Curcumin and Bone Density

Research outlines new use for this curcumin phytosome

By Alan Miller, ND

Reference

Riva A, Togni S, Giacomelli L, et al. Effects of a curcumin-based supplementation in asymptomatic subjects with low bone density: a preliminary 24-week supplement study. Eur Rev Med Pharmacol Sci. 2017;21:1684-1689.

Study Design

A 24-week, open pilot supplement human study [Editor's note: The study’s authors clarify, “Supplement studies define the field of activity of pharma-standard supplements and their possible preventive, pre-therapeutic applications. ‘Supplement human studies’ produce supplementary data to be compared with those from the best available management plans.”]

Study Objectives

To compare efficacy and safety of supplementation with curcumin phytosome plus standard management of osteopenia to standard management alone

Participants

Fifty-seven elderly men (average age 71 years) who were otherwise healthy (BMI<25 kg/m2) and diagnosed with osteopenia via DXA. Study participants self-selected to participate in either standard management (ie, a dietary evaluation followed by a diet adequate in vitamin D, vitamin C, and calcium and a regular exercise program consisting of 4-times-weekly weight training, walking, or running; n=28) or standard management with the addition of “a supplement” (n=29).

Exclusion criteria included a diagnosis of hypertension or hypercholesterolemia. All subjects also had normal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. No placebo was given in this open-label study.

Intervention

The supplement was 1,000 mg curcumin phytosome (Meriva) given daily as a single dose.

Outcome Measures

Bone densiometry was assessed with ultrasound. Specifically, calcaneus densiometry was performed by using Sahara clinical bone sonometer (Hologic Inc., Marlborough, MA, USA) and the fifth digit and jaw were done using a semi-quantitative, high-resolution ultrasound scanner (Preirus, Hitachi, Tokyo, Japan).

Bone density was determined at 4, 12, and 24 weeks and compared to the group’s baseline values and the other group’s outcomes.

Key Findings

At the 12-week and 24-week follow up, bone density was significantly improved (P<0.05) compared to baseline at the calcaneus, upper jaw, and fifth digit. The ultrasound transmission of the calcaneus decreased (corresponding to bone density increase) by 18.4% and 21% at weeks 12 and 24 respectively (P≤0.05). Fifth digit and upper jaw parameters also had statistically significant (P≤0.05) improvements at week 12 (6.9% and 2.3%, respectively) as well as week 24 (7.1% and 4.8%, respectively). Those receiving only standard care had no significant changes in bone density parameters. No adverse events or tolerability issues were noted.

Practice Implications

Practitioners considering treatments to improve bone density in patients with osteopenia likely include nutrients like calcium, magnesium, vitamin D, vitamin K, and omega-3 fatty acids.

Curcumin might not come to mind as a standard addition to this regimen, but this study in elderly men with reduced bone density suggests perhaps it should be. It should be noted that the Meriva curcumin phytosome preparation contains 20 percent curcumin extract, 40 percent phosphatidylcholine, and 40 percent cellulose. Thus, the daily dose of curcumin delivered was 200 mg.

However, the phytosome formulation may have unique absorption properties. In a study comparison of curcumin with (Meriva) and without phytosome in 9 healthy volunteers, Cuomo and colleagues found that 200 mg of Meriva had circulating curcuminoid levels equal to 5.8 grams of comparative dry powder. This represents 29 times higher levels, suggesting the phytosome greatly increased absorption and/or limited metabolism of the curcumin.1

The significantly improved bone density in the curcumin group noted at the 12- and 24-week exams, compared to the control group, suggests curcumin may be a valuable addition to standard management of reduced bone density. While curcumin extracts have demonstrated efficacy in preventing loss of bone density in experimental animals,2-5 this is the first study in humans showing improved bone density after supplementing with curcumin. A plausible mechanism may be curcumin’s activity in inhibiting osteoclastic bone resorption, possibly by its well-known interference in nuclear factor kappa B (NF-KB) signaling, which is also the main mechanism in curcumin’s anti-inflammatory effects.4,6

The formulation of this product is of interest because the Hordaland Health Study found dietary choline was directly associated with bone mineral density.7,8 A follow-up study with a similar structure, but using a placebo consisting of cellulose and phosphatidylcholine, would help strengthen the evidence.

This was a preliminary study that bears repeating in a larger group, but it appears we can add osteopenia to the list of clinical conditions curcumin phytosome has been shown in human clinical studies to be effective in treating, including pain,9 delayed onset muscle soreness after exercise,10 osteoarthritis,11 benign prostatic hyperplasia,12 sarcopenia,13 uveitis,14 nonalcoholic fatty liver,15 and quality of life in cancer treatment.16

Conflict of Interest Statement

It should be noted that three of the authors of the paper reviewed here are employed by the maker of Meriva, Indena Corporation. A fourth author works as a consultant to the company. In addition, one of the authors, F. Franceschi, MD, is an assistant editor at the journal in which this article was published. I am also employed by a company, Thorne Research, that profits from the sale of Meriva.

About the Author

Alan Miller, ND, has 28 years of experience as a naturopathic physician in the areas of clinical practice, clinical research, technical writing, medical education, product formulation, product development, and technical support. Dr. Miller was founding Senior Editor of Alternative Medicine Review, the first peer-reviewed, MEDLINE-indexed journal of clinical therapeutics in integrative medicine. He was Chief Medical Editor of the book Alternative Medicine Review- Monographs, Volume One, has authored over 20 scientific papers, and is an author and contributing editor to Pizzorno and Murray’s Textbook of Natural Medicine.

Alan has worked for Thorne Research for 23 years and is currently Executive Director, Medical Education, where he oversees the development and implementation of Thorne Research’s national and international medical education strategy. Alan holds a Doctor of Naturopathic Medicine degree from Bastyr University.

References

  1. Cuomo J, Appendino G, Dern AS, et al. Comparative absorption of a standardized curcuminoid mixture and its lecithin formulation. J Nat Prod. 2011;74(4):664-669.
  2. Chen Z, Xue J, Shen T, et al. Curcumin alleviates glucocorticoid-induced osteoporosis by protecting osteoblasts from apoptosis in vivo and in vitro. Clin Exp Pharmacol Physiol. 2016;43(2):268-276.
  3. Kim WK, Ke K, Sul OJ, et al. Curcumin protects against ovariectomy-induced bone loss and decreases osteoclastogenesis. J Cell Biochem. 2011;112(11):3159-3166.
  4. Oh S, Kyung TW, Choi HS. Curcumin inhibits osteoclastogenesis by decreasing receptor activator of nuclear factor-kappaB ligand (RANKL) in bone marrow stromal cells. Mol Cells. 2008;26(5):486-489.
  5. Yang X, He B, Liu P, et al. Treatment with curcumin alleviates sublesional bone loss following spinal cord injury in rats. Eur J Pharmacol. 2015;765:209-216.
  6. Jobin C, Bradham CA, Russo MP, et al. Curcumin blocks cytokine-mediated NF-kappa B activation and proinflammatory gene expression by inhibiting inhibitory factor I-kappa B kinase activity. J Immunol. 1999;163(6):3474-3483.
  7. Øyen, Nygard OK, Gjesdal CG, et al. Plasma choline, nicotine exposure, and risk of low bone mineral density and hip fracture: The Hordaland Health Study. J Bone Min Res. 2014; 29:242-250.
  8. Øyen J, Gjesdal CG, Karlsson T, et al. Dietary choline intake is directly associated with bone mineral density in the Hordaland Health Study. J Nutr. 2017;147:572-57
  9. Di Pierro F, Rapacioli G, Di Maio EA, et al. Comparative evaluation of the pain-relieving properties of a lecithinized formulation of curcumin (Meriva®), nimesulide, and acetaminophen. J Pain Res. 2013;6:201-205.
  10. Drobnic F, Riera J, Appendino G, et al. Reduction of delayed onset muscle soreness by a novel curcumin delivery system (Meriva®): a randomised, placebo-controlled trial. J Int Soc Sports Nutr. 2014;11:31.
  11. Belcaro G, Cesarone MR, Dugall M, et al. Product-evaluation registry of Meriva®, a curcumin-phosphatidylcholine complex, for the complementary management of osteoarthritis. Panminerva Med. 2010;52(2 Suppl 1):55-62.
  12. Ledda A, Belcaro G, Dugall M, et al. Meriva®, a lecithinized curcumin delivery system, in the control of benign prostatic hyperplasia: a pilot, product evaluation registry study. Panminerva Med. 2012;54(1 Suppl 4):17-22.
  13. Franceschi F, Feregalli B, Togni S, et al. A novel phospholipid delivery system of curcumin (Meriva®) preserve muscular mass in healthy aging subjects. Eur Rev Med Pharmacol Sci. 2016;20(4):762-766.
  14. Allegri P, Mastromarino A, Neri P. Management of chronic anterior uveitis relapses: efficacy of oral phospholipidic curcumin treatment. Long-term follow-up. Clin Ophthalmol. 2010;21(4):1201-1206.
  15. Pahani Y, Kianpour P, Mohtashami R, et al. Efficacy and safety of phytosomal curcumin in non-alcoholic fatty liver disease: a randomized controlled trial. Drug Res. 2017;67(04):244-251.
  16. Belcaro G, Hosoi M, Pellegrini L, et al. A controlled study of a lecithinized delivery system of curcumin (Meriva®) to alleviate the adverse effects of cancer treatment. Phytother Res. 2014;28(3):444-450.