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There is an osteoporosis crises and less utilized solutions to it!

Old age is usually plagued by osteoporosis, where increased bone weakness increases the risk of a broken bone. Spine, forearm, and hip bones are most common victims of osteoporosis. It is frequently a problem of lower bone mass but increased bone mass than normal can also contribute to it. Several diseases, such as alcoholism, anorexia, hyperthyroidism, kidney problems, menopause, several medicines, such as chemotherapy, SSRIs, proton pump inhibitors, anti-epileptic medicines, and bad habits, such as smoking and lack of exercise can also increase osteoporosis. One would imagine that a crises of this sort has been dealt with good medicines already. That is not the case.

Anti-osteoporosis Drugs and Cancer Risk

Cancer can be regarded an age-related disease because the incidence of most cancers show an age-dependent rise, beginning in midlife. Osteoporosis, particularly that after menopause has a midlife onset and this disease if continues to progress (measured by decline in bone mineral density) significantly increases the risk of fracture. The present clinically used drugs for post-menopausal osteoporosis are aimed at curtailing the risk of fractures at spine and hip by increasing the bone and mineral density (BMD).

These anti-osteoporosis drugs are either resorbtion inhibitors that decrease bone breakdown (e.g. bisphosphonates) or formation stimulator that increases new bone formation (parathyroid hormone). Both categories of drugs curtail fracture risk. However, both increase the risk of cancers. According to the U.S. FDA, BPs increases risk of esophageal cancer and parathyroid hormone increases the risk of bone cancer.

In recent past, two other hormone-based anti-osteoporosis therapies including hormone replacement therapy (consisting of estrogen) and calcitonin have been withdrawn for their increased risk of cancers if used long term as required in the case of post-menopausal osteoporosis.

It is interesting to note the pattern emerging for the past three decades with respect to post-menopausal osteoporosis therapy, i.e. hormones are being introduced one after the other and each one of those so far has been withdrawn/flagged carcinogenic. Even the first line of therapy (BPs) is now associated with cancer by the U.S. Food and Drug Administration.

Anti-osteoporosis Drugs and Fracture

Although, BPs reduce the risk of any fracture yet are associated with atypical thighbone fracture unprovoked by major trauma and is a debilitating condition. This association is stronger than the one between smoking and lung cancer. Too much suppression of bone breakdown by BPs impairs the ability of bone to renew itself as measured bone breakdown is a physiologic process which is necessary prerequisite for new bone formation.

BPs Stay in Bones Years after Discontinuation

Because of its very high affinity to bone, BPs bind and stay in bones several years after one has discontinued this therapy and thus continues to remain exposed to the adverse effects of these drugs.

Alternatives

Polyphenolic compounds in dietary products such as EGCG in green tea, withanolides in Ashwagandha, quercetin in red onion and resveratrol in red wine have anti-cancerous as well anti-osteoporotic activities. Various Indian medicinal plants such as Hajora (Cissus quadrangularis), Shisham (Dalbergia sissoo), Ashwagandha (Withania somnifera) etc. have shown good bone conserving effects. Therefore, polyphenol-enriched products with anti-osteoporosis effect are safe alternatives to the clinically used drugs. These products if taken daily with 1200 mg calcium and 800 IU vitamin D will cut the risk of fracture by maintaining a healthy bone without the associated risk of the drugs mentioned before. Rather, these products could curtail the risk of age-related cancers.

Dalbergia sissoo tree

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