The Fable of the Boiling Frog
A Cautionary Tale about Osteoporosis and Bone Health
The parable describes a frog being boiled in a pot of water. In this parable, a frog is placed into tepid water and the pot is slowly heated. The premise is that if the water is heated slowly enough the frog is unable to perceive the change in environment, and will not try to escape the impending death. In the second scenario the frog is placed directly into boiling hot water, at which point the frog jumps out in self preservation.
Various scientists have tested the theory with varying degrees of confirmation and/or refuting. What is important is the thought experiment “caution[s] people to be aware of … gradual change lest they suffer eventual undesirable consequences.” Sometimes referred to as “boiling frog syndrome”.
Osteoporosis is a boiling frog syndrome – Unseen, Asymptomatic, Unproblematic – until one day we fracture.
There are striking parallels between the boiling frog syndrome parable and the pathophysiology of osteoporosis. Let's craft the metaphor and the narrative together.
The Illusion of Normalcy (The Tepid Water)
Boiling Frog: When the water is tepid, the frog feels comfortable and safe. It perceives its environment as normal and non-threatening.
Osteoporosis: For decades, a person loses bone density without any visible signs, and no physical symptoms. There is no pain, no fever, no malaise or fatigue. The person feels “healthy”, creating a false sense of security that their bones are strong.
Gradual, Unnoticed Decline (The Rising Temperature)
Boiling Frog: The temperature rises by fractions of a degree, the change is so subtle that it falls below the frogs threshold of perception. Over the span of hours, the water temperature rises several degrees.
Osteoporosis: Bone loss happens microscopically, year over year. A person might lose 1-3% of their bone mass annually – and it would be imperceptible to the senses, but can have devastating cumulative effects after only 5 to 10 years.
Adaptation and Rationalization (Adjusting to the Environment)
Boiling Frog: As the water slowly warms, the frog’s body does what it can to thermoregulate to match the environment rather than escape.
Osteoporosis: As the disease progresses, patients may rationalize subtle changes like height loss and a stooped posture as common signs of aging rather than recognizing it as signs of a disease that requires intervention.
The Critical Tipping Point (The Boiling Point)
Boiling Frog: Eventually, the water reaches a temperature where the frog can no longer survive. By the time it realizes there is any danger, it is too weak to escape.
Osteoporosis: The “boiling point” in this disease is the first fragility fracture. This is often the first moment the patient realizes they have a disease. By this stage, the skeletal structure is already severely compromised, making treatment much harder than prevention would have been.
What you can do (The Jump)
Here’s the good news: unlike the frog, you have tools to test the water temperature before it boils.
A DEXA scan can tell you what your bone density is at various points in your spine or hips. This is like having a digital thermometer in the water, allowing us to track the progress and state of the disease process.
So what are my options? “Can I just take oral supplements like calcium and Vitamin D?”
Yes. and No. Published studies show that calcium and Vitamin D supplementation is appropriate for those who are nutritionally deficient to correct for nutritional deficiencies like diet and food choice/availability. However, that same study found that combined supplementation of calcium and vitamin D offered no statistically significant changes in fracture risk for Postmenopausal Women with Osteoporosis.
Unfortunately for those suffering from the effects of osteoporosis, by the time it is usually detected or diagnosed – it is often too late – and the metaphorical waters are already boiling.
You wouldn’t drop a handful of ice cubes into a pot of boiling water and expect it to stop boiling. You’d turn off the stove first.
What does this look like in Osteoporosis? It looks like stopping osteoclasts in their tracks with Zoledronic Acid (Reclast, Zometa). Osteoclasts are “bone-cleanup” cells that act in our bodies to resorb bone mineral aka hydroxyapatite. By using Zoledronic Acid to disable these osteoclasts, we are effectively turning off the stove and preventing further damage from occurring to your bones. Zoledronic Acid has the additional benefits over traditional oral bisphosphonates (Fosamax) of 1-year effectiveness versus daily/weekly pills, and also forgoes the inconvenient side effects of GERD (aka heartburn or gastric reflux). So if you are currently taking oral bisphosphonates like Fosamax and experiencing GERD, gastric reflux, or heartburn as a side effect and are having trouble adhering to your medication regimen, consider Zoledronic Acid infusion as an effective alternative.
The good news is that Core Health Infusion Center and Bueno Bones are champions of bone health at El Camino Health in Mountain View, CA. Located at the heart of Silicon Valley, we are proud to serve the community that powers the leading edge of tech. Schedule a bone health consultation with us to get started.