Which Osteoporosis Medication, If Any, Is Right For You?

We’ve written about osteoporosis before, so here’s a quick recap first in case you missed these:

• The Bare-bones Truth About Osteoporosis
• Exercises To Do (And Exercises To Avoid) If You Have Osteoporosis
• We Are Such Stuff As Fish Are Made Of
• Vit D + Calcium: Too Much Of A Good Thing?

All of those look and diet and/or exercise, with “diet” including supplementation. But what of medications?

So many choices (not all of them right for everyone)

The UK’s Royal Osteoporosis Society says of the very many osteoporosis meds available:

❝In terms of effectiveness, they all reduce your risk of broken bones by roughly the same amount.

Which treatment is right for you will depend on a number of things.❞

…before then going on to list a pageful of things it will depend on, and giving no specific information about what prescriptions or proscriptions may be made based on those factors.

Source: Royal Osteoporosis Society | Which medication should I take?

We’ll try to do better than that here, though we have less space. So let’s get down to it…

First line drug offerings

After diet/supplementation and (if applicable) hormones, the first line of actual drug offerings are generally biphosphates.

Biphosphates work by slowing down your osteoclasts—the cells that break down your bones. They may sound like terrible things to have in the body at all, but remember, your body is always rebuilding itself and destruction is a necessary act to facilitate creation. However, sometimes things can get out of balance, and biphosphates help tip things back into balance.

Common biphosphates include Alendronate/Fosamax, Risedronate/Actonel, Ibandronate/Boniva, and Zolendronic acid/Reclast.

A common downside is that they aren’t absorbed well by the stomach (despite being mostly oral administration, though IV versions exist too) and can cause heartburn / general stomach upset.

An uncommon downside is that messing with the body’s ability to break down bones can cause bones to be rebuilt-in-place slightly incorrectly, which can—paradoxically—cause fractures. But that’s rare and is more common if the drugs are taken in much higher doses (as for bone cancer rather than osteoporosis).

Bone-builders

If you already have low bone density (so you’re fighting to rebuild your bones, not just slow deterioration), then you may need more of a boost.

Bone-building medications include Teriparatide/Forteo, Abaloparatide/Tymlos, and Romosozumab/Evenity.

These are usually given by injection, usually for a course of one or two years.

Once the bone has been built up, it’ll probably be recommended that you switch to a biphosphate or other bone-stabilizing medication.

Estrogen-like effects, without estrogen

If your osteoporosis (or osteoporosis risk) comes from being post-menopausal, estrogen is a very common (and effective!) prescription. However, some people may wish to avoid it, if for example you have a heightened breast cancer risk, which estrogen can exacerbate.

So, medications that have estrogen-like effects post-menopause, but without actually increasing estrogen levels, include: Raloxifene/Evista, and also all the meds we mentioned in the bone-building category above.

Raloxifene/Evista specifically mimics the action of estrogen on bones, while at the same time blocking the effect of estrogen on other tissues.

Learn more…

Want a more thorough grounding than we have room for here? You might find the following resource useful:

List of 82 Osteoporosis Medications Compared (this has a big table which is sortable by various variables)

Take care!

Winning The Biological Arms Race

The human immune system (and indeed, other immune systems, but we are all humans here, after all) is in a constant state of war with pathogens, and that war is a constant biological arms race:

• We improve our defenses and destroy the attackers; the 1% of pathogens that survived now “know” how to counter that trick.
• The pathogens wreak havoc in our systems; the n% of us that survive now have immune systems that “know” how to counter that trick.

Vaccines are a mighty tool in our favor here, because they’re the technology that stops our n% from also being a very low number.

With vaccines, we can effectively pass on established defenses onto the population at large, as this cute video explains very well and very simply in 57 seconds:

Click Here If The Embedded Video Doesn’t Load Automatically!

The problem with vaccines

The problem is that this accelerates the arms race. It’s like a chess game where we are able to respond to every move quickly (which is good for us), and/but this means passing the move over to our opponent sooner.

That problem’s hard to avoid, because the alternative has always been “let people die in much larger numbers”.

Traditional vs mRNA vaccines

A quick refresher before we continue to the big news of the day:

• Traditional vaccines use a disabled version of a pathogen to trigger an immune response that will teach the body to recognize the pathogen ready for when the full version shows up
• mRNA vaccines use a custom-made bit of genetic information to tell the body to make its own harmless fake pathogen and then respond to the harmless fake pathogen it made.

Note: this happens independently of the host’s DNA, so no, it does not change your DNA

See also: The Truth About Vaccines

Here’s a more detailed explainer (with a helpful diagram) using the COVID mRNA vaccine as an example:

Genome.gov | How does an mRNA vaccine work?

However, this still leaves us “chasing strains”, because as the pathogen (in this case, a virus) adapts, the vaccine has to be updated too, hence all the boosters.

This is a lot like a security update for your computer’s antivirus software. They’re annoying, but they do an important job.

No more “chasing strains”

The press conference soundbite on this sums it up well:

❝Scientists at UC Riverside have demonstrated a new, RNA-based vaccine strategy that is effective against any strain of a virus and can be used safely even by babies or the immunocompromised.❞

~ Jules Bernstein

Read in full: Vaccine breakthrough means no more chasing strains

You may be wondering: what makes this one effective against any strain?

❝What I want to emphasize about this vaccine strategy is that it is broad.

It is broadly applicable to any number of viruses, broadly effective against any variant of a virus, and safe for a broad spectrum of people. This could be the universal vaccine that we have been looking for.

Viruses may mutate in regions not targeted by traditional vaccines. However, we are targeting their whole genome with thousands of small RNAs. They cannot escape this.❞

~ Dr. Rong Hai

Importantly, this means it can be applied not just to one disease, let alone just one strain of COVID. Rather, it can be used for a wide variety of viruses that have similar viral functions—COVID / SARS in general, including influenza, and even viruses such as dengue.

How it does this: the above article explains in more detail, but in few words: it targets tiny strings of the genome that are present in all strains of the virus.

Illustrative example: if you wanted to block 10almonds (please don’t), you could block our email address.

But if we were malicious (we’re not) we could be sneaky and change it, so you’d have to block the new one, and the cycle repeats.

But if you were block all emails containing the tiny string of characters “10almonds”, changing our email address would no longer penetrate your defenses.

Now imagine also blocking strings such as “One-Minute Book Review” and “Today’s almonds have been activated by” and other strings we use in every email.

Now multiply this by thousands of strings (because genomes are much larger than our little newsletter), and you see its effectiveness!

Great! How can I get this?

It’s still in the testing stages for now; this is “breaking news” science, after all.

The study itself

…is paywalled for now, sadly, but if you happen to have institutional access, here it is:

Live-attenuated virus vaccine defective in RNAi suppression induces rapid protection in neonatal and adult mice lacking mature B and T cells

Take care!