Robert Gorter, MD, PhD, is emeritus professor of the University of California San Francisco Medical School (UCSF)
Introduction to CBD and Osteoporosis
Osteoporosis is a bone diseases characterized by a loss of bone mass, leading to skeletal fragility and fractures. One of two women and one of eight men will be diagnosed with osteoporosis. It is called a “silent disease” because you cannot feel or see your bones becoming thinner over time. Unfortunately, many people are diagnosed with osteoporosis only after a painful fracture has occurred. All older adults are at risk but certain individuals have factors that can increase their chance of developing the disease.
Osteoporosis is a usually preventable decalcification of bone and always leads to significant symptoms and diseases, decreased life expectancy and decreased quality of life.
Dr. Gorter offers his knowledge and view on osteoporosis and how it can be prevented in most cases with CBD. In addition, Dr. Gorter explains the modes of action of CBD and makes understandable all the positive effects in aging.
Osteoporosis decreases the life expectancy in women by approx. six years and in men by approx. four years; and it affects all elderly people in their quality of life and independence. With a greying population, where the elderly life longer, osteoporosis is becoming a major economic factor and costs society hundreds of billions of US Dollars or Euros per year.
In this article, as a Cannabis sativa L. expert since 1971, Dr. Gorter discusses the efficacy of CBD in treatment and prevention of osteoporosis. CBD has no side effects and is very low in costs.
Elderly woman with osteoporosis showing the characteristic curved back from compression fractures of her back bones.
March 25th, 2018
Osteoporosis is a disease where increased bone weakness increases the risk of a broken bone. It is the most common reason for a broken bone among the elderly. Bones that commonly break include the vertebrae in the spine, the bones of the forearm, and the hip. Until a broken bone occurs there are typically no symptoms. Bones may weaken to such a degree that a break may occur with minor stress or spontaneously. Chronic pain and a decreased ability to carry out normal activities usually occur following a broken bone.
Osteoporosis may be due to lower than normal bone mass and greater than normal bone loss. Bone loss increases after menopause due to lower levels of estrogen. Osteoporosis may also occur due to a number of diseases or treatments including alcoholism, anorexia, hyperthyroidism, kidney disease, and surgical removal of the ovaries. Several prescribed medications increase the rate of bone loss including some anti-seizure medications, chemotherapy, proton pump inhibitors, selective serotonin reuptake inhibitors, Non-Steroidal Anti-Inflammatory drugs and steroids. Not enough exercise and smoking are also risk factors. Osteoporosis is defined as a bone density of 2.5 standard deviations below that of a young adult. This is typically measured by dual-energy X-ray absorptiometry at the hip or hand.
Osteoporosis is an age-related disorder that causes the gradual loss of bone density and strength. When the thoracic vertebrae are affected, there can be a gradual collapse of the vertebrae. This results is kyphosis, an excessive curvature of the thoracic region
Prevention of osteoporosis includes a proper diet during childhood and efforts to avoid the numerous medications that cause the condition. Efforts to prevent broken bones in those with osteoporosis include a good diet, exercise, and fall prevention and Cannabidiol (CBD). Lifestyle changes such as stopping smoking and not drinking alcohol always help. Biphosphonate-containing medications are useful in those with previous broken bones due to osteoporosis or in bone metastases.
Osteoporosis becomes more common with age. About 15% of white people in their 50s and 70% of those over 80 are affected. It is more common in women than men. In the developed world, depending on the method of diagnosis, 2% to 8% of males and 9% to 38% of females are affected. Rates of disease in the developing world are unclear. About 22 million women and 5.5 million men in the European Union had osteoporosis in 2010. In the United States in 2010 about eight million women and one to two million men had osteoporosis. Caucasians and Asian people are at greater risk. The word osteoporosis is from the Greek terms for “porous bones”.
Osteoporosis itself has no symptoms; its main consequence is the increased risk of bone fractures. Osteoporotic fractures occur in situations where healthy people would not normally break a bone; they are therefore regarded as fragility fractures. Typical fragility fractures occur in the vertebral column, rib, hip and wrist.
Fractures are the most dangerous aspect of osteoporosis. Debilitating acute and chronic pain in the elderly is often attributed to fractures from osteoporosis and can lead to further disability and earlier mortality. These fractures may also be asymptomatic. The most common osteoporotic fractures are of the wrist, spine, shoulder and hip. The symptoms of a vertebral collapse (“compression fracture”) are sudden back pain, often with radicular pain (shooting pain due to nerve root compression) and rarely with spinal cord compression or cauda equina syndrome. Multiple vertebral fractures lead to a stooped posture, loss of height, and chronic pain with resultant reduction in mobility.
Risk factors for osteoporotic fracture can be split between non-modifiable and (potentially) modifiable. In addition, osteoporosis is a recognized complication of specific diseases and disorders. Medication use is theoretically modifiable, although in many cases, the use of medication that increases osteoporosis risk may be unavoidable. Nicotine but not caffeine is a risk factor for osteoporosis.
Bone density peaks at about 30 years of age. Women lose bone mass more rapidly than men.
The most important risk factors for osteoporosis are advanced age (in both men and women) and female sex; estrogen deficiency following menopause or surgical removal of the ovaries is correlated with a rapid reduction in bone mineral density, while in men, a decrease in testosterone levels has a comparable (but less pronounced) effect.
Race: While osteoporosis occurs in people from all ethnic groups, European or Asian ancestry predisposes for osteoporosis.
Heredity: Those with a family history of fracture or osteoporosis are at an increased risk; the heritability of the fracture, as well as low bone mineral density, is relatively high, ranging from 25 to 80%. At least 30 genes are associated with the development of osteoporosis.
Those who have already had a fracture are at least twice as likely to have another fracture compared to someone of the same age and sex. Early menopause/hysterectomy is another predisposing factor.
Physique: A small stature is also a non-modifiable risk factor associated with the development of osteoporosis.
Consumption of alcohol: Although small amounts of alcohol are probably beneficial (bone density increases with increasing alcohol intake), chronic heavy drinking increases fracture risk despite any beneficial effects on bone density.
Vitamin D deficiency: Low circulating Vitamin D is common among the elderly worldwide. Mild vitamin D insufficiency is associated with increased parathyroid hormone (PTH) production. PTH increases bone resorption, leading to bone loss. A positive association exists between serum 1,25-dihydroxycholecalciferol levels and bone mineral density, while PTH is negatively associated with bone mineral density.
Tobacco smoking (nicotine): Many studies have associated smoking with decreased bone health, but the mechanisms are unclear. Tobacco smoking has been proposed to inhibit the activity of osteoblasts, and is an independent risk factor for osteoporosis. Smoking also results in increased breakdown of exogenous estrogen, lower body weight and earlier menopause, all of which contribute to lower bone mineral density.
Malnutrition: Nutrition has an important and complex role in maintenance of good bone. Identified risk factors include low dietary calcium and/or phosphorus, magnesium, zinc, boron, iron, fluoride, copper, vitamins A, K, E and C (and D where skin exposure to sunlight provides an inadequate supply). Excess sodium is a risk factor. High blood acidity may be diet-related, and is a known antagonist of bone. Some have identified low protein intake as associated with lower peak bone mass during adolescence and lower bone mineral density in elderly populations. Conversely, some have identified low protein intake as a positive factor, protein is among the causes of dietary acidity. Imbalance of omega-6 to omega-3 polyunsaturated fats is yet another identified risk factor.
High dietary protein from animal sources: Research has found an association between diets high in animal protein and increased urinary calcium, and have been linked to an increase in fractures. However, the relevance of this observation to bone density is unclear, since higher protein diets tend to increase absorption of calcium from the diet and are associated with higher bone density. Indeed, it has recently been argued that low protein diets cause poor bone health. No interventional trials have been performed on dietary protein in the prevention and treatment of osteoporosis.
Underweight/inactive: Bone remodeling occurs in response to physical stress, so physical inactivity can lead to significant bone loss. Weight bearing exercise can increase peak bone mass achieved in adolescence and a highly significant correlation between bone strength and muscle strength has been determined. The incidence of osteoporosis is lower in overweight people.
Endurance training: In female endurance athletes, large volumes of training can lead to decreased bone density and an increased risk of osteoporosis. This effect might be caused by intense training suppressing menstruation, producing amenorrhea, and it is part of the female athlete triad. However, for male athletes, the situation is less clear, and although some studies have reported low bone density in elite male endurance athletes, others have instead seen increased leg bone density.
Heavy metals: A strong association between cadmium and lead with bone disease has been established. Low-level exposure to cadmium is associated with an increased loss of bone mineral density readily in both genders, leading to pain and increased risk of fractures, especially in the elderly and in females. Higher cadmium exposure results in osteomalacia (softening of the bone).
Soft drinks: Some studies indicate soft drinks (many of which contain phosphoric acid) increase the risk of osteoporosis, at least in women. Others suggest soft drinks may displace calcium-containing drinks from the diet rather than directly causing osteoporosis.
Proton pump inhibitors (such as lansoprazole, esomeprazole, or omeprazole) that decrease stomach acid, are a risk for bone fractures if taken for two or more years, due to decreased absorption of calcium in the stomach.
The body regulates calcium homeostasis with two pathways; one is signaled to turn on when blood calcium levels drop below normal and one is the pathway that is signaled to turn on when blood calcium levels are elevated.
Many diseases and disorders have been associated with osteoporosis. For some, the underlying mechanism influencing the bone metabolism is straightforward, whereas for others the causes are multiple or unknown.
In general, immobilization causes bone loss (following the ‘use it or lose it’ rule). For example, localized osteoporosis can occur after prolonged immobilization of a fractured limb in a cast. This is also more common in active people with a high bone turn-over (for example, athletes). Other examples include bone loss during space flight or in people who are bedridden or use wheelchairs for various reasons.
Hypogonadal states can cause secondary osteoporosis. These include Turner syndrome, Klinefelter syndrome, Kallmann syndrome, anorexia nervosa, andropause, hypothalamic amenorrhea or hyperprolactinemia. In females, the effect of hypogonadism is mediated by estrogen deficiency. It can appear as
early menopause (<45 years) or from prolonged premenopausal amenorrhea (>1 year). Bilateral oophorectomy (surgical removal of the ovaries) and premature ovarian failure cause deficient estrogen production. In males, testosterone deficiency is the cause (for example, andropause or after surgical or chemical removal of the testes).
Endocrine disorders that can induce bone loss include Cushing’s syndrome, hyperparathyroidism, hyperthyroidism, hypothyroidism, diabetes mellitus type 1 and 2, acromegaly, and adrenal insufficiency.
Malnutrition, parenteral nutrition and malabsorption can lead to osteoporosis. Nutritional and gastrointestinal disorders that can predispose to osteoporosis include undiagnosed and untreated coeliac disease (both symptomatic and asymptomatic people), Crohn’s disease, ulcerative colitis, cystic fibrosis, surgery (after gastrectomy, intestinal bypass surgery or bowel resection) and severe liver disease (especially primary biliary cirrhosis). People with lactose intolerance or milk allergy may develop osteoporosis due to restrictions of calcium-containing foods. Individuals with bulimia can also develop osteoporosis. Those with an otherwise adequate calcium intake can develop osteoporosis due to the inability to absorb calcium and/or vitamin D. Other micronutrients such as vitamin K or vitamin B12 deficiency may also contribute.
People with rheumatologic disorders such as rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus and polyarticular juvenile idiopathic arthritis are at increased risk of osteoporosis, either as part of their disease or because of other risk factors (notably corticosteroid therapy). Systemic diseases such as amyloidosis and sarcoidosis can also lead to osteoporosis.
Renal insufficiency can lead to renal osteodystrophy.
Hematologic disorders linked to osteoporosis are multiple myeloma and other monoclonal gammopathies, lymphoma, leukemia, mastocytosis, hemophilia, sickle-cell disease and thalassemia.
Several inherited disorders have been linked to osteoporosis. These include osteogenesis imperfecta, Marfan syndrome, hemochromatosis, hypophosphatasia (for which it is often misdiagnosed), glycogen storage diseases, homocystinuria, Ehlers–Danlos syndrome, porphyria, Menkes’ syndrome, epidermolysis bullosa and Gaucher’s disease.
People with scoliosis of unknown cause also have a higher risk of osteoporosis. Bone loss can be a feature of complex regional pain syndrome. It is also more frequent in people with Parkinson’s disease and chronic obstructive pulmonary disease.
People with Parkinson’s disease have a higher risk of broken bones. This is related to poor balance and poor bone density. In Parkinson’s disease there may be a link between the loss of dopaminergic neurons and altered calcium metabolism (and iron metabolism) causing a stiffening of the skeleton and kyphosis.
Fractures of the long bones acutely impair mobility and may require surgery. Hip fracture, in particular, usually requires prompt surgery, as serious risks are associated with it, such as deep vein thrombosis and pulmonary embolism, and increased mortality.
Fracture risk calculators assess the risk of fracture based upon several criteria, including age, smoking, alcohol usage, weight, and gender. Osteoporosis is a part of frailty syndrome.
Recently, a study was published by The Journal of Bone and Mineral Research, conducted by researchers from the Tel Aviv University and Hebrew University. This study showed that cannabidiol (CBD) strengthens bones and accelerates the healing of fractures, without causing any psychotropic effects.
Bone density peaks at about 30 years of age. Women lose bone mass more rapidly than men
Dr. Gorter: “This study proved that CBD alone improves the healing of fractures in all ages and in addition, in the elderly and women in their menopause, prevents or significantly improves osteoporosis (bone loss at older age).”
The team of experts inflicted femoral fractures on rats, and then gave CBD to some of them, while others received CBD plus tetrahydrocannabinol (THC). The conclusion was that, compared to the placebo group, rats fed with CBD alone experienced the same effects, regardless of the addition of THC.
Illustration depicting normal standing posture and in osteoporosis
Dr. Gorter adds: “Clinical observational studies in humans have already proven the benefits of CBD in anti-aging and the prevention of osteoporosis.”
Dr. Gorter: “The same team at the University of Tel-Aviv previously found that the body contains receptors which respond to cannabinoid compounds, and they are not confined to the brain. This study showed that the skeleton has cannabinoid receptors as well which trigger bone formation and prevent bone loss; and the second study just confirmed this.”
“This study is just a part of all research dedicated to the medical benefits of marijuana compounds, and new findings might stimulate researchers to analyze the positive effects of marijuana in the treatment of osteoporosis or other bone diseases.”
The medical properties of Cannabis sativa are numerous, and it is primarily used to boost appetite in the case of AIDS, to lower the side-effects of chemotherapy, and to soothe chronic pain. Numerous studies claim that it can regulate blood sugar, decelerate HIV progression, and treat multiple sclerosis, Parkinson’s disease and various forms of epilepsy.
Dr. Gorter: CBD is a strong COX-1 and COX-2 inhibitor without any side effects. Therefore, CBD inhibits the metastasis of many (all?) cancers and destroys leukemia and lymphoma cells of various kinds.
The journal Neuropsychopharmacology published a 2013 study which discovered that CBD is as effective as several antipsychotic drugs, which are commonly used in the treatment of schizophrenia and paranoia but CBD causes no side-effects. Several studies have also found and confirmed that CBD can be used as a safe antipsychotic.
Dr. Gorter: “We only respond to Cannabis because through evolution, we have developed intrinsic compounds (the so-called Endocannabinoids) and specific receptors that are also activated by compounds in the cannabis plant. One can compare the Endocannabinoid system with the endorphin system and its specific receptors.”
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