The Truth About Osteoporosis Drugs

By Andrea Bartels CNP NNCP RNT Registered Nutritional Therapist 21 Apr 2023

The Truth About Osteoporosis Drugs

There’s a common misconception that bisphosphonate drugs build bone.  Bisphosphonates are a class of medications that are prescribed to individuals who are diagnosed with osteopenia or osteoporosis. Examples of these drugs are Actonel (risedronate), Fosamax (alendronate), Didrocal (etidronate) and Aclasta (zoledronic acid).

Bisphosphonates work by inhibiting the function of osteoclasts—the cells that are designed to demolish old bone cells. The logic here is that doing this prevents bone from deteriorating as quickly. However, it’s not quite that simple.

The truth is, bisphosphonates can only halt further bone density loss.  That’s right: these bone resorption-inhibitors simply preserve old bone instead of making new bone.

They do NOT build new bone cells, and they don’t stimulate bone-building activities, either. These drugs are not substitutes for calcium and other nutrients important for building strong bones.

That’s not all. Side effects can include nausea, abdominal pain and loose stool. Other less common symptoms can include pain in the joints, muscles or bones; even less common but even more disturbing is the occurrence of osteonecrosis of the jawbone and esophageal cancer in some patients taking bisphosphonates.

So, with these limitations, why are bisphosphonates prescribed to individuals with low bone density?  Perhaps because they are relatively inexpensive, compared to some of the newer drugs, like Forteo and Prolia—which are injectable hormone analogues.

All Structures Need Support

Bones are in fact composed of two main components, like a brick wall. Collagen is the protein that forms the structure of our bones, rather like bricks in the wall.   The minerals are the mortar in between the bricks—holding the bricks together, adding strength and resistance to fracture. What happens to the wall when the mortar erodes? It crumbles and is prone to collapsing on impact.

Similarly, our bones lose strength when they become demineralized.  There are many factors that contribute to demineralization, including an incomplete diet, sedentary lifestyle, hormone deficiencies and more.

Bone Nutrition

Protein, minerals and vitamins are needed to build and maintain bone density. Some of these nutrients include vitamin D3, vitamin C, vitamin K2 and of course, calcium. What roles do they play?

Vitamin D3 appears to regulate the usage of calcium by muscles, nerves and bones. It’s well established that vitamin D deficiency causes rickets in children and osteomalacia in adults---the softening of the long bones of the body. We also know that osteoporosis and related bone fractures is more prevalent in populations with lower blood levels of vitamin D. 

Vitamin K2 is important to the formation of osteocalcin, a protein used to make new bone cells. Vitamin K2 also directs calcium to where it’s supposed to go. Its most bioavailable form—MK7-- is not found in many foods. Supplementation is a good idea if you don’t eat fermented soy products.

Vitamin C is essential for collagen production, collagen being the protein that bones are made of.  Since vitamin C is only found in fresh fruits and vegetables, it’s no wonder that higher bone density is associated with higher intake of these foods.

Calcium is the most abundant mineral in the body, giving bones their strength. With the help of vitamin D and vitamin K, dietary calcium is deposited into bone where it becomes a major part of a complex of several minerals, proteins and bone-growth factors, called calcium hydroxyapatite.  

It takes a team of nutrients to maintain healthy bones. 

Find out more about bone health and nutrition in our free webinar.

References

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Kim YA, Kim KM, Lim S, et al. Favorable effect of dietary vitamin C on bone mineral density in postmenopausal women (KNHANES IV, 2009): discrepancies regarding skeletal sites, age, and vitamin D status. Osteoporos Int. 2015;26(9):2329-2337.

North American Menopause Society. The role of calcium in peri- and postmenopausal women: consensus opinion of The North American Menopause Society. Menopause. 2001 Summer;8(2):84-95. 

Office of Dietary Supplements. “Vitamin D Fact Sheet for Health Professionals”. National Institutes of Health. Accessed online November 11, 2022.

Osteoporosis Canada.  “Bisphosphonates: The most common family of drugs used to treat osteoporosis.” Accessed online April 13, 2023.

Pasquali M, Mandanici G, Conte C, Muci ML, Mazzaferro S. Understanding the different functions of vitamin D. G Ital Nefrol. 26; 2009 Jul-Aug; Suppl 46:53-7.

Schurgers L.J., Teunissen K.J.F., Hamulyák K., Knapen M.H.J., Vik H., Vermeer C. Vitamin K-containing dietary supplements: Comparison of synthetic vitamin K1 and natto-derived menaquinone-7. Blood 2007;109:3279–3283. 

Sunyecz JA. The use of calcium and vitamin D in the management of osteoporosis. Ther Clin Risk Manag. 2008;4(4):827-836.

Villa JKD, Diaz MAN, Pizziolo VR, Martino HSD. Effect of vitamin K in bone metabolism and vascular calcification: A review of mechanisms of action and evidences. Crit Rev Food Sci Nutr. 2017 Dec 12;57(18):3959-3970.

Whitaker M, Guo J, Kehoe T, Benson G. Bisphosphonates for osteoporosis--where do we go from here?. N Engl J Med. 2012;366(22):2048-2051.