Curcumin for GIOP
Research Review by: Paul Anderson, NMD
Title: Curcumin alleviates glucocorticoid-induced osteoporosis through the regulation of the Wnt signaling pathway
Reference: Chen Z. et.al. Curcumin alleviates glucocorticoid-induced osteoporosis through the regulation of the Wnt signaling pathway. International Journal of Molecular Medicine. 37: 329-338, 2016. DOI: 10.3892/ijmm.2015.2432
Design: Interventional (rat) in vivo and in vitro trial.
Prescription of prolonged glucocorticoid (GC) treatment results in osteopenia and osteoporosis. This study aimed to evaluate the protective effects of curcumin on the bones of rats with dexamethasone (DXM)-induced osteoporosis. This is a groundbreaking advance from prior studies and if the results translate to humans would hold a great deal of therapeutic value for the many thousands of people prescribed prolonged GC. Other studies have investigated some of the mechanistic benefits of curcumin on bone health.
A 2013 study demonstrated in rats that a high-dose curcumin has therapeutic advantages over a low-dose curcumin of an antiresorptive effect on bone remodeling and improving bone mechanical strength. In this study the doses used were “low-dose” (10 mg/kg) curcumin group, and “high-dose” (50 mg/kg) curcumin group. Both groups had biochemical benefit but the high-dose group had the most improvement in bone strength and remodeling.
For comparison the dose given the rats in the Chen, et.al. study was 100 mg/kg.
Other cell line studies assessed the effects of curcumin on the Vitamin D Receptor (VDR) genomics, the activity of 1,25 hydroxylase and other biochemical factors. While these papers did not assess effect of curcumin on bone health they do add to the potential list of mechanisms by which curcumin affects bone metabolism in a positive manner.
Because this was a rodent study the authors’ conclusions included this summary: “In conclusion, in this study, we demonstrated that curcumin attenuated DXM-induced osteoporosis in vivo and osteoblast differentiation dysfunction in vitro. Furthermore, the mechanisms underlying the bone-protective effects of curcumin against DXM-induced osteoporosis involved the activation of the Wnt/β-catenin pathway. In future, curcumin may become a potential bone-protective therapeutic agent for the treatment of glucocorticoid induced osteoporosis (GIOP).”
So what can this mean for (human) practice? Beyond all the potential (known and unknown) mechanisms of action of curcumin on bone metabolism this data shows us that, as we see in so many areas of health, curcumin is a powerful agent in improving bone health. Whether due to normal aging, non-steroid medications or GIOP, osteopenia and osteoporosis are conditions with high morbidity and mortality that need as many safe therapies as can be offered. The available prescription therapies have both variable efficacy as well as potentially significant side effect profiles so natural therapy options are needed. The following are practical clinical applications of this information:
- Dose dependent effect:
In this study and the others mentioned, curcumin did show a dose dependent effect. This is partly an artifact of the single agent nature of the studies which naturally excludes therapeutic synergy which is mentioned below. If looking at the two rat studies the treatment effect was seen at 50 to 100 mg/kg oral dosing which in the typical “70 kg average adult” (as used in pharmacology) equals 3,500 mg to 7,000 mg of curcumin daily. As close as I can tell from the studies neither study used any “absorption enhanced” curcumin. We do know from other studies that oral curcumin in various forms does show highly variable absorption based on its formulation. Given this fact the oral dose in a human to achieve these benefits is likely lower if a highly absorbable form and synergistic therapies are used.
- Synergy of therapies:
One limit of single agent research is that it necessarily excludes synergistic effects of other agents in search of isolating the effect in question. In healthcare of course we often attempt to take advantage of synergy for many reasons. In the case of bone metabolism one should attend to the basics (protein intake, digestion and absorption, mineral intake and others. If these predicates are present then the “pathway manipulators” such as curcumin and some fat soluble vitamins have substrate to work with. The fat soluble vitamins D and K are also known to aid bone metabolism in many of the same areas as elucidated about curcumin in the paper being reviewed. If one can assure the intake of all these factors the benefit of curcumin will be additive.
In people who are taking long term corticosteroids the prevention of bone density related side effects is one therapeutic goal that can have profound health benefits. This and prior studies regarding the exceptional effects curcumin can have on bone protection (with and without GC involvement) add a powerful tool to the natural therapeutic options in the care of bone health.
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