Managing Osteopenia and Osteoporosis with Botanical Medicine

milk thistle — Milk Thistle (*Silybum marianum)*

Our bones are powerful! I’m still amazed sometimes that these hardened structures, allowing for muscle attachments and acting as a scaffold for movement, are indeed very much alive. Right now, as you’re reading this, they are hard at work creating blood cells and maintaining their structure and intricate framework.

Maintaining bone integrity as our patients age is paramount to aging well. Each year over 300,000 people are hospitalized for hip fractures. Hip fractures are associated with increased overall morbidity and mortality^7,8,9,10. If we want to help people live longer and live well we must help them maintain good bone health, keep them from falling, keep them out of hospitals, and keep them moving. We can most definitely help them face this challenge.

Statistics & Diagnostic Assessments of Osteoporosis and Osteopenia
An estimated 44 million Americans are affected by osteoporosis or low bone mass, with people primarily over the age of 55 being most affected^11,12. (Note: these statistics vary upon the source, please see resources cited.) Women are more impacted than men, but both are at risk for fractures depending on their bone integrity and overall risk factors. Low bone density is less common before menopause. As estrogen levels decline, we see a reduction in bone mineral density in peri-menopausal and post-menopausal women. This is definitely an avenue in which supportive therapies can be applied.

walker The FRAX score (Fracture Risk Assessment Tool) is commonly used in clinical practice to assess the 10-year fracture risk for patients to help guide clinical treatments¹³. This is often included by radiologists on DEXA scan reports.

DEXA scans are used to determine bone mineral density (BMD) and patients with T-scores less than or equal to -2.5 are diagnosed with osteoporosis, while T-scores between -1.0 and -2.5 are considered osteopenic. Additionally, DEXAs can also be useful in assessing current or past fractures and healing.

You can also monitor bone resorption using the urinary n-telopeptide test^14,15. This is an excellent monitoring tool that can be tracked over time (more often than the typical 2-year DEXA scan recommendation) to assess if your patient’s bone resorption rates and subsequent bone deposition rates are improving.

Herbs for Better Bone Integrity
Two of our biggest botanical tools to improve bone health are nutritive herbs and those with SERM (selective estrogen receptor modifiers) activity^1,2,4,26,27. Nutritive herbs offer support not only for bones but also the supporting connective tissues.

Interestingly, as I looked into the literature on nutritive herbs and osteoporosis I found these same herbs had other constituents that offered defense against bone loss.

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Arctium lappa (Burdock root)
When you first think of this herb for bone health, you may primarily think of its nutritive action, as the root contains minerals (calcium, iron, silica, and potassium). Calcium recommendations for osteoporosis range between 800-1200mg of total daily calcium²⁰. Raw burdock root contains about 41mg of calcium per 100g of fresh root if patients are choosing to consume the plant. Amounts of silica in burdock root vary, however, it’s important to note that this is an important mineral in bone and connective tissue. Higher levels of dietary silica intake are associated with better overall bone density. Additionally, Arctium lappa seed contains the active constituent arctigen which has been shown to inhibit RANKL-mediated osteoclast differentiation in bone marrow and suppress RANKL-mediated bone resorption^16,17,18,19. This is the same pathway that Denosumab (trade names: Prolia and Xgeva) act on.

Arctium is readily available as a tea or tincture and would be great to consider in a combination osteoporosis formulation. Arctium root can be found at local markets and cooked.

Equisetum arvense (Horsetail)
Much of the research available on Equisetum and osteoporosis is via rat studies^7,21,22. However, these studies have shown significant findings. In one study on rat mandible density, it was found rats consuming daily Equisetum had increased mandibular BMD. Another in vitro study showed this herb induces human osteoblasts which may show promise for use in improving human osteoblastic activity with regular consumption²⁹. This herb is commonly used as a tea along with other nutritive herbs as it also contains minerals (silica, manganese, potassium, and calcium).

Studies on bone density included Equisetum alcoholic extract. It can also be used in a hot infusion for nutrient extraction.

Actaea racemosa (Black cohosh)
Actaea has long been used as an herb for post-menopausal symptoms through estrogenic-like effects³⁰. It also has SERM activity, and SERMs have been shown to block osteoclasitc activity and provide antiresorptive effects^23,24,25. This is how the bisphosphonates (eg Fosamax) work. However, bisphosphonates have side effects including GI upset, increased fracture risk, and osteonecrosis of the jaw.

Actea is most commonly used in tincture via alcoholic extract or taken as a dry herb in capsule form.

Lepedium meyenii (Maca)

Studies with rats fed Lepeium meyenii alcoholic extract showed improved bone density in ovariectomized rats suggestive of Lededium offering improved bone integrity in the presence of hormone decline for post-menopausal women²⁸. Another study compared the use of Lepedium on rats that had glucocorticoid induced osteoporosis and demonstrated its potential for improved bone density alongside bisphosphonates or by itself^31,32. Unfortunately, the literature on humans is limited, but Lepedium has a longstanding history as a hormone modulator and use in peri- and post-menopause to improve symptoms of hot flashes.

Studies referenced used Lepedium via alcoholic extract, but this herb has long been consumed as a food. Typically dried for 2 months before use, it’s readily available in powdered form and patients can easily add to smoothies, sprinkle on oatmeal, or other foods.

Silybum marianum (Milk thistle)
This herb is more than just a potent hepatoprotective botanical. Its active constituent, silymarin, from Silybum seed has been shown to have SERM-like activity and performs similarly to estradiol supplementation in ovariectomized rats³³.

This study used an alcoholic extract, however, Silybum has been regularly used in both tincture and dry herb formulations.

Conclusion
There are numerous botanicals we can utilize to further support bone density. The aforementioned herbs could be combined into a targeted botanical formulation and/or considered in combination products as a part of a long-term health prevention plan. Other herbs not discussed that offer significant hormone modulation or have been shown helpful in other postmenopausal symptoms (hot flashes, mood lability, vaginal dryness, etc) or hormonal balance in general (eg low libido, reduced fertility, low sperm count) would be worth considering in a combination formula to support all aspects of healthy aging.

Lastly, in addition to botanicals, I have to mention optimal calcium, vitamin D, strontium, and vitamin K intake. These combined with botanicals, a supportive diet (there is a great amount of research on the Mediterranean diet and osteoporosis), and weight bearing exercise can help our patients (and ourselves) age well.

Note: The information on this site is provided as a research resource for health professionals and is not intended to replace diagnosis and treatment by a qualified health care practitioner. Consult your medical care provider before using any herbal medicine.

Meet Our Contributor:
Dr. Allison Williams is a naturopathic doctor practicing at her clinic in Mesa, AZ. She focuses on primary care medicine and is passionate about bringing back the ‘old school family doctor’, complete with house calls! She completed a 2-year general medicine residency at the Southwest College of Naturopathic Medicine where she now teaches botanical medicine as adjunct faculty. Her practice combines her knowledge of conventional and alternative therapies. And, of course, she loves the power of plant medicine! You can find her online at drallisonwilliams.com or takingcareofyourhuman.com.

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