Treatments for Osteoporosis

t It can be more challenging to diagnose than other symptoms. You can see my previous videos about it here and here. In this article, we explore some available treatments for osteoporosis.

Symptoms for this silent disease are not external, and often don’t cause pain or discomfort until it’s too late. You have to get tested for it to get diagnosed for it. Osteoporosis is more common in women than men especially when they reach menopause. I mean… are you surprised?

Silent Disease

First of all, women tend to have smaller, thinner bones than men. We can thank evolution for this one. Oestrogen, a hormone in women that besides all other functions, protects bones, decreases sharply when women reach menopause. This can then cause bone loss. For some women, this bone loss is quick and severe. So, already thin bones + less bone protection = bad news.

Two major factors which affect your chance of getting osteoporosis are:

1. The amount of bone mass you have when you reach menopause. The greater your bone density is, to begin with, the lower your chance of developing osteoporosis. If you had low bone mass or other risk factors that caused you to lose bone, your chance of getting osteoporosis goes up.

2. How fast you lose bone mass after you reach menopause. For some women, bone loss happens faster than others. In fact, a woman can lose up to 20% of her bone density during the five-seven years following menopause. If you lose bone mass quickly, you have a greater chance of developing osteoporosis.

Osteoporosis and Oestrogen

During menopause, the normal bone turnover cycle is affected by lower oestrogen levels. This because of oestrogen receptors (meaning a site where the oestrogen can bind to) in osteoclast progenitor cells and multi-nucleated osteoclasts. The osteoclastic resorption activity increases while the osteoblastic activity decreases. As a result, the amount of bone resorbed exceeds the amount deposited, which leads to a net loss of bone. The increase of overall bone resorption is due to a weakened inhibition effect due to the reduction of available oestrogen on both osteoclastogenesis (in simple words production of “new” bone from cells) and osteoclast activity. Treatments are available in order to slow down osteoporosis progression.

Or to put it simply: With a drop in oestrogen caused by the menopause, there is a more rapid decrease in bone density and bone loss becomes faster than bone growth. 

Illustration showing a normal bone compared to osteoporosis.

Treatments for Osteoporosis

HRT

The stage before osteoporosis is osteopenia, which is a reduction in bone mineral density, visible with a Dexa Scan (Bone Density scan). This is not yet osteoporosis, therefore with specific measures, the progression can be slow down. First of all, Hormone Replacement Therapy (HRT). HRT helps not only with menopause associated symptoms, but it can also prevent bone loss because your oestrogen levels increase and for many women, this helps to and reduce the risk of broken bones.

A woman can lose up to 20% of her bone density during the five – seven years following menopause.

Bisphosphonates

Other than HRT, the most common treatment for osteoporosis bisphosphonates. Bisphosphonates are a group of drugs that work by slowing bone loss. They reduce the risk of hip and spine fractures. Bone renewal is a slow process, but in many people, an increase in bone density can be measured over five years of treatment.  They are not free of side effects though. There are several different bisphosphonates, and they have different formulations. They can be taken:

  • by mouth (orally)
  • through a drip into a vein (intravenous infusion)
  • by injection into a vein (intravenous injection).

Oral bisphosphonates tend to be poorly absorbed by the body and can cause irritation of the gullet (heartburn), so it’s very important that you carefully follow the instructions given for taking the medication. Side-effects include:

  • itchy rashes or photosensitivity (rash on exposure to sunlight)
  • a sore mouth
  • flu-like symptoms (more common with intravenous treatment)
  • bone pain (more common with intravenous treatments)
  • muscle pain
  • headaches

Read here to find out my top tips regarding osteoporosis!

Other treatments for osteoporosis

There is also another treatment available but it is reserved to people who have already had more than 2 fractures in their vertebrae (at least in some countries, in other may be available for everyone) or a very aggressive osteoporosis. Parathyroid hormone therapy uses a synthetic form of the hormone produced by the parathyroid glands (PTH). This powerful drug – Teriparatide (Forteo) – stimulates new bone growth. It can treat osteoporosis in people who are at high risk of fractures.

Drugs like bisphosphonates only slow the loss of bone density. Teriparatide helps your body to increase bone mineral density and consequently bone strength.

Teriparatide is a relatively new drug, we don’t know much about its long-term effects.

Isoflavones

On top of that, there are alternative solutions for people that do not want to use normal drugs in light of side effects or for any personal reason. One of those is Combined Red Clover Isoflavones and probiotics.

Why do Isoflavones have a beneficial effect? Isoflavones, or phytoestrogens, are substances called Selective Estrogen Receptor Modulators (SERM), which means they prefer to bind to specific types of receptors on cells. These are called oestrogen receptors which exist in 2 versions.

The alpha version found in high concentrations around the breast and uterus, and a beta version around the bones, kidneys, lungs and intestines. Isoflavones present in Red Clover, bind to beta receptors 1,000 times more strongly than to alpha ones. This means that they can have a balancing effect, without adversely affecting the oestrogen-sensitive breast and uterine tissue, thus helping to stabilise the hormone balance without any side effects. The lactic acid fermentation ensures that the glucose bound to phytoestrogens separates, making the phytoestrogen easily absorbable.

Herrens Mark

The fermented red clover extract from Herrens Mark underwent successfully two clinical trials. The first one, demonstrated an amazing outcome in reducing hot flushes, meanwhile, the second one demonstrated its efficacy in treating osteopenia, by preserving bone density in the spine.

Two groups of women all with osteopenia (a precursor to osteoporosis) were recruited for the study. All women were tested over the course of one year. The results showed a surprising effect on the decalcification of bones in the group treated. Results are the following:

• The placebo group (the ones not taking the extract, but think they are) lost 3% of their bone mass during the year

• Scans of the treated group showed a marked slowdown in the decalcification process in both the spine and the hip sockets (measured after one year by DEXA scan). This study demonstrated the positive effect of Fermented red clover extract in the treatment of 2 menopausal symptoms, one of which is osteoporosis. What else, it has no side effects! Scientific evidence demonstrates that this is a convincing alternative to deal with osteoporosis. I will start the treatment myself and will have a Dexa scan in the fall. I’ll keep you updated!

REFERENCES:

Ther Adv Musculoskelet Dis. 2019 Oct 5;11:1759720X19877994. doi: 10.1177/1759720X19877994. eCollection 2019.

Update on the safety and efficacy of teriparatide in the treatment of osteoporosis. Minisola S, Cipriani C, Grotta GD, Colangelo L, Occhiuto M, BiondiP, Sonato C, Vigna E, Cilli M, Pepe J.