The Future for Osteoporosis: Are Anabolic Therapies the Answer?
It is estimated that more than 200 million people globally live with osteoporosis and the International Osteoporosis Foundation says that as many as 1 in 3 women and 1 in 5 men over 50 will experience an osteoporosis fracture in their remaining lifetime. This debilitating and painful condition is something that can be managed, but better treatments are needed and research in the field of osteoanabolic therapy has proven promising.
Research published in Expert Opinion on Emerging Drugs found osteoanabolic therapy for osteoporosis can restore (to some degree) the bone’s microarchitecture, the main feature of this disease. With this promising future ahead, anabolic therapies including SARMs can be explored to treat osteoporosis as we move towards finding effective long-term therapy or even a cure.
Understanding Osteoporosis & its Impact
Osteoporosis is one of the most common bone diseases there is. It occurs when the body begins to lose too much bone or makes too little bone, or it can be a combination of both factors. This in turn means bones are weaker and break more easily if a person should fall. In the most severe cases bones can break from a minor bump or graze or even a sneeze or cough.
Osteoporosis translates literally as “porous bone”, and this is a close description of how the bones appear when looked at under a microscope. Healthy bones appear like a honeycomb when looked at microscopically. However, when you look at bones affected by osteoporosis the holes within the honeycomb are much larger. These bones have a lower density than healthy bones and often contain abnormal tissue structure. As bones lose density, they have a higher chance of breaking. Once you reach 50 and you suffer a fracture, you should always for further investigation including bone density testing.
Around 54 million Americans have low bone density, which increases their risk of osteoporosis. This in turn means any fracture can become a serious concern. Osteoporotic fractures usually occur in the hip, spine or wrist but any bone in the body can be affected and the condition can cause permanent pain. When the condition affects the vertebrae it can also cause a loss in height. It’s a condition that can significantly limit mobility, which in turn can cause damage to a person’s mental health, leading to depression or isolation. Many patients require long-term care once the condition becomes more serious.
The National Osteoporosis Society estimates the condition is responsible for around 2 million broken bones every year and this equates to costs of around $19 billion. The condition is particularly devastating as many people don’t have a clue it’s a problem until they suffer a fracture and then their bone density is looked at in more detail. It’s a disease which clearly needs more research to help minimize the huge impact it currently has.
Causes of Osteoporosis
Osteoporosis is most commonly caused by old age and the natural degeneration of the body. There are also a wide range of conditions that can exacerbate or increase the likelihood of the condition developing including:
- Autoimmune disorders: including lupus, multiple sclerosis, ankylosing spondylitis and rheumatoid arthritis
- Gastrointestinal disorders: including inflammatory bowel disease and celiac disease
- Medical procedures: including gastrointestinal bypass operations
- Cancer: most commonly prostate or breast cancer
- Hematologic disorders: including leukemia, sickle cell disease or multiple myeloma
- Bone disorders: including thalassemia
- Hormonal disorders: including hyperthyroidism, diabetes, premature menopause and Cushing’s syndrome
- Nervous system disorders: including Parkinson’s disease, stroke and spinal cord injuries
- Other conditions: including AIDS, COPD, Polio, organ transplants and scoliosis
These are just some of the conditions that may be linked to premature osteoporosis or a higher chance of getting the disease. There are also others, so anyone who suffers with these conditions or similar may consider bone density testing.
There are also a range of medications linked to the condition. Bone loss may be greater if you’re required to take higher doses or take a particular drug for an extended period of time. Doctors should fully discuss any treatment options and their long-term effects before you make a decision, and it is often a case of weighing up the risks. Medications which can cause bone loss include:
- Aluminum-containing antacids
- Some anti seizure medicines
- Cancer chemotherapeutic drugs
- Some Aromatase inhibitors
- Thyroid hormones in excess
- Gonadotropin releasing hormone (GnRH)
- Medroxyprogesterone acetate for contraception
- Steroids (glucocorticoids) such as cortisone and prednisone
- Selective serotonin reuptake inhibitors (SSRIs)
This, again, is not an exhaustive list.
Current Treatment Options
There are treatments available for osteoporosis. As with all medication, different treatments will be suitable for different patients and there may be some trial and error. There are drug therapies available for osteoporosis including:
- Bisphosphonates: a type of antiresorptive drugs which slow bone loss and minimize fracture risk.
- Estrogen-receptor modulators: specifically for women, these drugs are designed specifically to reduce the risk of spine fractures in post-menopausal women.
- Calcitonin: another treatment for postmenopausal women which helps to prevent spinal fracture and can help with pain management after a fracture.
- Parathyroid hormone: The FDA has approved the use of this hormone for people with a high risk of fracture as it can stimulate bone formation.
- Monoclonal antibodies (denosumab, romosozumab): these immune therapies can be taken by women who have been through the menopause.
Alternative Therapies for Osteoporosis
The future of osteoporosis treatment is interesting, as research is consistently finding new drugs to consider for managing the condition. Recently, research has found injecting a particular kind of stem cell into mice could reverse osteoporosis and bone loss in a way that could be beneficial for humans too.
Some patients with osteoporosis may also look for other therapies to minimize their pain. Osteopathic treatment may be able to lead to some relief from symptoms, as massage and gentle movement of the affected joints can help promote circulation and improve movement, helping with any related mobility problems.
Patients who are newly diagnosed may also be asked to consider lifestyle changes to protect their bones and joints. Weight loss, quitting smoking and drinking in moderation are all considerations for a healthy lifestyle in general but they are particularly important if your bone density is lower than average. Putting extra pressure on your joints is dangerous and could lead to a higher risk of fractures.
Exploring SARMs as an Osteoporosis Treatment Option
Osteoanabolic agents, also known as SARMs (selective androgen receptor modulators) have been found to slow osteoporosis, although none are currently in wide use. SARMs can protect bone but there have been issues in getting them into the bloodstream in pill form and also due to their side effects. SARMs are often more easily ingested sublingually which is not a traditional way for medicating osteoporosis patients.
SARMs are a type of molecular compound that will either activate or repress the androgen receptor within our cells. The androgen receptor is a naturally occurring protein that changes how our genes are switched on or off in many of the body’s tissues. It coordinates much of the body’s cellular activity, from tissue growth to blood cell formation to metabolism. Evidence shows that specific SARMs, notably the aryl propionamide SARM, S-4, can prevent bone loss and improve bone strength.
The administration of androgens can result in a number of side effects including prostate enlargement, problems with cholesterol and triglyceride levels in the blood. However, SARMs are designed to leave behind the negative side effects of steroids and keep the anabolic (generally good) side effects in place, for the treatment of several conditions including bone-related disorders. Osteoanabolic treatments would look to build bone without the negative effects on the prostate and blood.
Bone cells include androgen receptors which respond to hormones, both produced by the body and in supplement form. Androgens and SARMs can increase the rate of formation of periosteal bone, whereas traditional treatments like bisphosphonates can inhibit this. This increased formation rate is what makes SARMs a potentially valuable option for osteoporosis patients. SARMs also do not cause the enzymatic reaction that turns testosterone into estradiol, one of the negative impacts of similar treatments.
SARMs in Clinical Use
Clinical and therapeutic use of SARMs for osteoporosis is likely to be in the form of a combined therapeutic approach. The most likely approach would be to combine SARMs with bisphosphonates as the drugs work in different ways to combat bone loss. Bisphosphonates stop osteoclastic destruction while SARMs increase bone formation so the combination of both therapies together could be an effective treatment for the condition in multiple ways. Research on rats has already shown that a combination of these two therapies had an effect on osteoporosis so scientists are looking for ways to combine the therapies for human use. The administration of SARMs will be dependent on a number of factors. For many people, they are an exciting prospect with the potential to limit bone density and loss.
High-risk patients are the prime concern for researchers. Research shared by Felicia Cosman, MD, at the 28th annual American Association of Clinical Endocrinologists (AACE) Scientific & Clinical Congress in Los Angeles, California focused on the value of an “anabolic-first” approach to treating the highest risk patients. While Cosman expressed excitement at the new therapies becoming available, she asserted how useful anabolic agents can be in helping patients with the fastest and largest fracture risk. This was further supported by the Oregon Osteoporosis Center which also endorsed advancing osteoporosis treatment with anabolic drugs in the first instance for high-risk patients.
The Future of Anabolic Agents for Osteoporosis Treatment
The treatment of osteoporosis involves trying to both limit bone loss and promote bone formation. A combination of therapies is looking to be the most effective way of moving forward for better treatment and giving millions of people more of a chance to enjoy less pain and better mobility on a daily basis.
SARMs research for osteoporosis is still considered to be a long way from approval and scientists are exploring the specifics of which anabolic agent is the best option for treating osteoporosis. Once they’ve pinned it down to the right anabolic agent, the next stages of testing and trials can be considered. Many questions still need to be answered, including the following:
- How often should treatment be given?
- What combination of therapies is the most effective?
- Can we define long-term impacts of the treatment?
- How to manage treatment for patients of different risk levels?
Osteoporosis is a serious concern for millions of Americans, especially as they age. 24.5% of women and 5.1% of men aged over 65 already have osteoporosis of the femur, neck or lumbar spine and this is a figure that experts believe will only increase. To combat this, commitment to research and new therapies needs to be prioritized and considering new treatments, while daunting, shouldn’t be avoided if they have the potential to make a significant difference. Treatment programs need to change and as osteoporosis becomes better understood, scientists and doctors can look for new approaches to treat the condition.
Anabolic therapies are an exciting and promising step forward in preventing the impact of osteoporosis and can promote bone growth and formation. Scientists and health professionals should look to advance the research and more patients may be able to benefit from the anabolic therapies and combination therapies that can make the disease more manageable. Recognized experts in the field are already advocating an anabolic-first approach for high-risk patients and in time, it may be able to be adapted for other patients. It’s an exciting new horizon for osteoporosis patients and could result in better prognosis and improved quality of life for many as research advances.