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.
