Staying contemporary with any area of health care is a task, but it is one I take seriously.  One of the tools I use to keep up is a weekly update from PubMed, the research database at the National Library of Medicine.  One of my primary searches for which I receive a weekly update is about new papers published on osteoporosis.

In my early days of practice, 1980, there was a total of 259 papers/studies on osteoporosis.  In 2025 that number had grown to 7339, a staggering 28-fold increase.  To keep up I receive a weekly update of all published just in the past week.  The latest – 140 new papers/studies.  One of the interesting changes that is evolving is the increasing interest and research on non-drug therapies.  Of the 140, 17 or 12% were on nutritional and non-drug therapies.

Some of the studies looked at the impact of several phytonutrients on osteoporosis including:

Magnolin, a phytonutrient in magnolia which was shown to increase osteogenesis, or the increase in osteoblastic bone repair.

Narigin, a flavonoid found in grapefruit, causes a bitter taste.  It has been proven to enhance the incorporation of minerals into bone.

Chaste Tree, and herb which is a phytoestrogen.  It replaced the effects of estrogen on bone remodeling.

Procyanidins, phytonutrients from apples, cocoa, grapes, and others were shown to slow osteoclastic bone removal similar to Fosamax.

Icariin, a flavonoid from the herb epimedium.  It restores the balance on bone removal and bone repair during bone remodeling.  It is one of our primary supplements for osteoporosis.

Epigallocatechin, the primary, highly active polyphenol in green tea, is known for its potent antioxidant, anti-inflammatory activity.  The study found that adding it to Fosamax enhanced its effect on bone mineral density.

Legume proteins increased osteoblastic bone repair.

Tocopherols, a main part of the vitamin E complex improved the function of osteocytes which are the cells that regulate bone remodeling.

Elaeagnus angustifolia (Russian olive) increased mesenchymal stem cell replenishment of bone building osteoblasts.

Ursolic acid, a natural triterpenoid compound found in apple peels, herbs (rosemary, thyme), and berries, known for its potential anti-inflammatory, antioxidant, and muscle-building properties were found to increase the differentiation of mesenchymal stem cells into osteoblasts which replace bone.

Last but not least, a study looked at adding mechanostimulation to the anabolic (bone building) drug Romosumaub or Evenity.  Both mesenchymal stem cells and osteoblasts have mechanoreceptors on the surface which when stimulated by mechanical force, activate cell activity.  There are many ways to add this mechanostimulation such as exercise but the most effective is PEMF therapy.  Studies found that adding this stimulation enhanced the benefit from the drug.

This increased interest in non-drug therapies is primarily the result of a phenomenon called the osteoporosis care gap.

 This is the gap between those diagnosed with osteoporosis and those who begin treatment.  Extensive study has found that 58% of those diagnosed do not begin treatment. 

Of those who do some form of treatment, the majority use calcium and vitamin D supplements.  While those are important, they are not enough to increase bone density enough to reduce fracture risk.  A total of 21% of those diagnosed begin some type of drug therapy.

While there are several factors involved in the osteoporosis care gap, perhaps the most driving one is concern about the adverse effects that are known to occur with these drugs.  As I see the increased research on non-drug therapies, it seems that these concerns are pushing interest in that direction.

We live in the information age and that is so true in health care.  So next Monday morning it will be coffee and sorting through the next wave of 100+ new papers/studies.