Which Osteoporosis Medication, If Any, Is Right For You?
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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!
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Falling: Is It Due To Age Or Health Issues?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
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 😎
❝What are the signs that a senior is falling due to health issues rather than just aging?❞
Superficial answer: having an ear infection can result in a loss of balance, and is not particularly tied to age as a risk factor
More useful answer: first, let’s consider these two true statements:
- The risks of falling (both the probability and the severity of consequences) increase with age
- Health issues (in general) tend to increase with age
With this in mind, it’s difficult to disconnect the two, as neither exist in a vacuum, and each is strongly associated with the other.
So the question is easier to answer by first flipping it, to ask:
❝What are the health issues that typically increase with age, that increase the chances of falling?❞
A non-exhaustive list includes:
- Loss of strength due to sarcopenia (reduced muscle mass)
- Loss of mobility due to increased stiffness (many causes, most of which worsen with age)
- Loss of risk-awareness due to diminished senses (for example, not seeing an obstacle until too late)
- Loss of risk-awareness due to reduced mental focus (cognitive decline producing absent-mindedness)
Note that in the last example there, and to a lesser extent the third one, reminds us that falls also often do not happen in a vacuum. There is (despite how it may sometimes feel!) no actual change in our physical relationship with gravity as we get older; most falls are about falling over things, even if it’s just one’s own feet:
The 4 Bad Habits That Cause The Most Falls While Walking
Disclaimer: sometimes a person may just fall down for no external reason. An example of why this may happen is if a person’s joint (for example an ankle or a knee) has a particular weakness that means it’ll occasionally just buckle and collapse under one’s own weight. This doesn’t even have to be a lot of weight! The weakness could be due to an old injury, or Ehlers-Danlos Syndrome (with its characteristic joint hypermobility symptoms), or something else entirely.
Now, notice how:
- all of these things can happen at any age
- all of these things are more likely to happen the older we get
- none of these things have to happen at any age
That last one’s important to remember! Aging is often viewed as an implacable Behemoth, but the truth is that it is many-faceted and every single one of those facets can be countered, to a greater or lesser degree.
Think of a room full of 80-year-olds, and now imagine that…
- One has the hearing of a 20-year-old
- One has the eyesight of a 20-year-old
- One has the sharp quick mind of a 20-year-old
- One has the cardiovascular fitness of a 20-year-old
…etc. Now, none of those things in isolation is unthinkable, so remember, there is no magic law of the universe saying we can’t have each of them:
Age & Aging: What Can (And Can’t) We Do About It?
Which means: that goes for the things that increase the risk of falling, too. In other words, we can combat sarcopenia with protein and resistance training, maintain our mobility, look after our sensory organs as best we can, nourish our brain and keep it sharp, etc etc etc:
Train For The Event Of Your Life! (Mobility As A Long-Term “Athletic” Goal For Personal Safety)
Which doesn’t mean: that we will necessarily succeed in all areas. Your writer here, broadly in excellent health, and whose lower body is still a veritable powerhouse in athletic terms, has a right ankle and left knee that will sometimes just buckle (yay, the aforementioned hypermobility).
So, it becomes a priority to pre-empt the consequences of that, for example:
- being able to fall with minimal impact (this is a matter of knowing how, and can be learned from “soft” martial arts such as aikido), and
- ensuring the skeleton can take a knock if necessary (keeping a good balance of vitamins, minerals, protein, etc; keeping an eye on bone density).
See also:
Fall Special ← appropriate for the coming season, but it’s about avoiding falling, and reducing the damage of falling if one does fall, including some exercises to try at home.
Take care!
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The Uses of Delusion – by Dr. Stuart Vyse
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Most of us try to live rational lives. We try to make the best decisions we can based on the information we have… And if we’re thoughtful, we even try to be aware of common logical fallacies, and overcome our personal biases too. But is self-delusion ever useful?
Dr. Stuart Vyse, psychologist and Fellow for the Committee for Skeptical Inquiry, argues that it can be.
From self-fulfilling prophecies of optimism and pessimism, to the role of delusion in love and loss, Dr. Vyse explores what separates useful delusion from dangerous irrationality.
We also read about such questions as (and proposed answers to):
- Why is placebo effect stronger if we attach a ritual to it?
- Why are negative superstitions harder to shake than positive ones?
- Why do we tend to hold to the notion of free will, despite so much evidence for determinism?
The style of the book is conversational, and captivating from the start; a highly compelling read.
Bottom line: if you’ve ever felt yourself wondering if you are deluding yourself and if so, whether that’s useful or counterproductive, this is the book for you!
Click here to check out The Uses of Delusion, and optimize yours!
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Better With Age – by Dr. Alan Castel
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This one isn’t about the biology of aging, so much as (as the subtitle promises) the psychology of it.
Dr. Castel first covers the grounds of what “successful aging” is, and the benefits that can be expected from doing it right. Spoiler, it’s not just “reduced decline”, there are numerous things that actually get better, too.
We also learn how our memory works differently—it can be worse, of course, but it can also be just different, in a way that tends to tie in with vastness of the accumulated knowledge over the years, allowing for easiest access to the things the brain thinks are most important—ranging from expertise in a certain field, to life-experience “wisdom”.
There’s a lot of advice that’s mostly not going to be anything new to regular readers of 10almonds, in terms of staying sharp with an active lifestyle and a well-nourished brain.
The style is very soft pop-science; there are citations dotted throughout, but mostly this is more of a “curl up with a book” book, not a textbook.
In the category of subjective criticism, it can be a little repetitive (but for those who like repetition for ease of learning, you will love this), and his name-dropping habit gets quite eyeroll-worthy quite quickly.
Bottom line: if you’d like to learn about the very many ways in which “over the hill” is simply defeatist pessimism, then this book can help you to ensure you do better.
Click here to check out Better With Age, and get better with age!
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The Philosophy Gym – by Dr. Stephen Law
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If you’d like to give those “little gray cells” an extra workout, this book is a great starting place.
Dr. Stephen Law is Director of Philosophy at the Department of Continuing Education, University of Oxford. As such, he’s no stranger to providing education that’s both attainable and yet challenging. Here, he lays out important philosophical questions, and challenges the reader to get to grips with them in a systematic fashion.
Each of the 25 questions/problems has a chapter devoted to it, and is ranked:
- Warm-up
- Moderate
- More Challenging
But, he doesn’t leave us to our own devices, nor does he do like a caricature of a philosopher and ask us endless rhetorical questions. Instead, he looks at various approaches taken by other philosophers over time, and invites the reader to try out those methods.
The real gain of this book is not the mere enjoyment of reading, but rather in taking those thinking skills and applying them in life… because most if not all of them do have real-world applications and/or implications too.
The book’s strongest point? That it doesn’t assume prior knowledge (and yet also doesn’t patronize the reader). Philosophy can be difficult to dip one’s toes into without a guide, because philosophers writing about philosophy can at first be like finding yourself at a party where you know nobody, but they all know each other.
In contrast, Law excels at giving quick, to-the-point ground-up summaries of key ideas and their progenitors.
In short: a wonderful way to get your brain doing things it might not have tried before!
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What Flexible Dieting Really Means
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When Flexibility Is The Dish Of The Day
This is Alan Aragon. Notwithstanding not being a “Dr. Alan Aragon”, he’s a research scientist with dozens of peer-reviewed nutrition science papers to his name, as well as being a personal trainer and fitness educator. Most importantly, he’s an ardent champion of making people’s pursuit of health and fitness more evidence-based.
We’ll be sharing some insights from a book of his that we haven’t reviewed yet, but we will link it at the bottom of today’s article in any case.
What does he want us to know?
First, get out of the 80s and into the 90s
In the world of popular dieting, the 80s were all about calorie-counting and low-fat diets. They did not particularly help.
In the 90s, it was discovered that not only was low-fat not the way to go, but also, regardless of the diet in question, rigid dieting leads to “disinhibition”, that is to say, there comes a point (usually not far into a diet) whereby one breaks the diet, at which point, the floodgates open and the dieter binges unhealthily.
Aragon would like to bring our attention to a number of studies that found this in various ways over the course of the 90s measuring various different metrics including rigid vs flexible dieting’s impacts on BMI, weight gain, weight loss, lean muscle mass changes, binge-eating, anxiety, depression, and so forth), but we only have so much room here, so here’s a 1999 study that’s pretty much the culmination of those:
Flexible vs. Rigid Dieting Strategies: Relationship with Adverse Behavioral Outcomes
So in short: trying to be very puritan about any aspect of dieting will not only not work, it will backfire.
Next, get out of the 90s into the 00s
…which is not only fun if you read “00s” out loud as “naughties”, but also actually appropriate in this case, because it is indeed important to be comfortable being a little bit naughty:
In 2000, Dr. Marika Tiggemann found that dichotomous perceptions of food (e.g. good/bad, clean/dirty, etc) were implicated as a dysfunctional cognitive style, and predicted not only eating disorders and mood disorders, but also adverse physical health outcomes:
Dieting and Cognitive Style: The Role of Current and Past Dieting Behaviour and Cognitions
This was rendered clearer, in terms of physical health outcomes, by Dr. Susan Byrne & Dr. Emma Dove, in 2009:
❝Weight loss was negatively associated with pre-treatment depression and frequency of treatment attendance, but not with dichotomous thinking. Females who regard their weight as unacceptably high and who think dichotomously may experience high levels of depression irrespective of their actual weight, while depression may be proportionate to the degree of obesity among those who do not think dichotomously❞
Aragon’s advice based on all this: while yes, some foods are better than others, it’s more useful to see foods as being part of a spectrum, rather than being absolutist or “black and white” about it.
Next: hit those perfect 10s… Imperfectly
The next decade expanded on this research, as science is wont to do, and for this one, Aragon shines a spotlight on Dr. Alice Berg’s 2018 study with obese women averaging 69 years of age, in which…
In other words (and in fact, to borrow Dr. Berg’s words from that paper),
❝encouraging a flexible approach to eating behavior and discouraging rigid adherence to a diet may lead to better intentional weight loss for overweight and obese older women❞
You may be wondering: what did this add to the studies from the 90s?
And the key here is: rather than being observational, this was interventional. In other words, rather than simply observing what happened to people who thought one way or another, this study took people who had a rigid, dichotomous approach to food, and gave them a 6-month behavioral intervention (in other words, support encouraging them to be more flexible and open in their approach to food), and found that this indeed improved matters for them.
Which means, it’s not a matter of fate or predisposition, as it could have been back in the 90s, per “some people are just like that; who’s to say which factor causes which”. Instead, now we know that this is an approach that can be adopted, and it can be expected to work.
Beyond weight loss
Now, so far we’ve talked mostly about weight loss, and only touched on other health outcomes. This is because:
- weight loss a very common goal for many
- it’s easy to measure so there’s a lot of science for it
Incidentally, if it’s a goal of yours, here’s what 10almonds had to say about that, along with two follow-up articles for other related goals:
Spoiler: we agree with Aragon, and recommend a relaxed and flexible approach to all three of these things
Aragon’s evidence-based approach to nutrition has found that this holds true for other aspects of healthy eating, too. For example…
To count or not to count?
It’s hard to do evidence-based anything without counting, and so Aragon talks a lot about this. Indeed, he does a lot of counting in scientific papers of his own, such as:
and
The effect of protein timing on muscle strength and hypertrophy: a meta-analysis
…as well as non-protein-related but diet-related topics such as:
But! For the at-home health enthusiast, Aragon recommends that the answer to the question “to count or not to count?” is “both”:
- Start off by indeed counting and tracking everything that is important to you (per whatever your current personal health intervention is, so it might be about calories, or grams of protein, or grams of carbs, or a certain fat balance, or something else entirely)
- Switch to a more relaxed counting approach once you get used to the above. By now you probably know the macros for a lot of your common meals, snacks, etc, and can tally them in your head without worrying about weighing portions and knowing the exact figures.
- Alternatively, count moderately standardized portions of relevant foods, such as “three servings of beans or legumes per day” or “no more than one portion of refined carbohydrates per day”
- Eventually, let habit take the wheel. Assuming you have established good dietary habits, this will now do you just fine.
This latter is the point whereby the advice (that Aragon also champions) of “allow yourself an unhealthy indulgence of 10–20% of your daily food”, as a budget of “discretionary calories”, eventually becomes redundant—because chances are, you’re no longer craving that donut, and at a certain point, eating foods far outside the range of healthiness you usually eat is not even something that you would feel inclined to do if offered.
But until that kicks in, allow yourself that budget of whatever unhealthy thing you enjoy, and (this next part is important…) do enjoy it.
Because it is no good whatsoever eating that cream-filled chocolate croissant and then feeling guilty about it; that’s the dichotomous thinking we had back in the 80s. Decide in advance you’re going to eat and enjoy it, then eat and enjoy it, then look back on it with a sense of “that was enjoyable” and move on.
The flipside of this is that the importance of allowing oneself a “little treat” is that doing so actively helps ensure that the “little treat” remains “little”. Without giving oneself permission, then suddenly, “well, since I broke my diet, I might as well throw the whole thing out the window and try again on Monday”.
On enjoying food fully, by the way:
Mindful Eating: How To Get More Nutrition Out Of The Same Food
Want to know more from Alan Aragon?
Today we’ve been working heavily from this book of his; we haven’t reviewed it yet, but we do recommend checking it out:
Enjoy!
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Monosodium Glutamate: Sinless Flavor-Enhancer Or Terrible Health Risk?
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What’s The Deal With MSG?
There are a lot of popular beliefs about MSG. Is there a grain of truth, or should we take them with a grain of salt? We’ll leap straight into myth-busting:
MSG is high in salt
True (technically) False (practically)
- MSG is a salt (a monosodium salt of L-glutamic acid), but to call it “full of salt” in practical terms is like calling coffee “full of fruit”. (Coffee beans are botanically fruit)
- It does contain sodium, though which is what the S stands for!
- We talked previously about how MSG’s sodium content is much lower than that of (table) salt. Specifically, it’s about one third of that of sodium chloride (e.g. table salt).
MSG triggers gluten sensitivity
False!
Or at least, because this kind of absolute negative is hard to prove in science, what we can say categorically is: it does not contain gluten. We understand that the similar name can cause that confusion. However:
- Gluten is a protein, found in wheat (and thus wheat-based foods).
- Glutamate is an amino acid, found in protein-rich foods.
- If you’re thinking “but proteins are made from amino acids”, yes, they are, but the foundational amino acid of gluten is glutamine, not glutamate. Different bricks → different house!
The body can’t process MSG correctly
False!
The body has glutamate receptors throughout the gut and nervous system.
The body metabolizes glutamate from MSG just the same as from any other food that contains it naturally.
Read: Update on food safety of monosodium l-glutamate (MSG) ← evidence-based safety review
MSG causes “Chinese Restaurant Syndrome”
False!
Racism causes that. It finds its origins in what was originally intended as a satirical joke, that the papers picked up and ran with, giving it that name in the 1960s. As to why it grew and persisted, that has more to do with US politics (the US has been often at odds with China for a long time) and xenophobia (people distrust immigrants, such as those who opened restaurants), including nationalistic rhetoric associating immigrants with diseases.
Read: Xenophobia in America in the Age of Coronavirus and Beyond ← academic paper that gives quite a compact yet comprehensive overview
Research science, meanwhile, has not found any such correlation, in more than 40 years of looking.
PS: we realize this item in the list is very US-centric. Apologies to our non-US subscribers. We know that this belief isn’t so much of a thing outside the US—though it certainly can crop up elsewhere sometimes, too.
Are there any health risks associated with MSG, then?
Well, as noted, it does contain sodium, albeit much less than table salt. So… do go easy on it, all the same.
Aside from that, the LD50 (a way of measuring toxicity) of MSG is 15.8g/kg, so if for example you weigh 150lb (68 kg), don’t eat 2.2lb (a kilogram) of MSG.
There have been some studies on rats (or in one case, fruit flies) that found high doses of MSG could cause heart problems and/or promote obesity. However:
- this has not been observed to be the case in humans
- those doses were really high, ranging from 1g/kg to 8g/kg. So that’d be the equivalent of our 150lb person eating it by the cupful
- it was injected (as a solution) into the rats, not ingested by them
- so don’t let someone inject you with a cup of MSG!
Read: A review of the alleged health hazards of monosodium glutamate
Bottom line on MSG and health:
Enjoy in moderation, but enjoy if you wish! MSG is just the salt form of the amino acid glutamate, which is found naturally in many foods, including shrimp, seaweed, and tomatoes.
Scientists have spent more than 40 years trying to find health risks for MSG, and will probably keep trying (which is as science should be), but for now… Everything has either come up negative, or has been the result of injecting laboratory animals with megadoses.
If you’d like to try it in your cooking as a low-sodium way to bring out the flavor of your dishes, you can order it online. Cheapest in bulk, but try it and see if you like it first!
(I’ll be real with you… I have 5 kg in the pantry myself and use about half a teaspoon a day, cooking for two)
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