. However, there was also a corresponding increase in osteoporosis. And I don’t remember any big splashy news reports about that. I have personally treated several women who suddenly stopped HRT in 2002, but did not replace it with anything, and consequently experienced a sudden loss of bone density resulting in pain, spinal deformity, fractures and lifelong disability. And aside from prescribing pain killers, their doctors have often done nothing to help them.

My mother, who died one year before Fosamax hit the market in 1995, brought on her own osteoporosis the same way. She had been taking HRT for several years, decided she was sick of it and stopped it, without informing her doctor, without taking a calcium supplement, and without any follow-up screening for bone density. Within five years, she developed the twenty compression fractures which were only discovered when an acute inability to pick up her head caused me to march her into her doctor’s office and demand an X-ray of her spine. It turned out to be the first spinal imaging this doctor had ever ordered for her, even though she’d been treating my increasingly humped-back mother for several years. The X-ray showed what any nitwit could see by looking at her, which is that she had by then developed severe spinal kyphosis due to osteoporosis. I was 35 at the time, and so help me, I wanted to slap this doctor upside the head. I didn’t. But I vowed at that moment that I would do everything I could to prevent the same fate for myself and others if I could.

“The Sky Is Falling! The Sky Is Falling!”

What I did was go to graduate school and become a PT, and later get certified training as an osteoporosis educator. Every year since, I’ve delivered at least one public education session about the disease. HRT has been much maligned, but in moderation, with proper monitoring by a physician, it is sometimes the best thing for treating the symptoms of menopause and preserving bone density while formulating a long-term strategy. And at least now, there are several non-hormonal options for treating bone loss, including a number of medications and nutritional supplements known to prevent or even reverse it, so that even when we lose our estrogen, we don’t have to crumble. Yet osteoporosis continues to be under-evaluated and under-treated. And for us cancer survivors and previvors and BRCA mutants, there are these oncologists running around like Chicken Little, hollering about how estrogen is bad, Bad, BAD, and trying to convince us to ferret out every last dastardly molecule. Well, forgive me if I am forced to holler back by pointing out once again that estrogen is not the enemy. Cancer is the enemy.

Nothing is ever simple where cancer is concerned and I’m about to make it even more confusing. But let me start with an assertion or three that has finally found a basis in medicine, unless you are one of those blinkered oncologists who have evidently forgotten that they wouldn’t be here, torturing us in the first place, were it not for estrogen. Assertion #1: Estrogen happens to be a remarkably useful substance. In addition to playing a rather key role in the continuation of the species, it makes us female, it helps our skeletons to develop in childhood and keeps them strong in adulthood; it helps us produce collagen to keep our skin and joints pliable; it keeps us from developing heart disease and strokes and high cholesterol; and it helps us think and focus. Pretty good stuff. Assertion #2, therefore, is that when our estrogen levels fluctuate, we certainly notice, whether it’s due to our monthly mensis or to pregnancy or to the first stirrings of peri-menopause. And Assertion #3 is that, when those levels plummet, with childbirth or oophorectomy or aromatase inhibitors or regular old menopause, our emotional and physical well-being can plummet as well. And finally, Assertion #4, estrogen is NOT the easily expendable substance that cancer docs may try to make us believe. Oh, and guess what? Removing its sources or preventing it from circulating in our bodies does not keep us from ever getting cancer. Yes, it may reduce the statistical likelihood, but it’s no guarantee.

Here’s where it gets complicated. We know that many breast cancers and ovarian cancers feed on estrogen. Research published earlier this year in the journal Cancer Research found that estrogen appears to suppress cancer-cell death somehow in estrogen-receptor-positive breast cancer, but very little is understood about why. Additional recent studies found that, rather than a single gene like BRCA, it appears that a group of genes may work in concert to enable hormone-sensitive breast and endometrial cancers to develop in the first place. These kinds of studies show promise for facilitating the development of therapies targeted at the actual mechanisms of tumor development. But in the meantime, in that kill-a-gnat-with-a-sledge-hammer approach characterizing much of cancer treatment, it’s easy to pick on estrogen itself and try to remove it from the equation altogether, despite what havoc that may wreak.

On the other hand, it has been documented for several years now that women who live in Asia and eat an Asian diet, which is typically high in soy products, low in animal fat and high in vegetables and fiber, have a significantly lower incidence of breast cancer than women in Western countries, who eat more animal fats and fewer vegetables. This observation has led to numerous studies about soy, isoflavones, phytoestrogens and other substances to see if there are further correlations between them and the increase or decrease of breast cancer risk. Unfortunately, there have been some compelling studies on both sides of the fence in the past several years. However, an excellent review of the research on this subject was published in Nutrition Journal 2008, 7:17 which concluded,

    “In this analysis and commentary we attempt to outline current concerns regarding the estrogen-like effects of isoflavones in the breast focusing primarily on the clinical trial data and place these concerns in the context of recent evidence regarding estrogen therapy use in postmenopausal women. Overall, there is little clinical evidence to suggest that isoflavones will increase breast cancer risk in healthy women or worsen the prognosis of breast cancer patients.”

In fact, another study, published in the Journal of Clinical Oncology in 2005 found that, “Short-term HRT use does not negate the protective effect of [bilateral prophylactic oophorectomy] on subsequent breast cancer risk in BRCA1/2 mutation carriers.” This means that post-oophorectomy BRCA women can safely use real hormone therapy to mitigate the sudden onset of menopause and its symptoms after losing their ovaries and thus their chief source of estrogen. And they can continue to use phytoestrogens from soy and other foods after HRT to continue to treat those symptoms. All of this is good news for our bones as well, because there are now prescription and over-the-counter soy estrogen supplements available that have been demonstrated to effectively prevent osteoporosis.

All of this tells only part of the story of this complex relationship between breast cancer, estrogen and the prevention and treatment of bone loss. And that means there will be another blog post or two on the subject. So, stay tuned.


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