Bone health – Is there a natural way to achieve it?

Until recently, patients of mainstream medicine were given a choice between two medical options for treating thinning bones, be it a diagnosis of osteopenia or the more-severe osteoporosis that they carry. Weight-bearing exercise is known to increase bone mass,1 but I am not content with trusting in that alone, as I suspect most are not. Medicine Choice 1 was the bisphosphonate class of medications, which demand 90% compliance2 for their minimal efficacy3 in preventing only one type of fracture,4,5 with no mortality benefit whatsoever.6 That class carries with it the serious side effects of osteonecrosis of the jaw7 and atypical fractures of the femoral neck,8 just to name two.9 If that were not enough bad news, the half-life of the most popular bisphosphonate, alendronate, is “greater than 10 years.” For how long exactly? No one knows, they just stopped looking at 10 years.10 So once taken, it stays in your body for an indefinite amount of time.

Medicine Choice 2 is tepiratide, which may regrow bone,11 but is given as a self-administered injection daily for two years. Why just two years, might one ask? Because in lab mice they saw an osteosarcoma (bone cancer) emerge after two years of use,12 and now post-marketing data reveals that two humans have also been diagnosed with osteosarcoma.13 Not really a medication I’d want to take. And after the two years it is recommended to switch to a bisphosphonate. So even this path leads ultimately to a bisphosphonate.

Enter OsteoStrong. Using the concept of osteogenic loading (stressing the bones with a heavy weight for a short duration, mimicking an impact), it uses our own effort to grow stronger bones and muscles. This can be done in as little as 15 minutes per week and has only the fabulous side effects of up to a 14% increase in bone mineral density, increased agility, decreased joint pain, improvements in strength and balance. The high-impact physiologic stress caused by lifting multiples of one’s body weight has been shown to regrow bone.14 For example, one study found the weight-bearing bones of skiers (who undergo multiple impacts per run) to be 10-60% stronger than normally active non-skiers.15 

Pre-menopausal women can generate (with correct physical activity) high enough impacts/stress to regrow bone, however those who are postmenopausal cannot, and need external help.16 So, while OsteoStrong is great for all, some populations may benefit even more. You will find it to be its own little community, as you’ll get to know all the staff, and are inevitably seeing the same fellow OsteoStrong-ers week after week, all working toward the common goal of better bone health. There are 4 machines that resemble high-tech versions of equipment you’ve seen in other gyms however these are different. With screens providing instant feedback on effort, and comparisons to prior visits, one gets instant motivation to grow stronger. This is also a good way to knock out a couple of the pillars of Lifestyle Medicine: regular physical activity and positive social connections! Of course there are other things we can do to preserve our bones, such as avoiding phosphates in soda,17 avoiding known offending medications such as systemic steroids,18 and we need to be doing those too, but OsteoStrong is another great arrow in the treatment quiver to have. Side note: be sure you are taking Vitamin D and avoiding calcium supplements, which have been shown to increase cardiovascular risk.19,20 Dietary calcium (think tofu, greens, nuts and seeds) has not been shown to increase this risk,21 and is the source from which we should be getting our calcium. 

And while it may sound like I would, I have no financial interest in OsteoStrong, I am just really excited that we have a center in our own community, and I can’t wait to recommend this to others!

References

  1. Michel BA, Lane NE, Bloch DA, Jones HH, Fries JF. Effect of changes in weight-bearing exercise on lumbar bone mass after age fifty. Ann Med. 1991 Oct;23(4):397-401.
  2. Penning-van Beest FJ, Erkens JA, Olson M, Herings RM. Loss of treatment benefit due to low compliance with bisphosphonate therapy. Osteoporos Int. 2008 Apr;19(4):511-7.
  3. Kim, J., Kim, K.M., Lim, S. et al. Efficacy of bisphosphonate therapy on postmenopausal osteoporotic women with and without diabetes: a prospective trial. BMC Endocr Disord 22, 99 (2022).
  4. Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures. JAMA 1998;280:2077-82
  5. McClung MR, Geusens P, Miller PD, Zippel H, Bensen WG, Roux C, et al. Effect of risedronate on hip fracture risk in elderly women. N Engl J Med 2001; 344:333-40
  6. Cummings SR, Lui L, Eastell R, Allen IE. Association Between Drug Treatments for Patients With Osteoporosis and Overall Mortality Rates: A Meta-analysis. JAMA Intern Med. 2019;179(11):1491–1500.
  7. ON: Gebara SN, Moubayed H. Risk of osteonecrosis of the jaw in cancer patients taking bisphosphonates. Am J Health Syst Pharm. 2009 Sep 1;66(17):1541-7.
  8. FF: Ott SM, Heckbert SR. Atypical Femur Fracture Risk versus Fragility Fracture Prevention with Bisphosphonates. N Engl J Med. 2020 Nov 26;383(22):2188-2189.
  9. Coleman RE. Risks and benefits of bisphosphonates. Br J Cancer. 2008 Jun 3;98(11):1736-40. doi: 10.1038/sj.bjc.6604382. Epub 2008 May 27.
  10. Gertz BJ, Holland SD, Kline WF, Matuszewski BK, Porras AG. Clinical pharmacology of alendronate sodium. Osteoporos Int. 1993;3 Suppl 3:S13-6.
  11. Eriksen EF, Robins DA. Teriparatide: A bone formation treatment for osteoporosis. Drugs Today (Barc). 2004 Nov;40(11):935-48.
  12. Subbiah V, Madsen VS, Raymond AK, Benjamin RS, Ludwig JA. Of mice and men: divergent risks of teriparatide-induced osteosarcoma. Osteoporos Int. 2010 Jun;21(6):1041-5.
  13. Ibid.
  14. Tobias JH, Gould V, Brunton L, et al. Physical Activity and Bone: May the Force be with You. Front Endocrinol (Lausanne). 2014;5:20. Published 2014 Mar 3.
  15. Nikander R, Sievänen H, Heinonen A, Karstila T, Kannus P. Load-specific differences in the structure of femoral neck and tibia between world-class moguls skiers and slalom skiers. Scand J Med Sci Sports. 2008;18(2):145-153.
  16. Vainionpää A, Korpelainen R, Vihriälä E, Rinta-Paavola A, Leppäluoto J, Jämsä T. Intensity of exercise is associated with bone density change in premenopausal women. Osteoporos Int. 2006;17(3):455-463.
  17. Ritz E, Hahn K, Ketteler M, Kuhlmann MK, Mann J. Phosphate additives in food–a health risk. Dtsch Arztebl Int. 2012;109(4):49-55.
  18. Body JJ. Prevention and treatment of side-effects of systemic treatment: bone loss. Ann Oncol. 2010;21 Suppl 7:vii180-vii185.
  19. A. Bolland MJ, Barber PA, Doughty RN, et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ. 2008;336(7638):262-266.
  20. B. Reid IR, Bolland MJ. Calcium risk-benefit updated–new WHI analyses. Maturitas. 2014;77(1):1-3.
  21. C. Reid IR, Bolland MJ. Risk factors: Calcium supplements and cardiovascular risk. Nat Rev Cardiol. 2012;9(9):497-498.