Conditions:
Osteoporosis

Principal Proposed Treatments
  • Calcium, Vitamin D, Ipriflavone, Isoflavones, Genistein, Trace Minerals, Fish Oil, GLA (Gamma-Linolenic Acid)
Other Proposed Treatments
  • Vitamin K, DHEA (Dehydroepiandrosterone), Black Tea, Black Cohosh, Folate, Horsetail, Magnesium, Manganese, Pregnenolone, Strontium, Vanadium, Vitamin B12, Boron, Progesterone, Estriol

Many factors are now known or suspected to accelerate the rate of bone loss. These include smoking, alcohol, low calcium intake, excessive phosphorus intake (such as found in soft drinks), lack of exercise, various medications, and several medical illnesses. Excessive consumption of vitamin A may also increase risk of osteoporosis,¹ and rapid weight loss may increase the risk in postmenopausal women.² Women are much more prone to osteoporosis than men and, for this reason, the following discussion focuses almost entirely on them.

Conventional medical treatment for osteoporosis in women centers mainly on hormone-replacement therapy. Although supplemental estrogen undoubtedly slows and perhaps even reverses osteoporosis, concern about the increased risk of breast cancer has caused many women and their physicians to rethink the use of this therapy. The so-called designer estrogen raloxifene (Evista) may offer benefits without this risk. Other drugs, such as Fosamax (a nonhormonal drug), can also help build bone.

Weight-bearing exercise is strongly recommended.

Principal Proposed Treatments for Osteoporosis

There is good evidence that calcium supplements may be able to slow the progression of osteoporosis. A combination of calcium and vitamin D may be able to produce even better effects. The semisynthetic substance ipriflavone may actually reverse the disease to some extent, although not all studies agree, and ipriflavone might present some risks. Soy or its isoflavone constituents may be helpful for osteoporosis, but study results remain conflicting.

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. (Although your body can manufacture vitamin D when exposed to the sun, in this age of sunblock, supplemental vitamin D may be necessary.) Numerous good studies indicate that calcium supplements can help prevent and slow osteoporosis.³ Calcium supplementation at the recommended doses appears to be able to reduce bone loss in postmenopausal women in every bone site except the spine.^4,5,6 Good evidence tells us that when vitamin D is taken along with calcium the results are even better.⁷ Combination treatment may be able to slow osteoporosis in the spine, and in some cases actually reverse osteoporosis to some extent. It may also protect against bone loss caused by corticosteroid drugs such as prednisone.^8,9

Calcium supplements, at least calcium-citrate malate, may do a better job of strengthening bones in individuals with relatively high protein intake.¹³⁵

However, calcium and vitamin D use must be continual. Improvements in bone rapidly disappear once the supplements are stopped.¹⁰

While estrogen is more powerful than calcium alone, taking calcium along with estrogen may offer additional benefits.¹¹ Calcium supplementation is also useful for young girls as a way to "put calcium in the bank"—building up a supply for the future.^12,13 However, regular exercise may be more important.¹⁴

Adding various trace minerals (zinc: 15 mg; copper: 2.5 mg; and manganese: 5 mg) along with calcium and vitamin D seems to produce further improvement.^15,16 However, copper by itself may not be helpful.¹³⁴

There is some evidence that essential fatty acids may 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 evening primrose oil) and omega-3 fatty acids (from fish oil) for a period of 18 months. At the end of the study period, the group receiving essential fatty acids had higher bone density and fewer fractures than the placebo group.¹⁷ However, a 12-month double-blind trial of 42 postmenopausal women found no benefit.¹⁸

The explanation for the discrepancy may lie in the differences between the women studied. The first study involved women living in nursing homes, while the second studied healthier women living on their own. The second group of women may have been better nourished, and already received enough essential fatty acids in their diet.

Interestingly, vitamin D may offer another benefit for osteoporosis: studies have found that when older individuals take vitamin D supplements, they have less of a tendency to sway while standing or walking, and may therefore be less likely to fall.^138,139 Since the most common adverse consequence of osteoporosis is a fracture due to a fall, this could be a meaningful benefit.

For more information, including dosage and safety issues, see the full articles on calcium and vitamin D.

Ipriflavone

Ipriflavone is a semisynthetic variation of soy isoflavones (see below). 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 over 1,700 participants have examined the effects of ipriflavone on various forms of osteoporosis.^31–42 Overall, it appears that ipriflavone can stop the progression of osteoporosis and perhaps reverse it to some extent.

For example, a 2-year double-blind study followed 198 postmenopausal women who had evidence of bone loss.⁴³ At the end of the study, there was a gain in bone density of 1% in the ipriflavone group compared to a loss of 0.7% in the placebo group.

Conversely, the largest and longest study of ipriflavone found no benefit.⁴⁴ In this 3-year trial of 474 postmenopausal women, no differences in extent of osteoporosis were seen between ipriflavone and placebo groups. However, for reasons that aren't clear, the researchers in this study gave women only 500 mg of calcium daily. All other major studies of ipriflavone gave participants 1,000 mg of calcium daily. It's possible that ipriflavone requires the higher dose of calcium to work properly.

Ipriflavone may also be helpful for preventing osteoporosis in women who are taking Lupron or corticosteroids, medications that accelerate bone loss.^45,46,47 (However, the combined use of ipriflavone and drugs that suppress the immune system, such as corticosteroids, presents risks.)

There is some evidence that combining ipriflavone with estrogen may improve anti-osteoporosis benefits.^48,49 However, we do not know whether such combinations increase or decrease the other benefits and adverse effects of estrogen-replacement therapy.

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.^50,51,52

For more information, including dosage and safety issues, see the full ipriflavone article.

Soy Isoflavones (and Other Soy Products)

Soy contains substances called isoflavones that produce effects in the body somewhat similar to the effects of estrogen. Soy, or isolated isoflavones, may be helpful for osteoporosis, but the evidence remains conflicting.

In one study that evaluated the benefits of soy isoflavones in osteoporosis, a total of 66 postmenopausal women took either placebo (soy protein with isoflavones removed) or soy protein containing 56 or 90 mg of soy isoflavones daily for 6 months.⁶⁵ The group that took the higher dosage of isoflavones showed significant gains in spinal bone density. There was little change in the placebo or low-dose isoflavone groups. This study suggests that soy isoflavones may be effective for osteoporosis.

Very nearly the same results were seen in a similar study as well. This 24-week double-blind study of 69 postmenopausal women found that isoflavone-rich soy products can significantly reduce bone loss from the spine.⁶⁶

Similar benefits have been seen in some, but not all, animal studies, as well as other human trials.^67–76 However, a couple of animal studies and one human trial failed to find benefit.^74,75,76,140 These conflicting results make it impossible to conclude, as yet, whether soy or soy isoflavones are helpful for osteoporosis.

Estrogen and most other medications for osteoporosis work by fighting bone breakdown. It has been suggested that soy may work in the other way by helping to increase new bone formation.^80,81

For more information, including dosage and safety issues, see the full soy article.

Other Proposed Treatments for Osteoporosis

Evidence suggests (but doesn't prove) that vitamin K may help prevent osteoporosis.^96–105 For more information, including dosage and safety issues, see the full vitamin K article.

Increasing evidence suggests that the hormone DHEA may be helpful for fighting osteoporosis in postmenopausal women, especially those over 70, but not in men.^106–109,136

Very preliminary evidence suggests that black tea, which is quite similar but not identical to green tea, may help protect against osteoporosis.¹¹⁰

Very weak evidence hints that black cohosh might help prevent osteoporosis.¹³⁷

A wide variety of other food supplements have also been suggested as useful for the prevention or reversal of osteoporosis, including folate, horsetail, magnesium, manganese, pregnenolone, strontium, vanadium, and vitamin B₁₂. However, there is as yet little direct evidence that they really work.

Boron is frequently mentioned as a treatment for osteoporosis as well.¹¹¹ However, there are some concerns that boron supplements may raise levels of the body's own estrogen, especially in women on estrogen-replacement therapy, and therefore might present an increased risk of cancer.^112,113 If you want to increase your boron intake, the best way might be to eat more fruits and vegetables. 

Although it has long been believed that eating a lot of animal-based protein increases the risk of osteoporosis, the results of a large study contradict this idea. This observational study of over 40,000 women suggests that the more animal protein you eat, the less likely you are to develop osteoporosis.¹¹⁴ Protein was also found to protect bone in adouble-blind study.¹¹⁵

The Progesterone Story

Many books promote the idea that natural progesterone prevents or even reduces osteoporosis. In this case, the term natural indicates that we are using the same progesterone found in the body. It is still made synthetically, but it is called "natural progesterone" to distinguish it from its chemical cousins known as progestins. Generally, prescription "progesterone" is actually a progestin.

The progesterone/osteoporosis story began with test tube and other preliminary studies suggesting that progesterone or progestins can stimulate the activity of cells that build bone.^116,117 Subsequently, a poorly designed and uncontrolled study (really, a series of case histories from one physician's practice) purportedly demonstrated that progesterone cream can slow or even reverse osteoporosis.^118,119,120

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.¹²¹

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.¹²²

The Estriol Story

For over a decade, some alternative medicine practitioners have popularized the use of a special form of estrogen called estriol, claiming that, unlike standard estrogen, it doesn't increase the risk of cancer. However, this claim is unfounded.

Controlled trials performed in Japan have found that estriol helps prevent bone loss in menopausal women,^123–127 although one small study found no benefit.¹²⁸

However, like other forms of estrogen, oral estriol stimulates the growth of uterine tissue. This leads to risk of uterine cancer.

In a placebo-controlled study of 1,110 women, uterine tissue stimulation was seen among women given estriol orally (1 to 2 mg daily) as compared to those given placebo.¹²⁹ Another large study found that oral estriol increased the risk of uterine cancer.¹³⁰ In another study of 48 women given estriol 1 mg twice daily, uterine tissue stimulation was seen in the majority of cases.¹³¹

In contrast, a 12-month double-blind trial of oral estriol (2 mg daily) in 68 Japanese women found no effect on the uterus.¹³² It may be that the high levels of soy in the Japanese diet altered the results. Additionally, test tube studies suggest that estriol is just as likely to cause breast cancer as any other form of estrogen.¹³³

The bottom line: if you use estriol, you should consider it like any other form of estrogen.

Last reviewed September 2002 by Medical Review Board

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