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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The How Not to Die Cookbook – by Dr. Michael Greger
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We’ve previously reviewed Dr. Greger’s “How Not To Die”, which is excellent and/but very science-dense.
This book is different, in that the science is referenced and explained throughout, but the focus is the recipes, and how to prepare delicious healthy food in accordance with the principles laid out in How Not To Die.
It also follows “Dr Greger’s Daily Dozen“, that is to say, the 12 specific things he advises we make sure to have every day, and thus helps us to include them in an easy, no-fuss fashion.
The recipes themselves are by Robin Robertson, and/but with plenty of notes by Dr Greger; they clearly collaborated closely in creating them.
The ingredients are all things one can find in any well-stocked supermarket, so unless you live in a food desert, you can make these things easily.
And yes, the foods are delicious too.
Bottom line: if you’re interested in cooking according to perhaps the most science-based dietary system out there, then this book is a top-tier choice.
Click here to check out The How Not To Die Cookbook, and live well!
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Heavy Metal Detox In A Pill?
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We have previous discussed assorted approaches to “detoxing”:
Detox: What’s Real, What’s Not, What’s Useful, What’s Dangerous?
Today we’re going to be looking at one we didn’t cover there, which is zeolite.
What is zeolite?
Zeolite is a mineral that occurs naturally and can also be synthesized, and it’s famous for absorbing other stuff from around it. Because of this property, it’s used in many things, including:
- Petrochemical catalysis
- Water treatment
- Nuclear waste reprocessing
- Cat litter
- Supplements (for detox purposes)
That’s, uh… An interesting list, isn’t it? So, we were curious as to whether this mineral that’s also used in fish tank filters is, in fact, overpriced gravel being sold to the gullible as a health supplement.
We had to do some digging on this one
Our journey didn’t start well, with this very dubious-looking paper being cited by a company selling zeolite supplements:
This immediately prompted two questions:
- Who is eating graphene?!* That stuff does not occur in nature (or at least; it hasn’t ever been found; the universe is a big place so it might exist elsewhere), has only relatively recently been synthesized, is very difficult to produce, is two-dimensional while being hard as diamonds, and exists only in truly tiny lab-made quantities worldwide. It would be orders of magnitude easier to find and eat uranium.
- Is this a reputable journal? Which question was easier to answer than the former one, and the answer is “no”; we hadn’t heard of this journal (ACTA Scientific), and neither it seems had most of the Internet, but we did find it on a list of predatory journals, here.
*The citation given in the above paper should by rights answer the question of who is eating graphene, since by rights they must have demonstrated it somehow, but it just doesn’t. Instead, it links to what it claims is a paper titled “Oxygenated Zeolite (Clinoptilite) Efficiently Removes Aluminum & Graphene Oxide”, but is in reality just someone’s blog post with a screenshot of an actual paper entitled “Novel, oxygenated clinoptilolite material efficiently removes aluminium from aluminium chloride-intoxicated rats in vivo”). Looking up this real paper in its real journal, it does not mention graphene.
All this to say: sometimes, unscrupulous people will just plain lie to you, which is why peer review is important, as is sourcing data from reputable journals. Which is what we do for you so that you don’t have to 🙂
It does, actually, work though (for heavy metal detox)
Notwithstanding the aforementioned bunk, we found this from a more reputable publisher:
❝In this study, we have presented clinical evidence supporting the use of an activated clinoptilolite (zeolite) suspension to safely and effectively increase the urinary excretion of potentially toxic heavy metals in healthy volunteers without negatively impacting the electrolyte profiles of the participants.
Significant increases in the urinary excretion of aluminum, antimony, arsenic, bismuth, cadmium, lead, mercury, nickel and tin were observed in the subjects participating in the two study groups as compared to placebo controls.❞
Also good for the gut and against inflammation
Specifically, it’s good for gut barrier integrity, i.e., against “leaky gut syndrome”:
❝Twelve weeks of zeolite supplementation exerted beneficial effects on intestinal wall integrity as indicated via decreased concentrations of the tight junction modulator zonulin.
This was accompanied by mild anti-inflammatory effects in this cohort of aerobically trained subjects.❞
May also be good against neurodegenerative diseases
If it is (which is plausible), it’ll probably because of removing heavy metals and improving gut barrier integrity—in other words, the things we just looked at in the two reputable peer-reviewed studies we examined above.
But the science is young for this one; here’s the current state of things:
Zeolite and Neurodegenerative Diseases
Is it safe?
Safety reviews have found it to be safe, for example:
Critical Review on Zeolite Clinoptilolite Safety and Medical Applications in vivo
However, if you are taking regular medications, we recommend checking with your pharmacist or doctor to ensure that zeolite will not also remove those medications from your system!
Want to try some?
We don’t sell it, but here for your convenience is an example product on Amazon 😎
Enjoy!
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More Things Dopamine Does For Us
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In this week’s news roundup, we have two dopamine items and one other for variety:
The real “dopamine switch”
Dopamine is well-known as “the reward chemical”, and indeed it is that, but it also plays a central role in many neurological processes, including:
- Linear task processing
- Motivation
- Learning and memory
- Motor functions
- Language faculties
Recent research has now shown its importance in cognitive flexibility, i.e. the ability to adapt to circumstances, and switch approaches appropriately to such, and generally not get stuck in a cognitive rut:
Read in full: Scientists confirm neurobiochemical link between dopamine and cognitive flexibility
Related: The Dopamine Myth
You may like the sound of this
It’s been known for a while that dopamine is involved in learning and memory (as mentioned above), but this has been established largely by associative studies, e.g. “people with lower dopamine levels learn less easily”. But scientists have now mapped out more of how it actually does that.
One more reason to ensure we have and maintain healthy dopamine levels!
Read in full: Songbirds highlight dopamine’s role in learning
Related: 10 Ways To Naturally Boost Dopamine
Resist Or Run!
When it comes to protecting against bone loss, resistance exercise remains key, but impact-laden activities such as running (but not lower-level everyday activity) can help too. There have been studies on the extent to which walking (a load-bearing activity) may be protective against bone loss, and the results of those studies have mostly been inconclusive.
This study looked into the incidence (or not, as the case may be) of bone-loading impacts in everyday movements, using accelerometers, and measured bone mineral density before and after testing periods. Those that had higher-intensity bone-loading movements (so, resistance training or running, for example) retained the best measures of bone density through menopause into postmenopause:
Read in full: Everyday physical activity does not slow bone loss during menopause, finds study
Related: The Bare-Bones Truth About Osteoporosis
Take care!
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What’s the difference between period pain and endometriosis pain?
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Menstruation, or a period, is the bleeding that occurs about monthly in healthy people born with a uterus, from puberty to menopause. This happens when the endometrium, the tissue that lines the inside of the uterus, is shed.
Endometriosis is a condition that occurs when endometrium-like tissue is found outside the uterus, usually within the pelvic cavity. It is often considered a major cause of pelvic pain.
Pelvic pain significantly impacts quality of life. But how can you tell the difference between period pain and endometriosis?
Polina Zimmerman/Pexels Periods and period pain
Periods involve shedding the 4-6 millimetre-thick endometrial lining from the inside of the uterus.
As the lining detaches from the wall of the uterus, the blood vessels which previously supplied the lining bleed. The uterine muscles contract, expelling the blood and crumbled endometrium.
The crumbled endometrium and blood mostly pass through the cervix and vagina. But almost everyone back-bleeds via their fallopian tubes into their pelvic cavity. This is known as “retrograde menstruation”.
Most of the lining is shed through the vagina. Andrey_Popov/Shutterstock The process of menstrual shedding is caused by inflammatory substances, which also cause nausea, vomiting, diarrhoea, headaches, aches, pains, dizziness, feeling faint, as well as stimulating pain receptors.
These inflammatory substances are responsible for the pain and symptoms in the week before a period and the first few days.
For women with heavy periods, their worst days of pain are usually the heaviest days of their period, coinciding with more cramps to expel clots and more retrograde bleeding.
Many women also have pain when they are releasing an egg from their ovary at the time of ovulation. Ovulation or mid-cycle pain can be worse in those who bleed more, as those women are more likely to bleed into the ovulation follicle.
Around 90% of adolescents experience period pain. Among these adolescents, 20% will experience such severe period pain they need time off from school and miss activities. These symptoms are too often normalised, without validation or acknowledgement.
What about endometriosis?
Many symptoms have been attributed to endometriosis, including painful periods, pain with sex, bladder and bowel-related pain, low back pain and thigh pain.
Other pain-related conditions such migraines and chronic fatigue have also been linked to endometriosis. But these other pain-related symptoms occur equally often in people with pelvic pain who don’t have endometriosis.
One in five adolescents who menstrate experience severe symptoms. CGN089/Shutterstock Repeated, significant period and ovulation pain can eventually lead some people to develop persistent or chronic pelvic pain, which lasts longer than six months. This appears to occur through a process known as central sensitisation, where the brain becomes more sensitive to pain and other sensory stimuli.
Central sensitisation can occur in people with persistent pain, independent of the presence or absence of endometriosis.
Eventually, many people with period and/or persistent pelvic pain will have an operation called a laparoscopy, which allows surgeons to examine organs in the pelvis and abdomen, and diagnose and treat endometriosis.
Yet only 50% of those with identical pain symptoms who undergo a laparoscopy will end up having endometriosis.
Endometriosis is also found in pain-free women. So we cannot predict who does and doesn’t have endometriosis from symptoms alone.
How is this pain managed?
Endometriosis surgery usually involves removing lesions and adhesions. But at least 30% of people return to pre-surgery pain levels within six months or have more pain than before.
After surgery, emergency department presentations for pain are unchanged and 50% have repeat surgery within a few years.
Suppressing periods using hormonal therapies (such as continuous oral contraceptive pills or progesterone-only approaches) can suppress endometriosis and reduce or eliminate pain, independent of the presence or absence of endometriosis.
Not every type or dose of hormonal medications suits everyone, so medications need to be individualised.
The current gold-standard approach to manage persistent pelvic pain involves a multidisciplinary team approach, with the aim of achieving sustained remission and improving quality of life. This may include:
- physiotherapy for pelvic floor and other musculoskeletal problems
- management of bladder and bowel symptoms
- support for self-managing pain
- lifestyle changes including diet and exercise
- psychological or group therapy, as our moods, stress levels and childhood events can affect how we feel and experience pain.
Whether you have period pain, chronic pelvic pain or pain you think is associated with endometriosis, if you feel pain, it’s real. If it’s disrupting your life, you deserve to be taken seriously and treated as the whole person you are.
Sonia R. Grover, Senior Research Fellow, Murdoch Children’s Research Institute; Clinical Professor of Gynaecology, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Antidepressants: Personalization Is Key!
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Antidepressants: Personalization Is Key!
Yesterday, we asked you for your opinions on antidepressants, and got the above-depicted, below-described, set of responses:
- Just over half of respondents said “They clearly help people, but should not be undertaken lightly”
- Just over a fifth of respondents said “They may help some people, but the side effects are alarming”
- Just under a sixth of respondents said “They’re a great way to correct an imbalance of neurochemicals”
- Four respondents said “They are no better than placebo, and are more likely to harm”
- Two respondents said “They merely mask the problem, and thus don’t really help”
So what does the science say?
❝They are no better than placebo, and are more likely to harm? True or False?❞
True or False depending on who you are and what you’re taking. Different antidepressants can work on many different systems with different mechanisms of action. This means if and only if you’re not taking the “right” antidepressant for you, then yes, you will get only placebo benefits:
- Placebo Effect in the Treatment of Depression and Anxiety ← randomly assigned antidepressants are, shockingly, luck of the draw in usefulness
- Antidepressants versus placebo in major depression: an overview ← “wow this science is messy”
- Comparative efficacy and acceptability of 21 antidepressant drugs: a systematic review and network meta-analysis ← “oh look, it makes a difference which antidepressant we give to people”
Rather than dismissing antidepressants as worthless, therefore, it is a good idea to find out (by examination or trial and error) what kind of antidepressant you need, if you indeed do need such.
Otherwise it is like getting a flu shot and being surprised when you still catch a cold!
❝They merely mask the problem, and thus don’t really help: True or False?❞
False, categorically.
The problem in depressed people is the depressed mood. This may be influenced by other factors, and antidepressants indeed won’t help directly with those, but they can enable the person to better tackle them (more on this later).
❝They may help some people, but the side-effects are alarming: True or False?❞
True or False depending on more factors than we can cover here.
Side-effects vary from drug to drug and person to person, of course. As does tolerability and acceptability, since to some extent these things are subjective.
One person’s dealbreaker may be another person’s shrugworthy minor inconvenience at most.
❝They’re a great way to correct an imbalance of neurochemicals: True or False?❞
True! Contingently.
That is to say: they’re a great way to correct an imbalance of neurochemicals if and only if your problem is (at least partly) an imbalance of neurochemicals. If it’s not, then your brain can have all the neurotransmitters it needs, and you will still be depressed, because (for example) the other factors* influencing your depression have not changed.
*common examples include low self-esteem, poor physical health, socioeconomic adversity, and ostensibly bleak prospects for the future.
For those for whom the problem is/was partly a neurochemical imbalance and partly other factors, the greatest help the antidepressants give is getting the brain into sufficient working order to be able to tackle those other factors.
Want to know more about the different kinds?
Here’s a helpful side-by-side comparison of common antidepressants, what type they are, and other considerations:
Mind | Comparing Antidepressants
Want a drug-free approach?
You might like our previous main feature:
The Mental Health First-Aid That You’ll Hopefully Never Need
Take care!
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Progesterone Menopausal HRT: When, Why, And How To Benefit
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Progesterone doesn’t get talked about as much as other sex hormones, so what’s its deal? Dr. Heather Hirsch explains:
Menopausal progesterone
Dr. Hirsch considers progesterone essential for menopausal women who are taking estrogen and have an intact uterus, to keep conditions at bay such as endometriosis or even uterine cancer.
However, she advises it is not critical in those without a uterus, unless there was a previous case of one of the above conditions.
10almonds addition: on the other hand, progesterone can still be beneficial from a metabolic and body composition standpoint, so do speak with your endocrinologist about it.
As an extra bonus: while not soporific (it won’t make you sleepy), taking progesterone at night will improve the quality of your sleep once you do sleep, so that’s a worthwhile thing for many!
Dr. Hirsch also discusses the merits of continuous vs cyclic use; continuous maintains the above sleep benefits, for example, while cyclic use can help stabilize menstrual patterns in late perimenopause and early menopause.
For more on these things, plus discussion of different types of progesterone, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- What Does “Balance Your Hormones” Even Mean?
- What You Should Have Been Told About The Menopause Beforehand
- HRT: Bioidentical vs Animal – A Tale Of Two Approaches
Take care!
Don’t Forget…
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