Many factors are known or suspected to accelerate the rate of bone loss. These include smoking, alcohol, low calcium intake, lack of exercise, various medications, and several medical illnesses. Excessive consumption of
In general, women are far more prone to osteoporosis than men. For this reason, the following discussion focuses almost entirely on women.
Hormone replacement therapy prevents or reverses osteoporosis in women. However, now that long-term use of hormone replacement therapy has been found to be unsafe, conventional medical treatment for osteoporosis in women centers mainly on drugs in the bisphosphonate family, such as Fosamax (taken along with calcium and vitamin D—
Principal Proposed Natural Treatments
There is good evidence that people with osteoporosis, or who are at risk for it, should take calcium and vitamin D supplements regardless of what other treatments they may be using.
Substances called isoflavones found in soy and other plants may be helpful for osteoporosis (as well as general menopausal symptoms
Calcium and Vitamin D
Calcium is necessary to build and maintain bone. You need vitamin D, too, as the body cannot absorb calcium without it. Many people do not get enough calcium in their daily diet. Although your body can manufacture vitamin D when exposed to the sun, supplemental vitamin D may be necessary in this age of sunblock.
According to most, but not all studies, calcium supplements (especially as calcium citrate, and taken with vitamin D) are slightly helpful for in preventing and slowing down bone loss in postmenopausal women. 3-7,121,130-131,140,165,171
One study found benefits for male seniors using a calcium and vitamin D-fortified milk product.
Vitamin D without calcium, however, does not appear to offer more than minimal bone-protective benefits for seniors, if that.
Use of calcium supplements early in life might put calcium "in the bank" and prevent problems later, especially when children also engage in physical exercise; however, study results are somewhat contradictory.
Certain other supplements may enhance the effects of calcium and vitamin D. One study found that adding various trace minerals (
There is some evidence that essential fatty acids may also enhance the effectiveness of calcium. In one study, 65 postmenopausal women were given calcium along with either placebo or a combination of omega-6 fatty acids (from
Interestingly, vitamin D may offer another benefit for osteoporosis in seniors: most, though not all, studies have found that vitamin D supplementation improves balance in seniors (especially female seniors) and reduces risk of falling.
There is weak, preliminary evidence that calcium supplementation in healthy, postmenopausal women may slightly increase the risk of cardiovascular events, such as myocardial infarction.
Genistein and Other Isoflavones
Soy contains substances called isoflavones that produce effects in the body somewhat similar to the effects of estrogen. (For this reason, they are called “phytoestrogens.”) Although study results are not entirely consistent, growing evidence suggests that
For example, in a 1-year, double-blind, placebo-controlled study, 90 women aged 47 to 57 were given genistein at a dose of 54 mg/day, standard hormone replacement therapy (HRT), or placebo.
In a 1-year, double-blind, placebo-controlled study of 203 postmenopausal Chinese women, use of soy isoflavones at a dose of 80 mg daily had mildly positive protective effects on bone mass in the hip.
Another study evaluated an isoflavone supplement made from
However, it is not clear that the consumption of foods rich in isoflavones offers the same benefits. For example, in placebo-controlled study involving 237 healthy women in the early stages of menopause, the consumption of isoflavone-enriched foods (providing an average of 110 mg isoflavone daily) for one year had no affect on bone density or metabolism.
Interestingly, the effect of isoflavones on bone may be more complex than that of estrogen. Bone is always undergoing two opposite processes at once: bone breakdown and bone formation. Estrogen acts on the first of these processes: it inhibits bone breakdown. Isoflavones may affect both sides of the equation at once: inhibiting bone breakdown while at the same time enhancing new bone formation.
In about one out of three people, intestinal bacteria convert some soy isoflavones into a substance called "equol." Isoflavones may have a greater bone-protecting effect in such "equol producers."
For more information, including dosage and safety issues, see the full
Growing evidence indicates that the mineral strontium (as strontium ranelate) is effective as an aid in the treatment of osteoporosis.
The best and largest study on strontium was a double-blind, placebo-controlled study of 1,649 postmenopausal women with osteoporosis.
While some treatments for osteoporosis act to increase bone formation, and others decrease bone breakdown, some evidence suggests that strontium ranelate has a dual effect, providing both these benefits at once.
There is one major caveat, however. At present, all major controlled clinical trials of strontium ranelate have involved some of the same researchers. Entirely independent confirmation is needed. It is not clear to what extent the “ranelate” portion of strontium ranelate is necessary for this benefit, or whether other strontium salts would work as well.
Note : The strontium used in these studies is not the same as the radioactive strontium that was such a concern during the decades of above-ground atomic testing.
For more information, including dosage and safety issues, see the full
Increasing, but inconsistent, evidence indicates that vitamin K
Perhaps the best evidence for a beneficial effect comes from a 3-year, double-blind, placebo-controlled trial of 181 women.
However, another placebo-controlled trial involving 452 older men and woman with normal levels of calcium and vitamin D failed to demonstrate any beneficial effects of 500 mcg per day of vitamin K supplementation on bone health over a 3-year period.
For more information, see the full
Ipriflavone is a semisynthetic variation of soy isoflavones. Ipriflavone appears to help prevent osteoporosis by interfering with bone breakdown. Estrogen works in much the same way, but ipriflavone does not appear to produce estrogenic effects anywhere else in the body other than in bone. For this reason, it probably doesn't increase the risk of breast or uterine cancer. However, it also doesn't reduce the hot flashes, night sweats, mood changes, or vaginal dryness of menopause. In addition, it may cause health risks of its own.
Numerous double-blind, placebo-controlled studies involving a total of more than 1,700 participants have examined the effects of ipriflavone on various forms of osteoporosis.
For example, a 2-year, double-blind study followed 198 postmenopausal women who had evidence of bone loss.
Conversely, the largest and longest study of ipriflavone found no benefit.
Ipriflavone may also be helpful for preventing osteoporosis in women who are taking Lupron or corticosteroids, medications that accelerate bone loss.
There is some evidence that combining ipriflavone with estrogen may improve anti-osteoporosis benefits.
Finally, for reasons that are not at all clear, ipriflavone appears to be able to reduce pain in osteoporosis-related fractures that have already occurred.
For more information, including dosage and safety issues, see the full
Other Proposed Natural Treatments
It is often said that magnesium
It has been suggested (though with little meaningful supporting evidence), that the typical American diet causes the body to become acidic, and that this in turn leads to bone loss. One study tested potassium citrate as a treatment for bone loss, in the belief that this supplement would counteract this hypothesized diet-related acidity.
Some evidence suggests that the hormone
Chinese studies suggest that the herb
has phytoestrogenic effects and, on this basis, may be helpful for preventing bone loss.
Although it has long been stated that high
According to one very preliminary study, but not another,
Although it has long been believed that consuming too much protein (especially animal-based protein) increases the risk of osteoporosis, the balance of available evidence suggests the reverse: if anything, high intake of protein appears to help strengthen bone.
The Progesterone Story
Many books promote the idea that natural
The progesterone/osteoporosis story began with
However, a 1-year, double-blind trial of 102 women given either progesterone cream (providing 20 mg progesterone daily) or placebo cream, along with calcium and multivitamins, found no evidence of any improvements in bone density attributable to progesterone.
Furthermore, in a 3-year study of 875 women, combination treatment with estrogen and oral progesterone was no more effective for osteoporosis than estrogen alone.
The Estriol Story
For over a decade, some alternative medicine practitioners have popularized the use of a special form of estrogen called
However, like other forms of estrogen, oral estriol stimulates the growth of uterine tissue. This leads to a risk of uterine cancer.
In a placebo-controlled study of 1,110 women, uterine tissue stimulation was seen among women given estriol orally (1 mg to 2 mg daily) as compared to those given placebo.
In contrast, a 12-month, double-blind trial of oral estriol (2 mg daily) in 68 Japanese women found no effect on the uterus.
The bottom line: If you use estriol, you should consider it like any other form of estrogen.
Various herbs and supplements may interact adversely with drugs used to treat osteoporosis. For more information on this potential risk, see the individual drug article in the
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