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Denosumab Bone Loss
Wait..what? Denosumab bone loss? While denosumab is FDA approved and has been shown to reduce the risk of “skeletal-related events” (fractures), it’s important to understand that there are long-term side effects associated with long-term administration.
Meaning, taking either denosumab or a bisphosphonate therapy for too long increases the risk of serious side effects.
The solution? Evidence-based non-conventional bone health therapies.
What evidence-based non-conventional bone health therapies are there?
1. Dietary Interventions
- Alkaline Diet: Eating more fruits and vegetables to promote an alkaline pH has been associated with better bone health. Some studies suggest that a more alkaline environment reduces calcium loss from bones.
- Prunes: Research indicates that prunes may improve bone density by reducing bone resorption (breakdown).
- Collagen Supplements: Hydrolyzed collagen may support bone matrix formation and improve bone mineral density (BMD).
2. Exercise and Physical Therapies
- Weight-Bearing Exercises: Activities like walking, jogging, and resistance training are known to improve BMD. Non-conventional forms like yoga and tai chi may enhance flexibility and reduce falls, indirectly benefiting bones.
- Vibration Therapy: Whole-body vibration platforms have shown promise in improving BMD and muscle strength, especially in older adults.
3. Supplements Beyond Calcium/Vitamin D
- Vitamin K2: Helps guide calcium to bones and away from arteries. Found in fermented foods and as a supplement.
- Magnesium: Supports bone mineralization. Deficiency is linked to lower BMD.
- Silicon (e.g., from horsetail or bamboo extracts): Promotes bone and connective tissue health.
- Strontium: Some forms (like strontium citrate, a non-prescription version) show evidence of improving bone density.
4. Herbal and Natural Remedies
- Traditional Chinese Medicine (TCM): Herbal formulations like Liu Wei Di Huang Wan or Dang Gui are used to strengthen bones, though evidence is mixed.
- Ayurveda: Herbs such as Ashwagandha and Cissus quadrangularis (“bone setter”) may support bone healing and density.
- Isoflavones (from Soy or Red Clover): Plant-derived compounds with estrogen-like effects may benefit postmenopausal bone health.
5. Acupuncture
Some evidence suggests acupuncture may help reduce pain associated with osteoporosis-related fractures and improve mobility, though its direct effects on bone density are less clear.
6. Electromagnetic and Light Therapies
- Pulsed Electromagnetic Field (PEMF) Therapy: Studies suggest PEMF can stimulate bone growth and improve fracture healing.
- Low-Level Laser Therapy (LLLT): May enhance osteoblast activity and aid in bone regeneration.
7. Mind-Body Approaches
- Yoga and Tai Chi: Improve balance, reduce falls, and may enhance bone health through weight-bearing poses and improved circulation.
- Meditation and Stress Reduction: Chronic stress can lead to high cortisol levels, which negatively affect bone density. Mindfulness and stress management may indirectly support bone health.
8. Gut Health and Bone Health Connection
- Probiotics: Certain strains (Lactobacillus reuteri) have shown potential in improving bone density by reducing inflammation and enhancing calcium absorption.
9. Functional Foods
- Dairy Alternatives Fortified with Calcium and Vitamin D: Almond, soy, or oat milk often contain added nutrients supporting bone health.
- Seaweed: High in calcium, magnesium, and other trace minerals essential for bone metabolism.
As a long-term MM survivor I have to stress that denosumab or bisphosphonate therapy can help newly diagnosed MM patients reduce the risk of fracture when the are first diagnosed. Unfortunately, these FDA approved therapies can’t be taken forever.
But bone health is a lifelong endeavor for MM survivors.
Email me at David.PeopleBeatingCancer@gmail.com with bone health questions.
Thank you,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
How to Stop Bone Loss After Denosumab? No Easy Answers
“Patients who discontinue treatment with the osteoporosis drug denosumab, despite transitioning to zoledronate, show significant losses in lumbar spine bone mineral density (BMD) within a year, according to the latest findings to show that the rapid rebound of bone loss after denosumab discontinuation is not easily prevented with other therapies — even bisphosphonates.
“When initiating denosumab for osteoporosis treatment, it is recommended to engage in thorough shared decision-making with the patient to ensure they understand the potential risks associated with discontinuing the medication…,”
The current results, reflecting the first year of the 2-year study, show that, overall, those receiving zoledronate (n = 76), had a significant decrease in lumbar spine BMD, compared with a slight increase in the denosumab continuation group (−0.68% vs 1.30%, respectively; P = .03)…
Fracture Risk Is the Overriding Concern
Meanwhile, the loss of lumbar spine BMD is of particular concern because of its role in what amounts to the broader, overriding concern of denosumab discontinuation — the risk for fracture, Fu noted.
“Real-world observations indicate that fractures caused by or associated with discontinuation of denosumab primarily occur in the spine,” he explained.
Previous research underscores the risk for fracture with denosumab discontinuation — and the greater risk with longer-term denosumab use, showing an 11.8% annual incidence of vertebral fracture after discontinuation of denosumab used for less than 2 years, increasing to 16.0% upon discontinuation after more than 2 years of treatment…
“The dilemma is what to do with longer-term users who stop, and the real question is not what happens to BMD, but what happens to fracture risk,” he wrote…”
Denosumab bone loss
Denosumab bone loss