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Osteopenia and Osteoporosis Alternative

May 12, 2010 Written by JP       [Font too small?]

Whenever possible, I like to turn the spotlight on alternative remedies to potentially dangerous medications. A class of drugs known as bisphophonates are best sellers in the senior population. Older women tend to be the primary recipients of prescriptions for Actonel, Boniva and Fosamax because they’re geared toward stemming the loss of bone density. My problem with bisphosphonates is the quality of bone they ultimately yield, which can be brittle, and their questionable side effect profile. Patients and physicians have reported instances of “acute influenza-like illness”, arterial fibrillation, esophageal irritation, gastrointestinal upset, musculoskeletal complaints and osteonecrosis (bone death) of the jaw that appear to be associated with long term use of these medications. (1,2,3)

A new report from the 2010 IOF World Congress of Osteoporosis seems to offer a viable alternative to bisphophonates. The evidence is based on a randomized, double-blind, placebo-controlled study carried out on a nutrient/phytochemical supplement. Over the course of 6 months, geniVida™ Bone Blend was shown to increase bone mineral density by up to 3.4% in a group of 58 “healthy, early post-menopausal women” between the ages of 45 to 55. (4)

In the United States, this multi-nutrient blend, consisting of 1,460 mg of fish oil concentrate, 30 mg of genistein, 800 IUs of Vitamin D and 100 mcg of Vitamin K1, is sold under the name Bonistein Max by Douglas Laboratories. It features a soy-free phytoestrogen (genistein) which was previously investigated and found helpful with other menopausal-related symptoms such as hot flashes. In the osteoporosis trial, the researchers provided the study volunteers with the Bonistein Max formula + 500 mg of calcium daily or a placebo which consisted of 500 mg of calcium/day over a 6 month period. (5,6,7)

If these encouraging results can be replicated, there is a real possibility that this nutraceutical formula could be used in place of or in conjunction with bisphosphonate drugs. In the meantime, at least we have some indication of the relative safety of this bone building supplement. Most of the ingredients contained in it have been widely studied over the past few decades, namely fish oil, Vitamins D and K. The only “wild card” in the bunch is the geniVida™ component of the blend.

Plant Based Omega-3′s May Support Skeletal Integrity
Source: Nutr J. 2007; 6: 2. (link)

Several investigations carried out over the past 5 years offer preliminary support for the safety of this “novel product containing 98.5% synthetic genistein aglycone” at dosages up to 300 mg per day – 10 times the amount used in the current study. A recent 12 week trial evaluating the effects of geniVida™ on hot flash incidence determined that there were no changes in endometrial thickness, hormone levels and other adverse reactions that would be anticipated in those using conventional hormone replacement therapy. (8,9,10)

One of the more interesting aspects of this bone building formula is hinted at in a 2005 paper appearing in the Journal of Physiological Pharmacology. It describes the similarities between genistein and a form of estrogen referred to as 17 beta-estradiol. A study from March 2008 adds relevance to this connection by revealing that a combination of fish oil (DHA) and 17 beta-estradiol is capable of preserving bone density. But what’s really fascinating about that particular experiment is that it failed to find the same benefit from a combination of DHA and phytoestrogens (plant-based estrogens). How then can we explain the positive findings reported at this year’s World of Congress of Osteoporosis? It’s hard to say for certain, but it’s possible that the combination/synergism of all of the nutrients in Bonistein Max is what’s making the difference. Or perhaps the highly-purified, non-soy form of genistein (geniVida™) more closely resembles the activity provided by 17 beta-estradiol as compared to un-purified, soy-based forms of genistein. (11,12,13)

The information presented today can best be described as a preliminary “report from the field”. In fact, the primary study in question has not yet been published in a peer-reviewed medical journal. But I felt it was worth discussing because there’s a desperate need for safer osteopenia and osteoporosis alternatives for the aging population. Much of the data upon which we rely in the alternative and complementary community is based on incomplete information. There simply isn’t as much research for making decisions as can be found in the realm of conventional medicine. So we’re left with a dilemma: Do we use well researched but questionable, conventional medications? Or, do we take a chance on a more natural approach that doesn’t have nearly as much documentation to back up its claims? This is an important consideration that needs to be made in concert with your health care providers who know the entirety of your medical history.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!

JP

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15 Comments & Updates to “Osteopenia and Osteoporosis Alternative”

  1. anne h Says:

    It’s somewhere between scary and pathetic….
    The way people trust the medical doctors and community….
    And look at these side effects.
    I’d rather have the problem than the answer in this case!
    Actually, neither. But gosh!

  2. Orna Izakson, ND, RH (AHG) Says:

    Nice piece, JP!

  3. JP Says:

    I hear you, Anne! :)

    Be well!

    JP

  4. JP Says:

    Thank you, Orna! :)

    Be well!

    JP

  5. crayolabarb Says:

    Hello JP!
    I just found your site tonight and am very impressed with the depth and breadth of your knowledge and your “inquisitive optimism”. I would like to know what you know about the use of Strontium for osteoporosis. I am a 58 yr. old female diagnosed with Osteoporosis 7 yrs ago. Did the BPs for 3 yrs, but became untrusting and switched to OTC Strontium. Just wonder if you know anything I haven’t found in my research.

    Thanks and I’ll keep reading your blog!
    Crayolabarb

  6. JP Says:

    Crayolabarb,

    Thank you for your kind words. I’ve done some preliminary research on strontium. But I’d like to dig a little bit deeper. I’ll use your question as a basis for an upcoming column topic. Please look for my column on strontium in the coming weeks. I’ll pull together the best information I can find. :)

    Be well!

    JP

  7. Kathy Hare Says:

    Your site is very informative, I’ve had some eye opening moments while reading the research you’ve compiled. I also would like to know if you found info on strontium and if it is better to take it for Osteoporosis instead of calcuim.

    Thank you and will pass your site along to my friends.
    Kathy

  8. JP Says:

    Thank you, Kathy. :)

    I’ll write an upcoming column about strontium. In the meantime, I think it’s fair to say that it’s not intended as a replacement for calcium. However, some experts advocate it’s use as an adjunct to calcium and Vitamin D. More info. to come soon.

    Be well!

    JP

  9. Minki Kim Says:

    Hi,

    I just stumbled upon your blog and I appreciate your judicious and polemic entries on so many health issues.

    I myself am a Structural Integrator (popularly known as a Rolfing) and have made huge strides with clients on how they cope with their osteopenia/porosis. Although complementary and alternative medicine cannot document its effectiveness and results, my clients report they haven’t felt better and more balanced holistically after receiving integrative bodywork, exercising right, and eating the appropriate way to nurture and build bone density.

    I have bookmarked your blog BTW.

    Great work!

    Minki Kim

  10. JP Says:

    Thanks a lot, Minki. Your thoughtful comments are much appreciated!

    Be well!

    JP

  11. JP Says:

    Update 06/08/15:

    http://www.ncbi.nlm.nih.gov/pubmed/26036434

    J Pineal Res. 2015 Jun 3.

    Melatonin improves bone mineral density (BMD) at the femoral neck in post-menopausal women with osteopenia: A randomized controlled trial.

    Melatonin is known for its regulation of circadian rhythm. Recently, studies have shown that melatonin may have a positive effect on the skeleton. By increasing age, the melatonin levels decrease, which may lead to a further imbalanced bone remodeling. We aimed to investigate whether treatment with melatonin could improve bone mass and integrity in humans. In a double-blind RCT, we randomized 81 post-menopausal osteopenic women to one-year daily treatment with melatonin 1mg (N=20), or 3mg (N=20), or placebo (N=41). At baseline and after one-year treatment, we measured BMD by DXA, quantitative computed tomography (QCT), and high resolution peripheral QCT (HR-pQCT), and determined calcitropic hormones and bone markers. Mean age of the study subjects was 63 (range 56-73) years. Compared to placebo, femoral neck BMD increased by 1.4% in response to melatonin (p<0.05) in a dose-dependent manner (p<0.01), as BMD increased by 0.5% in the 1mg/d group (p=0.55) and by 2.3% (p<0.01) in the 3mg/d group. In the melatonin group, trabecular thickness in tibia increased by 2.2% (p=0.04), and vBMD in the spine by 3.6% (p=0.04) in the 3mg/d. Treatment did not significantly affect BMD at other sites or levels of bone turnover markers, however, 24h urinary calcium was decreased in response to melatonin by 12.2% (p=0.02). In conclusion, one-year treatment with melatonin increased BMD at femoral neck in a dose-dependent manner, while high dose melatonin increased vBMD in the spine. Further studies are needed to assess the mechanisms of action and whether the positive effect of night-time melatonin will protect against fractures.

    Be well!

    JP

  12. JP Says:

    Updated 12/16/16:

    http://onlinelibrary.wiley.com/doi/10.1002/jbmr.3058/abstract

    J Bone Miner Res. 2016 Dec 12.

    The Association Between Protein Intake by Source and Osteoporotic Fracture in Older Men: A Prospective Cohort Study.

    Dietary protein is a potentially modifiable risk factor for fracture. Our objectives were to assess the association of protein intake with incident fracture among older men and whether these associations varied by protein source or by skeletal site. We studied a longitudinal cohort of 5875 men (mean age 73.6, SD = 5.9 years) in the Osteoporotic Fractures in Men (MrOS) study. At baseline, protein intake was assessed as percent of total energy intake (TEI) with mean intake from all sources = 16.1%TEI. Incident clinical fractures were confirmed by physician review of medical records. There were 612 major osteoporotic fractures, 806 low-trauma fractures, 270 hip fractures, 193 spine fractures, and 919 non-hip non-spine fractures during 15 years of follow-up. We used Cox proportional hazards models with age, race, height, clinical site, TEI, physical activity, marital status, osteoporosis, gastrointestinal surgery, smoking, oral corticosteroids use, alcohol consumption, and calcium and vitamin D supplements as covariates to compute hazard ratios (HR) with 95% confidence intervals (CI), all expressed per unit (SD = 2.9%TEI) increase. Higher protein intake was associated with a decreased risk of major osteoporotic fracture (HR = 0.92 [95% CI: 0.84, 1.00]) with a similar association found for low-trauma fracture. The association between protein and fracture varied by protein source; e.g. increased dairy protein and non-dairy animal protein were associated with a decreased risk of hip fracture (HR = 0.80 [95% CI: 0.65, 0.98] and HR = 0.84 [95% CI: 0.72, 0.97], respectively), while plant-source protein was not (HR = 0.99 [95% CI: 0.78, 1.24]). The association between protein and fracture varied by fracture site; total protein was associated with a decreased risk of hip fracture (HR = 0.84 [95% CI: 0.73, 0.95]), but not clinical spine fracture (HR = 1.06 [95% CI: 0.92, 1.22]). In conclusion, those with high protein intake (particularly high animal protein intake) as a percentage of TEI have a lower risk of major osteoporotic fracture.

    Be well!

    JP

  13. JP Says:

    Updated 09/16/17:

    http://www.mdpi.com/2304-8158/6/9/78/htm

    Foods. 2017 Sep 7;6(9).

    The Macular Carotenoids Lutein and Zeaxanthin Are Related to Increased Bone Density in Young Healthy Adults.

    Lutein (L) and zeaxanthin (Z) status can be quantified by measuring their concentrations both in serum and, non-invasively, in retinal tissue. This has resulted in a unique ability to assess their role in a number of tissues ranging from cardiovascular to central nervous system tissue. Recent reports using animal models have suggested yet another role, a developmental increase in bone mass. To test this, we assessed L and Z status in 63 young healthy adults. LZ status was determined by measuring LZ in serum (using HPLC) and retina tissue (measuring macular pigment optical density, MPOD, using customized heterochromatic flicker photometry). Bone density was measured using dual-energy X-ray absorptiometry (DXA). Although serum LZ was generally not related to bone mass, MPOD was significantly related to bone density in the proximal femur and lumbar spine. In general, our results are consistent with carotenoids, specifically LZ, playing a role in optimal bone health.

    Be well!

    JP

  14. JP Says:

    Updated 1/6/18:

    https://www.ncbi.nlm.nih.gov/pubmed/29304057

    PLoS One. 2018 Jan 5;13(1):e0190539.

    Long-chain omega-3 polyunsaturated fatty acid dietary intake is positively associated with bone mineral density in normal and osteopenic Spanish women.

    The regular consumption of long-chain omega-3 polyunsaturated fatty acids (LCO3-PUFAs) results in general health benefits. The intake of LCO3-PUFAs has been reported to contribute to bone metabolism. We aimed to investigate the relationships between dietary intakes of LCO3-PUFAs and bone mineral density (BMD) in Spanish women aged 20-79 years old. A total of 1865 female subjects (20-79 years old) were enrolled, and lumbar (L2, L3, L3 and total spine), hip (femoral neck (FN), femoral trochanter (FT) and Ward’s triangle (WT)) bone mineral density (BMD) were measured by dual energy X-ray absorptiometry (DXA). Dietary intakes of total energy, calcium, vitamin D, alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and n-6 fatty acids (linoleic acid (LA) and arachidonic acid (AA)) were assessed by a self-administered food frequency questionnaire (FFQ). Spearman’s rank correlations between LCO3-PUFAs and BMD were estimated. Partial correlations controlling for age, weight, height, dietary calcium, vitamin D, menopausal status and energy were calculated. A multiple regression analysis was computed to assess significant associations with BMD in this population. After adjustment for potential confounding factors, there were positive correlations between ALA, EPA and DHA intake and BMD. According to the WHO diagnosis criteria for osteoporosis, in this population of normal and osteopenic women, the dietary intake of ALA was also significantly associated with BMD at the hip. In normal women, the dietary intake of DHA was also significantly associated with BMD at the lumbar spine. No significant associations between LCO3-PUFAs and BMD were detected in the lumbar spine of osteopenic or osteoporotic women. The dietary intake of LCO3-PUFAs was positively associated with BMD in Spanish women at both the hips and the lumbar spine. We highlight that the intake of LCO3-PUFAs is not significantly associated with BMD in osteoporotic women; however, the intake of LCO3-PUFAs seems to be positively associated with BMD at both the hips and the lumbar spine in normal and osteopenic women.

    Be well!

    JP

  15. JP Says:

    Updated 10/08/18:

    https://link.springer.com/article/10.1007%2Fs00223-018-0481-6

    Calcif Tissue Int. 2018 Oct 6.

    Bone Microstructure in Response to Vitamin D3 Supplementation: A Randomized Placebo-Controlled Trial.

    Vitamin D supplementation is often used in the prevention and treatment of osteoporosis, but the role of vitamin D has lately been questioned. We aimed to investigate the effect of 3 months of daily vitamin D3 supplementation (70 µg [2800 IU] vs. placebo) initiated in winter months on bone health. This study is a double-blinded placebo-controlled randomized trial. Bone health was assessed by bone turnover markers, DXA, HRpQCT, and QCT scans. The participants were 81 healthy postmenopausal women with low 25(OH)D (<  50 nmol/l) and high PTH levels (> 6.9 pmol/l) at screening. Vitamin D3 supplementation significantly increased levels of 25(OH)D and 1,25(OH)2D by 59 nmol/l and 19 pmol/l, respectively, whereas PTH was reduced by 0.7 pmol/l (all p < 0.0001). Compared with placebo, vitamin D3 did not affect bone turnover markers, aBMD by DXA or trabecular bone score. Vitamin D3 increased trabecular vBMD (QCT scans) in the trochanter region (0.4 vs. - 0.7 g/cm3) and the femoral neck (2.1 vs. - 1.8 g/cm3) pall < 0.05. HRpQCT scans of the distal tibia showed reduced trabecular number (- 0.03 vs. 0.05 mm-1) and increased trabecular thickness (0.001 vs. - 0.005 mm), as well as an improved estimated bone strength as assessed by failure load (0.1 vs. - 0.1 kN), and stiffness (2.3 vs. - 3.1 kN/mm pall ≤ 0.01). Changes in 25(OH)D correlated significantly with changes in trabecular thickness, stiffness, and failure load. Three months of vitamin D3 supplementation improved bone strength and trabecular thickness in tibia, vBMD in the trochanter and femoral neck, but did not affect aBMD.

    Be well!

    JP

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