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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Flexible Dieting – by Alan Aragon
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This is the book from which we were working, for the most part, in our recent Expert Insights feature with Alan Aragon. We’ll re-iterate here: despite not being a Dr. Aragon, he’s a well-published research scientist with decades in the field of nutritional science, as well as being a personal trainer and fitness educator.
As you may gather from our other article, there’s a lot more to this book than “eat what you like”. Specifically, as the title suggests, there’s a lot of science—decades of it, and while we had room to cite a few studies in our article, he cites many many more; several citations per page of a 288-page book.
So, that sets the book apart from a lot of its genre; instead of just “here’s what some gym-bro thinks”, it’s “here’s what decades of data says”.
Another strength of this book is how clearly he explains such a lot of science—he explains terms as they come up, as well as having a generous glossary. He also explains things clearly and simply without undue dumbing down—just clarity of communication.
The style is to-the-point and instructional; it’s neither full of fitness-enthusiast hype nor dry academia, and keeps a light and friendly conversational tone throughout.
Bottom line: if you’d like to get your diet in order and you want to do it right while also knowing which things still need attention (and why) and which you can relax about (and why), then this book will get you there.
Click here to check out Flexible Dieting, and take an easy, relaxed control of yours!
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Ashwagandha: The Root of All Even-Mindedness?
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Ashwagandha: The Root Of All Even-Mindedness?
In the past few years, Ashwagandha root has been enjoying popular use in consumer products ranging from specialist nootropic supplement stacks, to supermarket teas and hot chocolates.
This herb is considered to have a calming effect, but the science goes a lot deeper than that. Let’s take a look!
Last summer, a systematic review was conducted, that asked the question:
Does Ashwagandha supplementation have a beneficial effect on the management of anxiety and stress?
While they broadly found the answer was “yes”, they expressed low confidence, and even went so far as to say there was contradictory evidence. We (10almonds) were not able to find any contradictory evidence, and their own full article had been made inaccessible to the public, so we couldn’t double-check theirs.
We promptly did our own research review, and we found many studies this year supporting Ashwaghanda’s use for the management of anxiety and stress, amongst other benefits.
First, know: Ashwagandha’s scientific name is “Withania somnifera”, so if you see that (or a derivative of it) mentioned in a paper or extract, it’s the same thing.
Onto the benefits…
A study from the same summer investigated “the efficacy of Withania somnifera supplementation on adults’ cognition and mood”, and declared that:
“in conclusion, Ashwagandha supplementation may improve the physiological, cognitive, and psychological effects of stress.”
We notice the legalistic “may improve”, but the data itself seems more compelling than that, because the study showed that it in fact “did improve” those things. Specifically, Ashwagandha out-performed placebo in most things they measured, and most (statistically) significantly, reduced cortisol output measurably. Cortisol, for any unfamiliar, is “the stress hormone”.
Another study that looked into its anti-stress properties is this one:
Ashwagandha Modulates Stress, Sleep Dynamics, and Mental Clarity
This study showed that Ashwagandha significantly outperformed placebo in many ways, including:
- sleep quality
- cognitive function
- energy, and
- perceptions of stress management.
Ashwagandha is popular among students, because it alleviates stress while also promising benefits to memory, attention, and thinking. So, this study on students caught our eye:
Their findings demonstrated that Ashwagandha increased college students’ perceived well-being through supporting sustained energy, heightened mental clarity, and enhanced sleep quality.
That was about perceived well-being and based on self-reports, though
So: what about hard science?
A later study (in September) found supplementation with 400 mg of Ashwagandha improved executive function, helped sustain attention, and increased short-term/working memory.
Read the study: Effects of Acute Ashwagandha Ingestion on Cognitive Function
❝But aside from the benefits regarding stress, anxiety, sleep quality, cognitive function, energy levels, attention, executive function, and memory, what has Ashwagandha ever done for us?❞
Well, there have been studies investigating its worth against depression, like this one:
Can Traditional Treatment Such as Ashwagandha Be Beneficial in Treating Depression?
Their broad answer: Ashwagandha works against depression, but they don’t know how it works.
They did add: “Studies also show that ashwagandha may bolster the immune system, increase stamina, fight inflammation and infection, combat tumors*, reduce stress, revive the libido, protect the liver and soothe jangled nerves.
That’s quite a lot, including a lot of physical benefits we’ve not explored in this research review which was more about Ashwagandha’s use as a nootropic!
We’ve been focusing on the more mainstream, well-studied benefits, but for any interested in Ashwagandha’s anti-cancer potential, here’s an example:
Evaluating anticancer properties of [Ashwagandha Extract]-a potent phytochemical
In summary:
There is a huge weight of evidence (of which we’ve barely skimmed the surface here in this newsletter, but there’s only so much we can include, so we try to whittle it down to the highest quality most recent most relevant research) to indicate that Ashwagandha is effective…
- Against stress
- Against anxiety
- Against depression
- For sleep quality
- For memory (working, short-term, and long-term)
- For mental clarity
- For attention
- For stamina
- For energy levels
- For libido
- For immune response
- Against inflammation
- Against cancer
- And more*
*(seriously, this is not hyperbole… We didn’t even look at its liver-protective functions, for instance)
Bottom line:
You’d probably like some Ashwagandha now, right? We know we would.
We don’t sell it (or anything else, for that matter), but happily the Internet does:
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Hazelnuts vs Chestnuts – Which is Healthier?
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Our Verdict
When comparing hazelnuts to chestnuts, we picked the hazelnuts.
Why?
This one’s not close.
In terms of macros, we have some big difference to start with, since chestnuts contain a lot more water and carbs whereas hazelnuts contain a lot more protein, fats, and fiber. The fats, as with most nuts, are healthy; in this case mostly being monounsaturated fat.
Because of the carbs and fiber being so polarized (i.e., chestnuts have most of the carbs and hazelnuts have most of the fiber), there’s a big difference in glycemic index; hazelnuts have a GI of 15 while chestnuts have a GI of 52.
In the category of vitamins, hazelnuts contain more of vitamins A, B1, B2, B3, B5, B6, and B9, while chestnuts contain more vitamin C.
When it comes to minerals, the story is similar: hazelnuts contain a lot more calcium, copper, iron, magnesium, manganese, phosphorus, and zinc, while chestnuts contain a tiny bit more potassium.
All in all, enjoy either or both, but nutritionally speaking, hazelnuts are a lot better in almost every way.
Want to learn more?
You might like to read:
Why You Should Diversify Your Nuts
Take care!
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Leek vs Scallions – Which is Healthier?
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Our Verdict
When comparing leek to scallions, we picked the leek.
Why?
In terms of macros, scallions might have a point: scallions have the lower glycemic index, thanks to leek having more carbs for the same amount of fiber. That said, leek already has a low glycemic index, so this is not a big deal.
When it comes to vitamins, leek has more of vitamins B1, B2, B3, B5, B6, B9, E, and choline, while scallions have more of vitamins A, C, and K. Noteworthily, a cup of chopped leek already provides the daily dose of vitamins A and K, and the difference in levels of vitamin C is minimal. All in all, an easy 8:3 win for leeks here, even without taking that into account.
In the category of minerals, leek has more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and selenium, while scallions have a little more zinc.
Both of these allium-family plants (i.e., related to garlic) have an abundance of polyphenols, especially kaempferol.
Of course, enjoy whatever goes best with your meal, but if you’re looking for nutritional density, then leek is where it’s at.
Want to learn more?
You might like to read:
The Many Health Benefits Of Garlic
Take care!
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What the Most Successful People Do Before Breakfast – by Laura Vanderkram
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First, what this is not:this is not a rehash of “The 5AM Club”, and nor is it a rehash of “The Seven Habits of Highly Effective People”.
What it is: packed with tips about time management for real people operating here in the real world. The kind of people who have non-negotiable time-specific responsibilities, and frequent unavoidable interruptions. The kind of people who have partners, families, and personal goals and aspirations too.
The “two other short guides” mentioned in the subtitle are her other books, whose titles start the same but instead of “…before Breakfast”, substitute:
- …on the Weekend
- …at Work
However, if you’re retired (we know many of our subscribers are), this still applies to you:
- The “weekend” book is about getting the most out of one’s leisure time, and we hope you have that too!
- The “work” book is about not getting lost in the nitty-gritty of the daily grind, and instead making sure to keep track of the big picture. You probably have this in your personal projects, too!
Bottom line: if, in the mornings, it sometimes seems like your get-up-and-go has got up and gone without you, then you will surely benefit from this book that outstrips its competitors in usefulness and applicability.
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Before You Reach For That Tylenol…
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First, on names: we’ve titled this with “Tylenol” because that’s a well-known brand name, but the drug name is paracetamol or acetaminophen:
- paracetamol is the drug name used by the World Health Organization, and thus also most countries.
- acetaminophen is the drug name used in Canada, Colombia, Iran, Japan, US, and Venezuela.
They are absolutely the same drug.
Firstly, obviously, do avoid overdose
The safe dosage described on the packet is generally accurate (usually around 4g/day, spaced out at 1g per 4 hours), and the dose required for toxicity is generally about 10g, or 200mg/kg body weight, whichever is lower. Since a single dose usually contains 2x 500mg = 1g, that makes overdose all too easy.
The amount required for toxicity can be misleading too, because that’s assuming…
- a healthy liver
- no other health problems
- no other medications that interact or add to the toxicity
- no medications that strain the liver (as with many pro-drugs, and drugs in general that are metabolized by the liver, which is lots).
Which is a lot of assumptions! Especially given that the liver can only process so much at once, meaning that if your liver has a lot of things to do, it can get a backlog, and you think “I’m not taking anything with this painkiller that I shouldn’t” but your liver is still metabolizing the last of last night’s glass of wine and one of your regular medications from this morning, because previously it was still metabolizing things from the day before yesterday, and so on.
See also: How To Regenerate Your Liver ← the liver is an incredible organ that does an amazing job, but it can’t do that if you don’t do this
Please don’t overdose deliberately either. Intentional overdoses make up a very large portion of acetaminophen overdoses (exact figures vary from year to year and place to place, but it’s always high), and what a lot of people doing that don’t realize is:
- it’s a very unpleasant way to die. You’ll take it, you might get some initial symptoms within the first hours or you might not, then you’ll probably feel better, and then the next day or so, you’ll enter the organs-shutting-down stage that usually will take most of a week to kill you slowly and painfully. Often your kidneys will go first but it’ll usually be liver necrosis that deals the final blow.
- it’s very difficult to treat. Stomach-pumping might work if you get it within 1 hour of overdose, and activated charcoal might help if you get it within 2 hours. Acetylcysteine may reduce the toxicity if you get it within the 8–48 hour window (depending on the speed of gastric emptying), but whether or not that will help depends on the severity of the overdose and other factors, so this is not something to bet on. After 48 hours, a liver transplant is the last resort, without which, mortality is around 95%.
Unfortunately, this means that a lot of people who do not fully intend to die horribly, and hoped to either die peacefully or else be saved, die horribly instead.
Ok, that was not a cheerful topic but it is important, before moving on, we’ll just put this here for anyone it may benefit:
How To Stay Alive (When You Really Don’t Want To) ← this is about suicidality, in yourself or others
Secondly, that dosage is for occasional use only
The problem often starts like this:
❝Due to its perceived safety, paracetamol has long been recommended as the first line drug treatment for osteoarthritis by many treatment guidelines, especially in older people who are at higher risk of drug-related complications❞
People with chronic pain, whether high or low on the pain level of that chronic pain, can very easily get into a habit of “I’ll just take this to take the edge off”, for example when getting up in the morning (often a trigger for pain starting) or going to bed at night (one needs to sleep and the pain is a barrier to that).
But… Those events, getting up and going to bed, it means that taking the drug also becomes part of one’s morning/evening routine—with many people even metering the doses out into pill organizers for the week, with this in mind.
A large (n=582,961) study looked at two groups of people, all aged 65+:
- 180,483 people who had been prescribed paracetamol repeatedly (≥2 prescriptions within six months)
- 402,478 people of the same age who had never been prescribed paracetamol repeatedly
The findings? Bearing in mind that “≥2 prescriptions within six months” is not something generally considered excessive…
❝Acetaminophen use was associated with an increased risk of peptic ulcer bleeding (aHR 1.24; 95% CI 1.16, 1.34), uncomplicated peptic-ulcers (aHR 1.20; 95% CI 1.10, 1.31), lower gastrointestinal-bleeding (aHR 1.36; 95% CI 1.29, 1.46), heart-failure (aHR 1.09; 95% CI 1.06, 1.13), hypertension (aHR 1.07; 95% CI 1.04, 1.11), and chronic kidney disease (aHR 1.19; 95% CI 1.13, 1.24).❞
The researchers concluded:
❝Despite its perceived safety, acetaminophen is associated with several serious complications. Given its minimal analgesic effectiveness, the use of acetaminophen as the first-line oral analgesic for long-term conditions in older people requires careful reconsideration.❞
You can see the study itself here: Incidence of side effects associated with acetaminophen in people aged 65 years or more: a prospective cohort study using data from the Clinical Practice Research Datalink
What to use instead?
It’s been established that taking aspirin regularly isn’t great either:
See: Low-Dose Aspirin & Anemia and Aspirin, CVD Risk, & Potential Counter-Risks
And as for ibuprofen, we don’t have an article about that yet, but it’s gut-unhealthy (harms your microbiome), and besides, anything it can do, ginger can do as well or better (in head-to-head trials; we’re not speaking hyperbolically here):
Ginger Does A Lot More Than You Think ← in fact, it was even found as effective as the combination of acetaminophen, ibuprofen, and caffeine
There are other options though, and as pain is complicated and there’s no one-size-fits-all solution, we’ve compiled the following:
- Dial Down Your Pain
- Stop Pain Spreading
- Managing Chronic Pain (Realistically!)
- The 7 Approaches To Pain Management
- Science-Based Alternative Pain Relief ← when painkillers aren’t helping, these things might
Take care!
Don’t Forget…
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