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Image source: Osteoporosis - Causes, Risk Factors & Treatment, Symptoms, MedicationsTreatment Of OsteoporosisA number of steps help to treat osteoporosis. They will minimize further bone loss and prevent fractures. They will also ease pain that may be present. As shown below, there are a number of factors that need to work in concert. You may notice that I did not mention Fosamax and bisphosphonates here.Clinical trial regarding Fosamax use in women with low bond densityDr. Murray (Ref. 12) explains how Merck advertised that testing bone mineral density followed by taking Fosamax would prevent hip fractures. A large study showed that there was no correlation between bone density testing and the prevention of fractures with Fosamax. The reason for this is, as I mentioned under “causes of osteoporosis” that a low bone density is only one factor that leads to hip fractures. In addition, there are a number of other factors that contribute to bone fractures as well. In postmenopausal women only 15 to 30 % of all hip fractures had osteoporosis as a cause. Fosamax reduced the relative rate of hip fractures by 50%. However, a closer analysis of the study showed that the study concentrated on high-risk women who had already a history of a fracture due to osteoporosis (Ref. 12, p.116).Fosamax did not play a significant role in preventing fractures in osteoporosis patientsOnly 2 out of 100 women in the placebo group had a hip fracture during the trial. The Fosamax group had only 1 out of 100 women who developed a hip fracture. This is indeed a relative risk reduction of 50%, but it was only a 2% absolute risk reduction. In other words, 98% of the treatment group would have fared just as well as the placebo group, had they NOT taken Fosamax. I had many visits from drug representatives in the past trying to convince me that the relative risk reduction would be the more important figure. This speaks against the evidence based medicine rules that say that a good drug would be one where less than 50 patients have to be treated to prevent one case with the disease. Here that number is 98, which is unacceptably high.Physical activity helps prevent osteoporosisA patient affected with osteoporosis needs to work closely together with the treating physician and ask for the various elements of treatment.Everybody can walk or engage in an exercise program. Smokers need to quit smoking and heavy drinkers need to quit drinking and likely would do well to join Alcoholics Anonymous. Otherwise it would be a waste of all the other elements of therapy, as it does not make sense to built up bone and then destroy it again.Chelation therapy to detoxify the bodyBooks like “Breakthrough” (Ref.8) by Suzanne Somers have reviewed newer insights of anti-aging medicine. This points out the importance of detoxifying the body from heavy metals like mercury, lead and cadmium (from smoking and air pollution). Glutathione/Vit. C or EDTA infusions can be given as a series of intravenous injections to detoxify your body. Most naturopaths are informed about this and can administer these infusions. Regular doctors are reluctant to get involved, although the science behind this has been established in the 1980’s and before.Calcium carbonate (such as in Rolaids), and a sensible diet, which is sugar free and free of refined carbohydrates (without starches, rice, potatoes and pasta), will all help (see Ref. 3 and 4). In other words a low carb diet that allows the low glycemic index foods .Low glycemic index dietLow glycemic index foods are green leaf vegetables, lettuce, red and green peppers, broccoli, cauliflower and other cooked vegetables etc, (glycemic index of up to 50) to deliver and absorb the necessary minerals for the bones. Further regarding the recommended diet, it should be a medium healthy fat diet (containing enough omega-3 fatty acids), but also contain adequate amounts of protein. Such diets are also called Mediterranean diet, Zone diet, South Beach diet and all of them will help. Vitamin D3 is useful to improve absorption of calcium. Molecularly distilled fish oil or Krill oil ( 4 to 6 capsules per day) will help to control inflammation, which is part of what is behind osteoporosis.Treatment of osteoporosis (practical hints)__________________________________________________prevention of falls : carpeting, hip protectors, avoid benzodiazepines; cataract surgery to ensure good vision. Regular exercise will improve balance and muscle co-ordination.calcium supplements : 1000 to 1500 mg per day is usually the official recommendation. 800 to 1000 mg may be better as an overdose of calcium could cause bursitis and tendinitis. Also an equal amount of magnesium is required to balance calcium (so, if you take 1000 mg of calcium daily, have magnesium 1000 mg daily also).vitamin K2: 200 micrograms daily are required to keep the calcium in the bones and away from the blood vessels, where calcium could otherwise be deposited causing arteriosclerosis (Ref.14).List of supplements continuedvitamin D : 400 IU to 800 IU to improve absorption and utilization of calcium. This was the recommendation until about 2005. Now 5000 to 8000 mg per day is recommended. Measure blood 25-hydroxyvitamin-D level (should be between 50 and 80 ng/mL) and titrate optimal dose (Ref. 13).calcitonin by injection or by nasal spraybisphosphonates : alendronate (Fosamax) inhibits osteoclast related bone absorption, increases bone density and prevents fractures in postmenopausal women. Although used widely, this is NOT recommended (see Ref. 10, p. 71)Final therapeutic measures for osteoporosissodium fluoride : used to be popular, but now most physicians have misgivings about it, because the new bone formation is low quality, more fragile bone leading to fractures (not a good idea, if this is what we want to prevent!). See Ref. 10 (p. 85)physical activity : walking, swimming, expander and stretching exercises builds up bone masschange of diet : a zone type diet will build up bone by avoiding hyperinsulinism (Ref. 3 and 4)physiotherapy treatments : strengthen and balance muscles to improve gait and prevent fallsbioidentical hormone replacement therapy : this will restore the balance of bone rebuilding (osteoblast activity) and bone destruction (osteoclast activity); bone density will be restored to youthful values. Testosterone in males and progesterone in females stimulates osteoblasts directly building up high quality bone.__________________________________________________Bioidentical hormones stimulate new bone formation from osteoblast cellsYour physician or naturopath will help you to decide whether estrogen/progesterone (in women) or testosterone therapy (in men) is necessary. In some patients it might be better to use calcitonin instead. However, as Ref. 8 points out it is important that only bioidentical hormone replacement is used to balance the body’s hormone network. The synthetic hormones that most doctors prescribe do not have the same effect on your hormone receptors as bioidentical hormones (this info comes from the branch of anti-aging medicine).Dr. Lee (Ref. 10) has shown that in women only progesterone will significantly stimulate osteoblast cells to produce new high quality bone. A saliva hormone test will show to your anti-aging physician or naturopath whether you are in need of bio-identical hormone replacement treatment. Many women beyond the age of 45 to 55 years of age produce less progesterone in their ovaries from this age onward.Menopause and andropauseMales have their own problem, which is a lower testosterone production beyond the age of 55 to 65. As the male change of life is about 10 years later than the hormone changes in women, osteoporosis tends to have a later onset in men. Men should also have saliva tests for their hormones done (the same set as women should have ordered) and this should include a panel of testosterone, estradiol, progesterone, DHEAS and cortisol. A knowledgeable physician or naturopath will be able to advise you what this means and what you should do. Typically if there is a significant drop in testosterone (in males) or significant drop of progesterone (in females) this will require the start of bio-identical hormone replacement via daily hormone cream applications.Vitamin D3 often low in osteoporosis patientsDr. Thierry Hertoghe and Dr. Ron Rothenberg summarized the treatment for osteoporosis at a recent conference in Las Vegas (Ref. 11). Often patients are deficient in Vit. D3 levels (a simple blood test will show this) and replacement with oral vitamin D3 (5000 IU per day) will rectify this. Vit. D helps to absorb calcium and incorporate it into the bones for strength.Human growth hormoneIn postmenopausal women estrogen is often missing while in older men testosterone is often low. In both sexes growth hormone levels are found to be extremely low as evidenced by IGF-1 levels in the blood. When the levels are low the person affected is considered growth hormone deficient and human growth hormone has to be given by injection (small daily needle, similar to insulin injections). There is now a large enough body of human experience according to these speakers at the conference (Ref.11) to know that small replacement doses of human growth hormone given to persons who are low in IGF-1 levels will not cause or aggravate cancer in them.Supplements to prevent osteoporosisThe following supplements help prevent osteoporosis according to Ref. 9.Calcium 250 to 500 mg per day for women on hormone replacement; without hormone replacement 750 to 1000 mg daily. Men: 250 to 500 mg daily when there is evidence of bone loss.Vit. D3 : 2000 to 5000 IU per day will prevent osteoporosis and many cancers (now 5000 IU to 8000 IU per day are recommended). Best have your blood levels for 25-hydroxy vitamin D3 checked, as absorption of vitamin D3 from the gut into the blood stream between various people vary greatly.Vit. C: 1000 to 2000 mg per day for repair and replacement of connective tissue and as an anti-oxidant.Vit. K2 for the manufacturing of osteocalcin that helps to attract calcium to bone. 200 micrograms daily recommended.Magnesium, manganese and zinc5. Magnesium 200 to 600 mg daily will help together with estrogen supplementation in postmenopausal women to increase bone density by 11%, but with estrogen alone only 0.7% when observed over 8-9 months (study cited in Ref.9).6. Manganese is an essential nutrient for hormone glands and bone; a dose of 5 to 20 mg daily are recommendable.7. Zinc is essential for treating inflammatory arthritis and metabolic andropause in men; it requires about 50 mg per day to stop the formation of estrogen from male hormones in fatty tissues by aromatase. Males need all of the testosterone replacement when the elderly patient’s andropause is treated with testosterone. Zinc supplementation helps to prevent prostate cancer from testosterone aromatization into estradiol in this context. Some men may not tolerate a possible side-effect of stomach upsets from zinc (never take it on an empty stomach).Folic acid and boron8. Although the RDA for folic acid is 0.4 mg, 1.0 mg daily is better. Folic acid helps prevent the build-up of homocysteine, which triggers osteoporosis and causes heart attacks. This should be taken together with vitamin B12 (1000 to 2000 micrograms); talk to your doctor about this as vitamin B12 could be injected also.9. Boron: This is an essential trace mineral; we need about 1 to 3 mg daily. It is contained in healthy plants from mineral rich soils. However, in a “normal” North American diet it may be sadly missing. Boron helps bone to retain calcium, and it is also needed for normal hormone function of estrogen, testosterone, DHEA and as well as for vitamin D3 function.Soy protein, remove problematical fluoride from toothpaste10. Soy protein: Some of it is good, but too much may be bad. The natural estrogen substances in soy bind to estrogen receptors, thus blocking excessive amounts of estrogen in males (obese males who are estrogen dominant and get metabolic osteoporosis). This will help to prevent bone loss (Ref.9).In addition, it is also important to re-emphasize that all fluoride from toothpastes, drinking water or other sources needs to be removed. It poisons enzyme systems in the body leading to premature mortality, but it also leads to brittle bones (osteoporosis) with ultimate fractures. Physicians prescribe bisphosphonates often due to lobbying by the drug industry. As indicated above these drugs should be avoided entirely, as they are not effective. Estrogen dominance from xenoestrogens in the environment (pesticides, cosmetics etc) has to be treated as this causes a relative loss of progesterone, the counter player of estrogens, and weakens bones in men as well (estrogen is a counter player to testosterone as well).ConclusionThe physician or naturopath is in the best position to advise the patient. Discussion of the pros and cons between patient and physician is important. There is often more than one right way to treat osteoporosis successfully. Physiotherapy treatments are important to strengthen certain muscle groups and to develop strength thus avoiding falls. Other measures to prevent falls as indicated in the table above are also important. An aging person may have cataracts, which lead to poor vision (L-Carnosin is a useful supplement in that case). After cataract surgery the patient often has a much more steady gait. Unfortunately, when elderly persons fall, their life experiences a permanent change. This happens often following a hip fracture. For those patients who end up in nursing home care, they lose their independence permanently.The above was first published by me here: Treatment Of Osteoporosis - Net Health BookReferences1. ABC of rheumatology, second edition, edited by Michael L. Snaith M.D., BMJ Books, 1999.2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 57.3. B. Sears: “The age-free zone”.Regan Books, Harper Collins, 2000.4. B. Sears: “Zone perfect meals in minutes”. Regan Books, Harper Collins, 1997.5. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders6. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.7. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier8. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 20089. Dr. Eugene Shippen and William Fryer: “The Testosterone Syndrome, the critical factor for energy, health & sexuality – Reversing the male menopause”. M. Evans, NY/USA, 200710. Dr. John R. Lee: Natural Progesterone- The remarkable roles of a remarkable hormone”, Jon Carpenter Publishing, 2nd edition, 1999, Bristol, England.11. 19th Annual World Congress Anti-Aging and Aesthetic Medicine in Las Vegas (December 8-10, 2011).12. Michael T. Murray, N.D.: “What the drug companies won’t tell you and your doctor doesn’t know” – The alternative treatments that may change your life – and the prescriptions that could harm you. Atria Books (subsidiary of Simon & Schuster Inc.), 2009.13. Suzanne Somers: “Bombshell – Explosive Medical Secrets that will redefine Aging”. Crown Publishing, 2012.14. S. A. Chako, Y. Song, L. Nathan et al.: “Relations of dietary magnesium intake to biomarkers of inflammation and endothelial dysfunction in an ethnically diverse cohort of postmenopausal women”. Diabetes Care 2010, Feb; 33 (2): 304-310.

Thanks for A2A. This an edit of my earlier comment.Metformin is promoted as something of a wonder drug, and is probably an advance on previous drugs which may be out of patent and no longer profitable. Raw materials are common and dirt cheap. And it has wonderful marketing people who are really on the ballYes, there are hardly any adverse effects (see below).Although you may find that a properly informed nutritional approach (orthomolecular, naturopathic etc) is perfectly adequate in many cases. Emergencies may need more aggressive treatment; bear in mind that diabetesII is an insidious disease.The market is helped along by a novel blood test - HbA1c - which includes many more people than established tests. I usually refer to it as hilariously inaccurate. Essentially it establishes the irrelevance of whether the subject has eaten sugar recently, but does so very badly. There were a number of conferences discussing where to set a level that was equivalent to a proper test, ending with something rather arbitrary which was possibly pitched to sell product.This is backed by the withdrawal of the gold-standard challenge test using proper technology.And of course, ‘official’ dietitians are trained (by pharma influences) to give terrible advice, and to fight off the people who are giving good nutritional advice, on the better-researched more alternative side. People who have overcome their diabetes are often banned from talking about it.And so-called food scientists in industry are just laughable from a health point of view (and in my experience horribly misinformed even about basics). Not their job to make people healthy.I do know from people I know, that some people develop problems after long term use of medications.I prefer to advocate for nutritional medicine (Alliance for Natural Health International) and homeopathy,(Yes homeopathy does work despite the noisy and prevalent pseudo-skeptical campaign against itsee my answer to How does homeopathy work?Homeopathy May Be Able To Cure Diabetes | Homeopathic AssociatesThis is a subject for experts, not for the average do-it-yourself approach, so consult an experienced homeopath and do not take undue risks)I’m sure the whole diabetes awareness thing saves lives, even though some cultures habitually try to ignore it. I am not convinced that pharmaceutical sales (and training of doctors as sales reps) are the only answer or even the best answer. And I am disgusted by attempts to suppress better answers.Link Metformin Side Effects: Common, Severe, Long Term - Drugs.comMetformin Side EffectsMedically reviewed by Drugs.com | Prescription Drug Information, Interactions & Side Effects. Last updated on Nov 20, 2018.OverviewSide EffectsDosageProfessionalTipsInteractionsMoreProfessionalManaging Side EffectsIn SummaryCommonly reported side effects of metformin include: lactic acidosis, diarrhea, nausea, nausea and vomiting, vomiting, and flatulence. Other side effects include: asthenia, and decreased vitamin b12 serum concentrate. See below for a comprehensive list of adverse effects.For the ConsumerApplies to metformin: oral solution, oral tablet, oral tablet extended releaseWarningOral route (Tablet; Tablet, Extended Release; Solution)Death, hypothermia, hypotension, and resistant bradyarrhythmias have been reported due to metformin-associated lactic acidosis. Onset may be subtle and include nonspecific symptoms such as malaise, myalgia, respiratory distress, somnolence, and abdominal distress; laboratory abnormalities include low pH, increased anion gap and elevated blood lactate. The risk of lactic acidosis increases with renal or hepatic impairment, aged 65 years or older, having a radiological study with contrast, surgery, or other procedures, hypoxic states, and excessive alcohol intake. If lactic acidosis is suspected, metformin hydrochloride should be discontinued, supportive measures started in a hospital setting. Prompt hemodialysis is recommended.Along with its needed effects, metformin may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.Check with your doctor immediately if any of the following side effects occur while taking metformin:More commonAbdominal or stomach discomfortcough or hoarsenessdecreased appetitediarrheafast or shallow breathingfever or chillsgeneral feeling of discomfortlower back or side painmuscle pain or crampingpainful or difficult urinationsleepinessLess commonAnxietyblurred visionchest discomfortcold sweatscomaconfusioncool, pale skindepressiondifficult or labored breathingdizzinessfast, irregular, pounding, or racing heartbeat or pulsefeeling of warmthheadacheincreased hungerincreased sweatingnauseanervousnessnightmaresredness of the face, neck, arms, and occasionally, upper chestseizuresshakinessshortness of breathslurred speechtightness in the chestunusual tiredness or weaknessRareBehavior change similar to being drunkdifficulty with concentratingdrowsinesslack or loss of strengthrestless sleepunusual sleepinessSome side effects of metformin may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:More commonAcid or sour stomachbelchingbloatedexcess air or gas in the stomach or intestinesfull feelingheartburnindigestionloss of appetitemetallic taste in the mouthpassing of gasstomachachestomach upset or painvomitingweight lossLess commonAbnormal stoolsbad, unusual, or unpleasant (after) tastechange in tastedifficulty with movingdiscoloration of the fingernails or toenailsflu-like symptomsjoint painmetallic taste in mouthrashrunny nosesneezingstuffy noseswollen jointsFor Healthcare ProfessionalsApplies to metformin: compounding powder, oral solution, oral tablet, oral tablet extended releaseGeneralGastrointestinal events such as nausea, vomiting, diarrhea, abdominal pain, and loss of appetite have been frequently reported during therapy initiation and resolve spontaneously in most cases.Adverse events in the pediatric population appear to be similar in nature and severity to that published in adults.[Ref]MetabolicCommon (1% to 10%): HypoglycemiaVery rare (less than 0.01%): Lactic acidosis[Ref]GastrointestinalVery common (10% or more): Diarrhea (53.2%), nausea/vomiting (25.5%), flatulence (12.1%)Common (1% to 10%): Indigestion, abdominal discomfort, abnormal stools, dyspepsia, loss of appetite[Ref]HematologicVery rare (less than 0.01%): Subnormal vitamin B12 levels[Ref]OtherCommon (1% to 10%): Asthenia, chills, flu syndrome, accidental injury[Ref]HepaticVery rare (less than 0.01%): Liver function test abnormalities, hepatitis[Ref]CardiovascularCommon (1% to 10%): Chest discomfort, flushing, palpitation[Ref]DermatologicCommon (1% to 10%): Rash, nail disorder, increased sweatingVery rare (less than 0.01%): Erythema, pruritus, urticaria[Ref]EndocrineFrequency not reported: Reduction in thyrotropin (TSH) levels[Ref]ImmunologicVery common (10% or more): Infection (20.5%)[Ref]MusculoskeletalCommon (1% to 10%): Myalgia[Ref]Nervous systemCommon (1% to 10%): Lightheadedness, taste disturbances[Ref]PsychiatricCommon (1% to 10%): Headache[Ref]RespiratoryCommon (1% to 10%): Rhinitis[Ref]References1. "Product Information. Glucophage (metformin)." Bristol-Myers Squibb, Princeton, NJ.2. "Product Information. Fortamet (metFORMIN)." Physicians Total Care, Tulsa, OK.3. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 04. "Product Information. Riomet (metFORMIN)." Ranbaxy Pharmaceuticals, Jacksonville, FL.5. Cerner Multum, Inc. "Australian Product Information." O 06. "Product Information. Glumetza (metFORMIN)." Biovail Pharmaceuticals Canada, Mississauga, IA.Further informationAlways consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.Some side effects may not be reported. You may report them to the FDA.Related questionsHow long does glucophage/Metformin stay in your system?What are the ingredient drugs contained in Qternmet XR?Medical DisclaimerNext → DosageMore about metforminDuring Pregnancy or BreastfeedingDosage InformationPatient TipsDrug ImagesDrug InteractionsCompare AlternativesSupport GroupPricing & CouponsEn Español503 ReviewsDrug class: non-sulfonylureasFDA Alerts (1)Consumer resourcesMetforminMetformin Extended-Release TabletsMetformin TabletsMetformin Oral SolutionMetformin (Advanced Reading)Other brands: Glucophage, Glucophage XR, Glumetza, Riomet, ... +2 moreProfessional resourcesMetformin Hydrochloride (AHFS Monograph)... +4 moreRelated treatment guidesDiabetes, Type 2Polycystic Ovary SyndromeDiabetes, Type 3cInsulin Resistance SyndromeFemale InfertilityDRUG STATUSRxAvailabilityPrescription onlyPregnancy & LactationRisk data availableN/ACSA Schedule*Not a controlled drugApproval HistoryDrug history at FDANEWSWhat to Know and Do About Possible Nitrosamines in Your MedicationNEWSBig Advances Made Against Diabetes in 2019NEWSFDA Testing Levels of Carcinogen in Diabetes Drug MetforminManufacturersAmneal Pharmaceuticals LLCApotex Corp.Breckenridge Pharmaceutical, Inc.More…Drug ClassNon-sulfonylureasRelated Drugsmetformin, Trulicity, Lantus, Victoza, Tresiba, LevemirUser Reviews & RatingsMetformin reviews7.1 / 10503 Reviews________Not much really. I’ve seen worse