04/25/2011 08:47 am ET Updated Jun 25, 2011

Osteoporosis Drugs: The Good, the Bad, the Natural Alternatives

Women (and men!) of a certain age who have been diagnosed with osteoporsis are frequently prescribed a bisphosphonate like Fosamax, Boniva, Actonel, Altevia or Reclast. In 2009 more than 5 million prescriptions for these drugs were written. But, as time has gone on, the dangers of long-term use of these drugs causing exactly fractures they were supposed to prevent -- and doing other damage -- have become well-known.

The FDA, which approved bisphosphonates in the first place has backpedaled a bit. Last October the government issued a warning about the increased risk of fractures of the femur -- the thigh bone -- for those who take these drugs for more than five years.

What a quandry for those who need to halt and reverse the bone loss that can lead to "dowager's hump," spinal compression fractures and fractures of the leg. And the number of people who suffer from bone loss is in the hundreds of millions.

Biphosphonates are popular among those whose doctors recommend a medication, possibly because they were the first drugs to be prescribed for building bone. But patients who have read about their drawbacks are afraid to take them for more than a short while, or afraid even to begin. And at the same time these patients are afraid not to take them!

What to do? Fortunately there are drugs other than bisphosphonates that can limit or reverse bone loss. The one I like the best is Evista, though it has side effects too. This drug is a SERM, selective estrogen receptor modulator, and is meant for post-menopausal women. Estrogen is crucial for keeping bone loss and regeneration in balance. SERMs bind to estrogen receptors on bone cells. The cells are fooled into thinking there is estrogen there, so they function like younger bones, keeping bone loss and replacement in balance. The same "trick" works on breast cells and other genital tissue, lowering the risk of breast and reproductive cancers.

Natural Osteoporosis Treatments

But drugs aren't the only answer. Medication or no medication, drinking alcohol and carbonated beverages and smoking aren't recommended, and a diet rich in calcium and Vitamin D is beneficial. Eat lots of vegetables and less red meat. Surprisingly the digestion of animal protein actually takes up some of the calcium bones need. Paradoxically that puts vegetarians and those who don't eat red meat in a good position with regard to bone health. We hear it again and again -- eat collard greens, bok choy and kale. And eat sardines and salmon. Vitamin D is important enough by itself and for calcium absorption that many of my patients take a supplement of 1000-2000 IU a day.

I believe yoga is another valuable tool for everyone's bone health. Not only is yoga weight-bearing. It's the far greater pressure created by one group of muscles opposing another that makes the difference. My clinical trial studying the benefits of yoga for osteoporosis and osteopenia has had significant early success, and it is ongoing now to test those initial results.

During the two-year study, participants added more than 3/4 of a point on the T scale in their DEXA bone density tests for the spine and 4/5 of a point for the hip, which is often the site of a fracture. They did this in one 10-minute yoga session a day. To explain this a little further, participants who had osteopenia improved enough to return to the normal bone density range. Some who had osteoporosis gained bone during the study and entered the osteopenia range.

The people in my study averaged 68 years of age, but yoga would have helped if they were much younger or much older to prevent, halt or reverse the process of bone loss. Eminently portable, quiet and just about free, yoga has few if any undesirable side-effects. Participants in my study did over 20,000 hours of yoga. There was not one injury! There is still room in the study, so if you're interested, you can sign up.

The bottom line

Whether you take medicines or not, you can improve your lifestyle by incorporating natural treatments. As for the medicines, ask questions and investigate, but if your doctor has a persuasive argument, follow his or her advice.