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:

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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  • Artichoke vs Asparagus – Which is Healthier?

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    Our Verdict

    When comparing artichoke to asparagus, we picked the artichoke.

    Why?

    Both are great and it was close!

    In terms of macros, artichoke has a little more protein and around 3x the carbs and fiber: the ratio there means that both vegetables have an identical glycemic index, so we’ll go with the “most food per food” reckoning of nutritional density, and call it for the artichoke.

    When it comes to vitamins, artichoke has more of vitamins B3, B5, B6, B7, B9, C, and choline, while asparagus has more of vitamins A, B1, B2, E, and K. Both very respectable nutritional sets, but artichoke gets a marginal 6:5 win on strength of numbers.

    In the category of minerals, artichoke has more calcium, copper, magnesium, manganese, phosphorus, and potassium, while asparagus has more iron, selenium, and zinc. A clearer 6:3 win for artichoke this time.

    Once again, both of these are great foods, so by all means enjoy either or both. But if you’re looking for the nutritionally densest option, it’s the artichoke!

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    What’s Your Plant Diversity Score?

    Take care!

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  • What’s So Special About Alpha-Lipoic Acid?

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    The Access-All-Areas Antioxidant

    Alpha-Lipoic Acid (ALA) is one of the most bioavailable antioxidants in existence. A bold claim, but most antioxidants are only water-soluble or fat-soluble, whereas ALA is both. This has far-reaching implications—and we mean that literally, because its “go everywhere” status means that it can access (and operate in) all living cells of the human body.

    We make it inside our body, and we can also get it in our diet, or take it as a supplement.

    What foods contain it?

    The richest food sources are:

    • For the meat-eaters: organ meats
    • For everyone: broccoli, tomatoes, & spinach

    However, supplements are more efficient at delivering it, by several orders of magnitude:

    Read more: Lipoic acid – biological activity and therapeutic potential

    What are its benefits?

    Most of its benefits are the usual benefits you would expect from any antioxidant, just, more of it. In particular, reduced inflammation and slowed skin aging are common reasons that people take ALA as a supplement.

    Does it really reduce inflammation?

    Yes, it does. This one’s not at all controversial, as this systematic review of studies shows:

    Effects of alpha-lipoic acid supplementation on C-reactive protein level: A systematic review and meta-analysis of randomized controlled clinical trials

    (C-reactive protein is a marker of inflammation)

    Does it really reduce skin aging?

    Again yes—which again is not surprising for such a potent antioxidant; remember that oxidative stress is one of the main agonists of cellular aging:

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    As a special feature, ALA shows particular strength against sun-related skin aging, because of how it protects against UV radiation and increases levels of gluthianone, which also helps:

    Where can I get some?

    We don’t sell it, but here for your convenience is an example product on Amazon

    Enjoy!

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  • Live Life in Crescendo – by Stephen Covey and Cynthia Covey-Haller

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    Stephen Covey is of course best known for his “7 Habits of Highly Effective People“, while the dozen books he wrote afterwards, not including this one, did not get the same acclaim.

    Not including this one, because this one was published posthumously and, notwithstanding the order of the names on the cover, in all likelihood his daughter wrote most of.

    And yet! The very spirit of this book is in defiance of 7 Habits being his “early career” magnum opus. We say “early career”, because he was 57 already when that was published, but it was one of his earlier books.

    In this work the authors lay out the case for how “your most important work is always ahead of you“, and that it is perfectly possible to “live life in crescendo“, and keep on giving whatever it is that we want to give to the world.

    We also learn, mostly through storytelling, of how people are infinitely more important than things, and that it is there that we should put our investments. And that while adversity may not make us stronger, it just means we may need to change our approach, to continue to be productive in whatever way is meaningful to us.

    Bottom line: if ever you wonder how your future could live up to your past (in a good way), this is the book to get you thinking.

    Click here to check out Live Life in Crescendo, and figure out what your next great work will be!

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  • Gut Health 2.0

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    Gene Expression & Gut Health

    Dr. Tim Spector, a renowned expert in Gut Health 2.0, offers valuable insights and expertise on the latest advancements in improving gut health and overall well-being. With years of research and

    This is Dr. Tim Spector. After training in medicine and becoming a consultant rheumatologist, he’s turned his attention to medical research, and is these days a specialist in twin studies, genetics, epigenetics, microbiome, and diet.

    What does he want us to know?

    For one thing: epigenetics are for more than just getting your grandparents’ trauma.

    More usefully: there are things we can do to improve epigenetic factors in our body

    DNA is often seen as the script by which our body does whatever it’s going to do, but it’s only part of the story. Thinking of DNA as some kind of “magical immutable law of reality” overlooks (to labor the metaphor) script revisions, notes made in the margins, directorial choices, and ad-lib improvizations, as well as the quality of the audience’s hearing and comprehension.

    Hence the premise of one of Dr. Spector’s older books, “Identically Different: Why We Can Change Our Genes

    (*in fact, it was his first, from all the way back in 2013, when he’d only been a doctor for 34 years)

    Gene expression will trump genes every time, and gene expression is something that can often be changed without getting in there with CRISPR / a big pair of scissors and some craft glue.

    How this happens on the micro level is beyond the scope of today’s article; part of it has to do with enzymes that get involved in the DNA transcription process, and those enzymes in turn are despatched or not depending on hormonal messaging—in the broadest sense of “hormonal”; all the body’s hormonal chemical messengers, not just the ones people think of as hormones.

    However, hormonal messaging (of many kinds) is strongly influenced by something we can control relatively easily with a little good (science-based) knowledge: the gut.

    The gut, the SAD, and the easy

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    This is very much in contrast with what in scientific literature is often abbreviated “SAD”, the Standard American Diet, which is very bad for the gut.

    However, Dr. Spector (while fully encouraging everyone to enjoy an evidence-based gut-healthy diet) wanted to do one better than just a sweeping one-size-fits-all advice, so he set up a big study with 15,000 identical twins; you can read about it here: TwinsUK

    The information that came out of that was about a lot more than just gene expression and gut health, but it did provide the foundation for Dr. Spector’s next project, ZOE.

    ZOE crowdsources huge amounts of data including individual metabolic responses to standardized meals in order to predict personalized food responses based on individual biology and unique microbiome profile.

    In other words, it takes the guesswork out of a) knowing what your genes mean for your food responses b) tailoring your food choices with your genetic expression in mind, and c) ultimately creating a positive feedback loop to much better health on all levels.

    Now, this is not an ad for ZOE, but if you so wish, you can…

    Want to know more?

    Dr. Spector has a bunch of books out, including some that we’ve reviewed previously:

    You can also check out our own previous main feature, which wasn’t about Dr. Spector’s work but was very adjacent:

    The Brain-Gut Highway: A Two-Way Street

    Enjoy!

    Don’t Forget…

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  • Sweet Dreams Are Made of THC (Or Are They?)

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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!

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    ❝I’m one of those older folks that have a hard time getting 7 hrs. I know a lot of it my fault…like a few beers at nite…🥰am now trying THC gummies for anxiety, instead of alcohol……less calories 😁how does THC affect our sleep,? Safer than alcohol…..I know your next article 😊😊😊😊❣️😊alot of us older kids do take gummies 😲😲😲thank you❞

    Great question! We wrote a little about CBD gummies (not THC) before:

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    For starters, let’s go ahead and say: you’re right that it’s safer (for most people) than alcohol—but that’s not a strong claim, because alcohol is very bad for pretty much everything, including sleep.

    So how does THC measure up when it comes to sleep quality?

    Good news: it affects the architecture of sleep in such a way that you will spend longer in deep sleep (delta wave activity), which means you get more restorative and restful sleep!

    See also: Alpha, beta, theta: what are brain states and brain waves? And can we control them?

    Bad news: it does so at the cost of reducing your REM sleep, which is also necessary for good brain health, and will cause cognitive impairment if you skip too much. Normally, if you are sleep-deprived, the brain will prioritize REM sleep at the cost of other kinds of sleep; it’s that important. However, if you are chemically impaired from getting healthy REM sleep, there’s not much your brain can do to save you from the effects of REM sleep loss.

    See: Cannabis, Cannabinoids, and Sleep: a Review of the Literature

    This is, by the way, a reason that THC gets prescribed for some sleep disorders, in cases where the initial sleep disruption was because of nightmares, as it will reduce those (along with any other dreams, as collateral damage):

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    One thing to be careful of if using THC as a sleep aid is that withdrawal may make your symptoms worse than they were to start with:

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    With all that in mind, you might consider (if you haven’t already tried it) seeing whether CBD alone improves your sleep, as while it does also extend time in deep sleep, it doesn’t reduce REM nearly as much as THC does:

    The effects of a brand-specific, hemp-derived cannabidiol product on physiological, biochemical, and psychometric outcomes in healthy adults: a double-blind, randomized clinical trial

    👆 this study was paid for by the brand being tested, so do be aware of potential publication bias. That’s not to say the study is necessarily corrupt, and indeed it probably wasn’t, but rather, the publication of the results was dependent on the company paying for them (so hypothetically they could have pulled funding from any number of other research groups that didn’t get the results they wanted, leaving this one to be the only one published). That being said, the study is interesting, which is why we’ve linked it, and it’s a good jumping-off-point for finding a lot of related papers, which you can see listed beneath it.

    CBD also has other benefits of its own, even without THC:

    CBD Oil: What Does The Science Say?

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  • Body Language (In The Real World)

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    Forget What You Think You Know About Body Language

    …unless it’s about a specific person whose habits and mannerisms you know intimately, in which case, you probably have enough personal data stored up to actually recognize patterns à la “when my spouse does this, then…”, and probably do know what’s going on.

    For everyone else… our body language can be as unique as our idiolect

    What’s an idiolect? It’s any one given person’s way of speaking/writing, in their natural state (i.e. without having to adjust their style for some reason, for example in a public-facing role at work, where style often becomes much narrower and more consciously-chosen).

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    To give an extreme example of how non-verbal communication can be very different than a person thinks, there’s an anecdote floating around the web of someone whose non-verbal autistic kid would, when he liked someone who was visiting the house, hide their shoes when they were about to leave, to cause them to stay longer. Then one day some relative visited and when she suggested that she “should be going sometime soon”, he hurried to bring her her shoes. She left, happy that the kid liked her (he did not).

    The above misunderstanding happened because the visitor had the previous life experience of “a person who brings me things is being helpful, and if they do it of their own free will, it’s because they like me”.

    In other words…

    Generalizations are often sound… In general

    …which does not help us when dealing with individuals, which as it turns out, everyone is.

    Clenched fists = tense and angry… Except when it’s just what’s comfortable for someone, or they have circulation issues, or this, or that, or the other.

    Pacing = agitated… Except when it’s just someone who finds the body in motion more comfortable

    Relaxed arms and hands = at ease and unthreatening… Unless it’s a practitioner of various martial arts for whom that is their default ready-for-action state.

    Folded arms = closed-off, cold, distant… Or it was just somewhere to put one’s hands.

    Lack of eye contact = deceitful, hiding something… Unless it’s actually for any one of a wide number of reasons, which brings us to our next section:

    A liar’s “tells”

    Again, if you know someone intimately and know what signs are associated with deceit in them, then great, that’s a thing you know. But for people in general…

    A lot of what is repeated about “how to know if someone is lying” has seeped into public consciousness from “what police use to justify their belief that someone is lying”.

    This is why many of the traditional “this person is lying” signs are based around behaviors that show up when in fact “this person is afraid, under pressure, and talking to an authority figure who has the power to ruin their life”:

    Research on Non-verbal Signs of Lies and Deceit: A Blind Alley

    But what about eye-accessing cues? They have science to them, right?

    For any unfamiliar: this is about the theory that when we are accessing different parts of our mind (such as memory or creativity, thus truthfulness or lying), our eyes move one way or another according to what faculty we’re accessing.

    Does it work? No

    But, if you carefully calibrate it for a specific person, such as by asking them questions along the lines of “describe your front door” or “describe your ideal holiday”, to see which ways they look for recall or creativity… Then also no:

    The Eyes Don’t Have It: Lie Detection and Neuro-Linguistic Programming

    How can we know what non-verbal communication means, then?

    With strangers? We can’t, simply. It’s on us to be open-minded, with a healthy balance of optimism and wariness.

    With people we know? We can build up a picture over time, learn the person’s patterns. Best of all, we can ask them. In the moment, and in general.

    For more on optimizing interpersonal communication, check out:

    Save Time With Better Communication

    …and the flipside of that:

    The Problem With Active Listening (And How To Do It Better)

    Take care!

    Don’t Forget…

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