Bone density conservation agents

Related article: Osteoporosis and osteopenia

A variety of medications including the bisphosphonates have been touted to conserve or increase bone mass. These drugs have a number of side effects and are known or suspected to interfere with proper immune function.


Bone has constant turnover, and is kept in balance (homeostasis) by osteoblasts creating bone and osteoclasts digesting bone. Bisphosphonates inhibit the digesting of bone by osteoclasts.

The bisphosphonate has a variety of side effects:1)

  • chronic musculoskeletal pain2)
  • atrial fibrillation – Numerous studies have shown that the frequency of atrial fibrillation increases with increasing age in both men and women. Data from the Framingham Heart Study showed a greater biennial incidence of AF with increasing age, with the odds ratio rising by a factor of 2.2 for every additional 10 years of age.3)
  • calcium deposition in the soft tissues4)
  • osteonecrosis of the jaw, i.e. bone death
  • reduced organ function, e.g. renal dysfunction or failure

Those patients with elevated 1,25-DPrimary biologically active vitamin D hormone. Activates the vitamin D nuclear receptor. Produced by hydroxylation of 25-D. Also known as 1,25-dihydroxycholecalciferol, 1,25-hydroxyvitamin D and calcitirol. – which is very common among those suffering from Th1 diseaseAny of the chronic inflammatory diseases caused by bacterial pathogens. – seem particularly predisposed to the adverse effects of dysregulated calcium metabolism.

All these meds have some effect on the immune or endocrine system and are, therefore, to be avoided.

Types of bisphopshonates

  • alendronate (Fosamax)
  • etidronate (Didronel)
  • ibandronate (Boniva)
  • pamidronate (Aredia)
  • risedronate (Actonel)
  • tiludronate (Skelid)
  • zoledronic acid (Zometa, Zomera, Aclasta and Reclast)

Other types of bone density conservation agents

  • calcitonin (Miacalcin nasal spray) – A synthetic hormone with unknown effects on the immune system
  • raloxifene (Evista) – An oral selective estrogen receptor modulator (SERM) that has estrogenic actions on bone and anti-estrogenic actions on the uterus and breast. It is used in the prevention ofosteoporosis in postmenopausal women. In a 2006 study published in New England Journal of Medicine, raloxifene produced significantly more strokes and blood clots than the placebo.5)
  • teriparatide (Forteo) – A hormonal injection of parathyroid hormone, a hormone secreted by the parathyroid gland that regulates calcium in the body. Parathyroid hormone controls many other hormones, and may cause deposition of calcium into soft tissues.

===== Notes and comments =====

FDA Alert - Oral Bisphosphonates: Ongoing Safety Review - https://bit.ly/9EfpXY

===== References =====

Arce K, Assael LA, Weissman JL, Markiewicz MR. Imaging findings in bisphosphonate-related osteonecrosis of jaws. J Oral Maxillofac Surg. 2009 May;67(5 Suppl):75-84. doi: 10.1016/j.joms.2008.12.002.
[PMID: 19371818] [DOI: 10.1016/j.joms.2008.12.002]
Bock O, Boerst H, Thomasius FE, Degner C, Stephan-Oelkers M, Valentine SM, Felsenberg D. Common musculoskeletal adverse effects of oral treatment with once weekly alendronate and risedronate in patients with osteoporosis and ways for their prevention. J Musculoskelet Neuronal Interact. 2007 Apr-Jun;7(2):144-8.
[PMID: 17627083]
Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994 Mar 16;271(11):840-4.
[PMID: 8114238]
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