With 39 million people at risk for osteoporosis, it is a major epidemic. While it predominantly affects women, who represent 80 percent of diagnoses, men are also at risk. Osteoporosis is diagnosed with a bone density scan. This test measures the mineral content in the bone and is the standard by which common osteoporosis therapies such as Fosamax, Actonel and Boniva (bisphosphonates) are measured. However, the most important question is not what a number is on a test, but what the risk for breaking a bone is. So what can you do to reduce fracture risk? After all, if you fracture a hip, you have a 20 percent chance of dying within a year, and if you survive you have a 20 percent chance of ending up in chronic nursing home care, with total costs that can exceed $100,000. The best strategy is to take a more holistic approach to bone health and not rely on just one form of prevention. Bisphosphonates only reduce vertebral fractures about 48 percent and hip fractures by 24 percent or less. Many people taking the medications have to stop because of side effects, and the FDA now has a black box warning on these drugs that they may actually increase the risk of fracture. And 4 to 8 percent of people taking these medications are at risk for bisphosphonate-related osteonecrosis of the jaw (BRONJ), a side effect in which the jaw bones begin to disintegrate. Whether or not the benefits outweigh the risks should be a conversation you have with your healthcare provider. The No. 1 risk of breaking a bone is falling, so anything that can be done to build muscle and balance may be helpful. Diets rich in green leafy vegetables may prevent osteoporosis. This is essentially the Mediterranean-style diet. Dietary supplements can also be exceedingly helpful. While most people take calcium and vitamin D, and think those nutrients are protecting them, research shows that those only reduce fractures about 16 percent. But that can be increased to 87 percent with MK4. This nutrient is a specific form of vitamin K2, and has been approved as a medicine in Japan since 1995 for the prevention and treatment of osteoporosis. While the bisphosphonates, calcium and vitamin D work to build bone mineral density, MK4 promotes the formation of connective tissue in bone, called bone collagen. Bone collagen provides the flexibility to bone to allow it to withstand an impact and not break. This is why the clinical trials on 45 mg daily of MK4 with calcium and vitamin D show that it can reduce fractures by 87 percent. It has been shown to be both safe and effective when taken long term. Many doctors who are not educated in nutritional medicine and who are not familiar with the research on MK4 may be concerned that this high amount of the nutrient may increase the risk for blood clots. However, research shows that MK4 does not increase clotting risk even in people taking more than 100 mg daily. The only known contraindication is warfarin (Coumadin), as MK4 interferes with this drug. MK4 is available as a dietary supplement in the United States and can be taken alone or along with any of the osteoporosis medications. It’s time to move beyond bone density and to ensure that healthcare providers and patients are focusing on what they can do to reduce fractures. — John Neustadt is president of NBI Pharmaceuticals and author of more than 100 research reviews. Steve Pieczenik is a board-certified psychiatrist, was a board examiner in neurology and psychiatry and is vice president of NBI Pharmaceuticals.