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)
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Brown Rice Protein: Strengths & Weaknesses
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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
❝I had a friend mention that recent research showed Brown Rice Protein Powder can be bad for you, possibly impacting your nutrient absorption. Is this true? I’ve been using it given it’s one of the few plant-based proteins with a full essential amino acid profile!❞
Firstly: we couldn’t find anything to corroborate the “brown rice protein powder [adversely] impacts nutrient absorption” idea, but we suspect that the reason for this belief is: brown rice (not brown rice protein powder) contains phytic acid, which is something of an antinutrient, in that it indeed reduces absorption of various other nutrients.
However, two things are important to note here:
- the phytic acid is found in whole grains, not in protein isolates as found in brown rice protein powder. The protein isolates contain protein… Isolated. No phytates!
- even in the case of eating whole grain rice, the phytic acid content is greatly reduced by two things: soaking and heating (especially if those two things are combined) ← doing this the way described results in bioavailability of nutrients that’s even better than if there were just no phytic acid, albeit it requires you having the time to soak, and do so at temperature.
tl;dr = no, it’s not true, unless there truly is some groundbreaking new research we couldn’t find—it was almost certainly a case of an understandable confusion about phytic acid.
Your question does give us one other thing to mention though:
Brown rice indeed technically contains all 9 essential amino acids, but it’s very low in several of them, most notably lysine.
However, if you use our Tasty Versatile Rice Recipe, the chia seeds we added to the rice have 100x the lysine that brown rice does, and the black pepper also boosts nutrient absorption.
Because your brown rice protein powder is a rice protein powder and not simply rice, it’s possible that they’ve tweaked it to overcome rice’s amino acid deficiencies. But, if you’re looking for a plant-based protein powder that is definitely a complete protein, soy is a very good option assuming you’re not allergic to that:
Amino Acid Compositions Of Soy Protein Isolate
If you’re wondering where to get it, you can see examples of them next to each other on Amazon here:
Brown Rice Protein Powder | Soy Protein Isolate Powder
Enjoy!
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Resistance Beyond Weights
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Resistance, Your Way
We’ve talked before about the importance of resistance training:
Resistance Is Useful! (Especially As We Get Older)
And we’ve even talked about how to make resistance training more effective:
(High Intensity Interval Training, but make it High Intensity Resistance Training)
Which resistance training exercises are best?
There are two reasonable correct answers here:
- The resistance training exercises that you will actually do (because it’s no good knowing the best exercise ever if you’re not going to do it because it is in some way offputting to you)
- The resistance training exercises that will prevent you from getting a broken bone in the event of some accident or incident
This latter is interesting, because when people think resistance training, the usually immediate go-to exercises are often things like the bench press, or the chest machine in the gym.
But ask yourself: how often do we hear about some friend or relative who in their old age has broken their humerus?
It can happen, for sure, but it’s not as often as breaking a hip, a tarsal (ankle bones), or a carpal (wrist bones).
So, how can we train to make those bones strong?
Strong bones grow under strong muscles
When archaeologists dig up a skeleton from a thousand years ago, one of the occupations that’s easy to recognize is an archer. Why?
An archer has an unusual frequent exercise: pushing with their left arm while pulling with their right arm. This will strengthen different muscles on each side, and thus, increase bone density in different places on each arm. The left first metacarpal and right first and second metacarpals and phalanges are also a giveaway.
This is because: one cannot grow strong muscles on weak bones (or else the muscles would just break the bones), so training muscles will force the body to strengthen the relevant bones.
So: if you want strong bones, train the muscles attached to those bones
This answers the question of “how am I supposed to exercise my hips” etc.
Weights, bodyweight, resistance bands
If you go to the gym, there’s a machine for everything, and a member of gym staff will be able to advise which of their machines will strengthen which muscles.
If you train with free weights at home:
- Wrist curls (forearm supported and stationary, lifting a dumbbell in your hand, palm-upwards) will strengthen the wrist
- The farmer’s walk (carrying a heavy weight in each hand) will also strengthen your wrist
- A modified version of this involves holding the weight with just your fingertips, and then raising and lowering it by curling and uncurling your fingers)
- Lateral leg raises (you will need ankle-weights for this) will strengthen your ankles and your hips, as will hip abductions (as in today’s featured video), especially with a weight attached.
- Ankle raises (going up on your tip-toes and down again, repeat) while holding weights in your hands will strengthen your ankles
If you don’t like weights:
- Press-ups will strengthen your wrists
- Fingertip press-ups are even better: to do these, do your press-ups as normal, except that the only parts of your hands in contact with the ground are your fingertips
- This same exercise can be done the other way around, by doing pull-ups
- And that same “even better” works by doing pull-ups, but holding the bar only with one’s fingertips, and curling one’s fingers to raise oneself up
- Lateral leg raises and hip abductions can be done with a resistance band instead of with weights. The great thing about these is that whereas weights are a fixed weight, resistance bands will always provide the right amount of resistance (because if it’s too easy, you just raise your leg further until it becomes difficult again, since the resistance offered is proportional to how much tension the band is under).
Remember, resistance training is still resistance training even if “all” you’re resisting is gravity!
If it fells like work, then it’s working
As for the rest of preparing to get older?
Check out:
Training Mobility Ready For Later Life
Take care!
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Elderly loss of energy
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
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
❝Please please give some information on elderly loss of energy and how it can be corrected. Please!❞
A lot of that is the metabolic slump described above! While we certainly wouldn’t describe 60 as elderly, and the health impacts from those changes at 45–55 get a gentler curve from 60 onwards… that curve is only going in one direction if we don’t take exceptionally good care of ourselves.
And of course, there’s also a degree of genetic lottery, and external factors we can’t entirely control (e.g. injuries etc).
One factor that gets overlooked a lot, though, is really easy to fix: B-vitamins.
In particular, vitamins B1, B5, B6, and B12. Of those, especially vitamins B1 and B12.
(Vitamins B5 and B6 are critical to health too, but relatively few people are deficient in those, while many are deficient in B1 and/or B12, especially as we get older)
Without going so detailed as to make this a main feature: these vitamins are essential for energy conversion from food, and they will make a big big difference.
You might especially want to consider taking sulbutiamine, which is a synthetic version of thiamin (vitamin B1), and instead of being water-soluble, it’s fat-soluble, and it easily crosses the blood-brain barrier, which is a big deal.
As ever, always check with your doctor because your needs/risks may be different. Also, there can be a lot of reasons for fatigue and you wouldn’t want to overlook something important.
You might also want to check out yesterday’s sponsor, as they offer personalized at-home health testing to check exactly this sort of thing.
❝What are natural ways to lose weight after 60? Taking into account bad knees or ankles, walking may be out as an exercise, running certainly is.❞
Losing weight is generally something that comes more from the kitchen than the gym, as most forms of exercise (except HIIT; see below) cause the metabolism to slow afterwards to compensate.
However, exercise is still very important, and swimming is a fine option if that’s available to you.
A word to the wise: people will often say “gentle activities, like tai chi or yoga”, and… These things are not the same.
Tai chi and yoga both focus on stability and suppleness, which are great, but:
- Yoga is based around mostly static self-support, often on the floor
- Tai chi will have you very often putting most of your weight on one slowly-increasingly bent knee at a time, and if you have bad knees, we’ll bet you winced while reading that.
So, maybe skip tai chi, or at least keep it to standing meditations and the like, not dynamic routines. Qigong, the same breathing exercises used in tai chi, is also an excellent way to improve your metabolism, by the way.
Ok, back onto HIIT:
You might like our previous article: How To Do HIIT* (Without Wrecking Your Body)
*High-Intensity Interval Training (the article also explains what this is and why you want to do it)
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Mythbusting The Mask Debate
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Mythbusting The Mask Debate
We asked you for your mask policy this respiratory virus season, and got the above-depicted, below-described, set of responses:
- A little under half of you said you will be masking when practical in indoor public places
- A little over a fifth of you said you will mask only if you have respiratory virus symptoms
- A little under a fifth of you said that you will not mask, because you don’t think it helps
- A much smaller minority of you (7%) said you will go with whatever people around you are doing
- An equally small minority of you said that you will not mask, because you’re not concerned about infections
So, what does the science say?
Wearing a mask reduces the transmission of respiratory viruses: True or False?
True…with limitations. The limitations include:
- The type of mask
- A homemade polyester single-sheet is not the same as an N95 respirator, for instance
- How well it is fitted
- It needs to be a physical barrier, so a loose-fitting “going through the motions” fit won’t help
- The condition of the mask
- And if applicable, the replaceable filter in the mask
- What exactly it has to stop
- What kind of virus, what kind of viral load, what kind of environment, is someone coughing/sneezing, etc
More details on these things can be found in the link at the end of today’s main feature, as it’s more than we could fit here!
Note: We’re talking about respiratory viruses in general in this main feature, but most extant up-to-date research is on COVID, so that’s going to appear quite a lot. Remember though, even COVID is not one beast, but many different variants, each with their own properties.
Nevertheless, the scientific consensus is “it does help, but is not a magical amulet”:
- 2021: Effectiveness of Face Masks in Reducing the Spread of COVID-19: A Model-Based Analysis
- 2022: Why Masks are Important during COVID‐19 Pandemic
- 2023: The mitigating effect of masks on the spread of COVID-19
Wearing a mask is actually unhygienic: True or False?
False, assuming your mask is clean when you put it on.
This (the fear of breathing more of one’s own germs in a cyclic fashion) was a point raised by some of those who expressed mask-unfavorable views in response to our poll.
There have been studies testing this, and they mostly say the same thing, “if it’s clean when you put it on, great, if not, then well yes, that can be a problem”:
❝A longer mask usage significantly increased the fungal colony numbers but not the bacterial colony numbers.
Although most identified microbes were non-pathogenic in humans; Staphylococcus epidermidis, Staphylococcus aureus, and Cladosporium, we found several pathogenic microbes; Bacillus cereus, Staphylococcus saprophyticus, Aspergillus, and Microsporum.
We also found no associations of mask-attached microbes with the transportation methods or gargling.
We propose that immunocompromised people should avoid repeated use of masks to prevent microbial infection.❞
Source: Bacterial and fungal isolation from face masks under the COVID-19 pandemic
Wearing a mask can mean we don’t get enough oxygen: True or False?
False, for any masks made-for-purpose (i.e., are by default “breathable”), under normal conditions:
- COVID‐19 pandemic: do surgical masks impact respiratory nasal functions?
- Performance Comparison of Single and Double Masks: Filtration Efficiencies, Breathing Resistance and CO2 Content
However, wearing a mask while engaging in strenuous best-effort cardiovascular exercise, will reduce VO₂max. To be clear, you will still have more than enough oxygen to function; it’s not considered a health hazard. However, it will reduce peak athletic performance:
…so if you are worrying about whether the mask will impede you breathing, ask yourself: am I engaging in an activity that requires my peak athletic performance?
Also: don’t let it get soaked with water, because…
Writer’s anecdote as an additional caveat: in the earliest days of the COVID pandemic, I had a simple cloth mask on, the one-piece polyester kind that we later learned quite useless. The fit wasn’t perfect either, but one day I was caught in heavy rain (I had left it on while going from one store to another while shopping), and suddenly, it fitted perfectly, as being soaked through caused it to cling beautifully to my face.
However, I was now effectively being waterboarded. I will say, it was not pleasant, but also I did not die. I did buy a new mask in the next store, though.
tl;dr = an exception to “no it won’t impede your breathing” is that a mask may indeed impede your breathing if it is made of cloth and literally soaked with water; that is how waterboarding works!
Want up-to-date information?
Most of the studies we cited today were from 2022 or 2023, but you can get up-to-date information and guidance from the World Health Organization, who really do not have any agenda besides actual world health, here:
Coronavirus disease (COVID-19): Masks | Frequently Asked Questions
At the time of writing this newsletter, the above information was last updated yesterday.
Take care!
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Kiwi vs Lemon – Which is Healthier?
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Our Verdict
When comparing kiwi to lemon, we picked the kiwi.
Why?
A fairly straightforward one today!
In terms of macros, kiwi has more protein, carbs, and fiber, the ratio of the latter two also giving it the lower glycemic index. An easy win for kiwi here.
In the category of vitamins, kiwi has more of vitamins A, B2, B3, B9, C, E, K, and choline, while lemon has more of vitamins B1 and B6. Yes, that’s right, lemon didn’t even win on the vitamin C that it’s famous for. In any case, a clear 8:2 win for kiwi.
Looking at minerals, kiwi has more calcium, copper, magnesium, manganese, phosphorus, potassium, and zinc, while lemon has more iron and selenium. So, looking at this 7:2 win for kiwi, you might want to reconsider that “glass of lemon water to replenish minerals” trend!
None of this is to knock lemons, by the way; lemons are still a very respectable fruit, nutritionally. Probably very few people are out there eating lemons the way one might eat kiwi…
(writer’s note: I say “very few”, as once upon a time when my son was small, I remember coming into the kitchen to find he had helped himself to lemon wedges and was just eating them, so it can happen. But I also one time when he was just as small, found him drinking hot sauce directly from the bottle, so hey, he clearly already enjoyed strong flavors. Lest I seem a very inattentive mother, I’ll say in my defense that our kitchen has no real toddler-height hazards when the oven is cold, and those items were from the bottom of the fridge, so easy to access if I leave the room for a moment to grab something)
…but what we do want to say here is: if you don’t care for lemons so much, you’re not missing out. If the lemon water isn’t calling to you, you can skip it guilt-free.
In any case, do enjoy either or both, but kiwi’s the clear winner here!
Want to learn more?
You might like to read:
Top 8 Fruits That Prevent & Kill Cancer ← kiwi is top of the list! It has some cool properties, as you’ll see, killing cancer cells while sparing healthy ones.
Take care!
Don’t Forget…
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Kiwi vs Lime – Which is Healthier?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Our Verdict
When comparing kiwi to lime, we picked the kiwi.
Why?
Looking at the macros first, kiwi has more protein, more carbs, and more fiber. As with most fruits, the fiber is the number we’re most interested in for health purposes; in this case, kiwi is just slightly ahead of lime on all three of those.
In terms of vitamins, kiwi has more of vitamins A, B2, B3, B6, B9, C, E, K, and choline, while lime has a tiny bit more vitamin B5. As in, the vitamin that’s in pretty much anything and is practically impossible to be deficient in unless you are literally starving to death. You may be thinking: aren’t limes a famously good source of vitamin C? And yes, yes they are. But kiwis have >3x more. In other big differences, kiwis also have >6x more vitamin E and >67 times more vitamin K.
When it comes to minerals, kiwi has more calcium, copper, magnesium, manganese, phosphorus, potassium, and zinc, while lime has more iron and selenium. Another easy win for kiwis.
In short: enjoy both; both are good. But kiwis are the more nutritionally dense option by almost every way of measuring it.
Want to learn more?
You might like to read:
Top 8 Fruits That Prevent & Kill Cancer ← kiwi is top of the list; it promotes cancer cell death while sparing healthy cells
Take care!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
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