Natural remedies for osteoporosis in postmenopausal women.

A 68-year-old woman diagnosed with osteoporosis attended a naturopath, who advised (a) exercise in the gym 2–3 times a week, because " walking wasn't good enough " ; (b) natural progesterone cream applied to the skin; (c) oral boron supplements; (d) codliver oil 1000 mg daily; (e) chelated calcium (instead of her current calcium carbonate); and recommended that she stop drinking tea. The patient challenged her general practitioner for not giving the same advice as the naturopath, suggesting he was remiss. Her GP wondered if there was any empirical basis for these recommendations in osteoporotic patients. ■ The revised question was: Is there empirical evidence that the following interventions reduce fracture rates and improve bone mineral density (BMD) in postmenopausal women with osteoporosis?: • exercise in the gym 2–3 times a week; • natural progesterone cream; • boron; • codliver oil; • chelated calcium supplement; • abstaining from tea. The ideal studies for this would be randomised controlled trials (RCTs) comparing each of the recommendations with either placebo or no treatment (or, in the case of the last recommendation, drinking tea) for the outcomes of interest: fracture rate and BMD. the Cochrane Library, using the search terms " osteoporosis " , " weight-bearing exercise " , " walking " , " progest " , " natural progesterone cream " , " boron " , " bone " , " cod liver oil " , " caltrate " , " calcium carbonate " , " tea " , " tannin " and " vitamin D ". Summary of findings We identified a number of studies that used the primary outcome measure of BMD, but none that assessed fracture rate as the primary outcome. Exercise Five meta-analyses were identified that demonstrated the effectiveness of aerobic and/or strength-training exercise in increasing BMD in different body regions, 1 the lumbar spine, 2-4 the hip, 5 and femoral neck. 4 The meta-analyses applied adequate eligibility criteria for the trials analysed and included either RCTs only 1,3,5 or RCTs and non-randomised controlled trials. 2 , 4 Four RCTs specifically evaluated the benefits of walking on BMD. The sample sizes were small in two of these trials but adequate in the other two. In a seven-month trial of 33 postmenopausal women, walking above (but not below) the anaerobic threshold (ie, sufficient to leave the subject panting) was found to significantly increase lumbar spine BMD in the walking …