Osteogenic Loading: Safe & Effective?

It’s Q&A Day at 10almonds!

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In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

So, no question/request too big or small 😎

❝Is OsteoStrong any good? The Internet seems to have mixed reviews, glowing or it’s a scam, nothing in between❞

It’s difficult (and potentially legally troublesome) to focus on the company, so we’ll focus on the method and the science.

First, for those unaware: OsteoStrong is a company offering exercises aimed at increasing bone density.

Those exercises are chiefly (if not entirely) isometric, albeit they use machines, allowing for biofeedback and progress-tracking. So, unlike most gym machines that will see a big range of motion, even if often just on one axis, theirs involve little-to-no movement, much like pushing against a wall, or pulling on the handle of a locked door.

So first we must examine: are isometric exercises good for bone density?

And the answer is: yes, and we shared some science and recommendations about this, here: Osteoporosis & Exercises: Which To Do (And Which To Avoid)

The science

The principle in use is that of osteogenic loading, which makes use of Wolff’s Law, which states that bone in a healthy animal will adapt to the stresses placed upon it, such that as loading on a particular bone increases, the bone will remodel itself over time to become stronger to resist that sort of loading. For example, the force or loading on bone through its axis can stimulate the bone’s natural function of increasing in density.

That “through its axis” is key here, and the way our skeleton works as a system of levers, allowing to exert potentially multiples of our own bodyweight in force.

If that sounds potentially dangerous in the case of osteoporosis (i.e., it could snap a bone), then: it is. So, this sort of axis-based exercise should definitely by undertaken under professional supervision (we recommend finding a good local physical therapist).

There has been some science done into OsteoStrong’s specific method, mostly paid for by the company itself, which (even if there is no deliberate unethical practice at hand) will tend to promote publication bias at the very least.

We would say, therefore, that best is to look at reviews of studies, rather than just the individual studies themselves.

One such research review found:

❝Seven studies were observational studies (e.g., case study/series, non-randomized trial) and two were randomized trials comparing OsteoStrong to exercise. There were no randomized controlled trials comparing OsteoStrong to a control group. Most studies had small sample sizes and potential conflicts of interest. The two largest studies included individuals on concurrent anti-resorptive treatment. Two of the trials reported on fractures, falls, or adverse events. Most trials reported on bone mineral density (BMD) at the lumbar spine and proximal femur. Effects on BMD were inconsistent across trials.

The research on OsteoStrong is mainly limited to small observational studies that are at risk of bias because of conflict of interest, imprecision, publication in a predatory journal, participants on anti-resorptive medications, or poor-quality research reporting. The effects of OsteoStrong on bone strength outcomes are inconsistent, and currently there is little data on safety of this intervention.❞

…which is not a very glowing report, but it’s not evidence that it doesn’t work, either.

You can find that paper here: OsteoStrong and bone health: a scoping review

There was a much-talked about study all so very recently (at time of writing); perhaps it’s how it came to your attention.

While the study concluded “OsteoStrong® is safe and feasible for postmenopausal women with low BMD”, if we look at the actual outcomes, we see:

• DEXA: no significant change at the hip, femoral neck, or lumbar spine.
• TBS: decreased by 1.8% (statistically significant, and also frankly terrible, by the way, this is serious).
• CT: several measures (volumetric BMD, trabecular BMD, cortical BMD, cortical thickness) declined (this is certainly not good, but not as bad as the above); most changes fell within the least significant change, except the distal radius.
• finite element analysis: no improvement in stiffness or load-to-failure.
• functional scores: observed small improvements, but not statistically significant (for example a 0.1s decrease in the stair climb time, with a sample size of 38, is not very impressive)
• bone turnover markers: CTX high and increased slightly; P1NP essentially unchanged, indicating continued net bone loss.
• body composition: no meaningful changes.

If we explain each measure this article will get very long, so we’ll just talk about the TBS, as that’s the only one where there was a meaningful change.

TBS is Trabecular Bone Scoring, and while DEXA scans, CT scans, etc look at density, TBS looks at quality. This is important, because your bones are made largely of minerals (or at least, they’re supposed to be, though bone mineral density (BMD) scores may differ!), and the structure of those minerals is just as important as the density, sometimes more so.

Think of it this way: have you seen the Golden Gate Bridge? Not very dense, is it? But the structure makes it very strong. San Andreas Fault? Actually the ground there is very dense, but the structure? Well, let’s just say there have been problems.

So, TBS is a very important indicator of fracture risk (a lower score being worse than a higher one).

You can read that paper in full, here: Feasibility, safety and efficacy of OsteoStrong® in postmenopausal women with low bone mineral density: A pilot study

This is unfortunate for the company, as their previous groundbreaking study used in promotional materials also ran into a little snag, with well-respected experts in the field putting in writing such criticisms as:

• “We really questioned the [journal] editor on how this paper got through the peer-review process.”
• “The claims [of the study] are totally misleading. They’re not supported by the data.”
• “The whole paper is extremely difficult to interpret. The way that they present the statistics actually doesn’t make any sense.”
• “I think that study was not of a standard that we would normally expect to read in that journal.”
• “There’s no way that you can make a claim that it’s an effective program.”
• “It is shocking that the editors allowed this to be published in a peer-reviewed journal and it indeed should be retracted and re-analysed at the very least.”
• “I think it is too flawed to draw any conclusions.”
• “That study is flawed and does not provide believable evidence on the effect of OsteoStrong”
• “It has no standing in medical science and should never have been published.”

Read more: Study backing OsteoStrong ‘bone-strengthening’ exercise program should be retracted: experts

(the paper has since been retracted pending correction)

In summary

The science for OsteoStrong might not be quite what one would hope for at this time.

However, isometric exercises themselves remain an excellent way to improve bone strength, and for a definitely safe approach, you might want to consider this an excellent book we reviewed a little while back:

Yoga for Osteoporosis – by Dr. Loren Fishman ← the title makes it seem like any one of a thousand other “gentle exercise” books, but actually this one has an incredible wealth of science, clear explanations, and there’s far more going on in here than one could ever reasonably expect of book with this title, so if this topic (avoiding/reversing osteoporosis) is at all relevant to you personally, we very strongly recommend this specific book.

Take care!