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Affecting more than 53 million people in the U.S. osteoporosis is a bone disease that causes low bone mass, bone fragility and an increased risk of fractures. Studies show that cannabis boosts bone density, strengthens bone tissue, and lowers the risk of osteoporosis.
Overview of Osteoporosis
Osteoporosis is a disease that causes bone to weaken and be highly susceptible to fractures. Bone tissue is constantly being broken down and replaced, but with osteoporosis, the building of new bone doesn’t keep up with the rate of old bone being removed. The bone loses density over time and becomes weak and brittle.
The most serious complication associated with osteoporosis is bone fractures, which can result from a fall but, in severe cases of the disease, can occur even if a person hasn’t fallen. The areas most susceptible to fractures are the hip, spine, and wrist.
Symptoms associated with osteoporosis are typically not noticeable during the early stages of bone loss. Once the bones have become severely weakened, a person with osteoporosis may experience back pain, a stooped posture, loss of height and a bone fracture caused by an event that under normal circumstances wouldn’t damage bone.
Bone density for most people peaks around their early 20s. With age, bone mass is lost at a faster rate than it’s created and density decreases. Therefore, the amount of bone mass developed during the years of youth impacts how likely a person is to develop osteoporosis. The disease affects men and women of all ages. White and Asian women, particularly once past menopause, experience the highest risk of the disease. The reduction of estrogen levels, thyroid problems, a low calcium intake, eating disorders, a sedentary lifestyle, excessive alcohol consumption, and tobacco use can increase the risk of developing osteoporosis.
Osteoporosis is typically treated with medications that stimulate bone growth. While the medications are effective, they can cause side effects of nausea, abdominal pain, swallowing difficulties, and an increased risk of ulcers. For postmenopausal women, estrogen therapy can help maintain bone density, but it does increase the risk of blood clots, uterine and breast cancers, and heart disease.
Findings: Effects of Cannabis on Osteoporosis
Studies have shown that cannabinoids and the endocannabinoid system play a key role in the regulation of bone metabolism6,13. A deficiency in CB1 cannabinoid receptors has been shown to be associated with accelerated age-dependent osteoporosis because it stimulates bone resorption and significantly reduces bone formation. Deficiencies in CB2 receptors have also been found to be associated with an enhanced bone turnover rate and thus osteoporosis1,4,5,7.
The cannabinoids found in cannabis have therapeutic potential against osteoporosis because of their interaction with the CB1 and CB2 cannabinoid receptors. They are involved in modulating the bone building and bone resorption functions. Research has found that tetrahydrocannabinol (THC), the major active cannabinoid found in marijuana, activates the CB1 and CB2 cannabinoid receptors3.
Activation of CB1 receptors inhibits the release of norepinephrine, which in turn helps balance the bone formation and bone resorption2,8. CB2 receptors are prevalent in bone cells and when activated, stimulate bone formation and inhibit bone resorption1,2,10. Studies have shown that CB2 agonists help combat against postmenopausal bone loss and osteoporosis caused by the surgical removal of ovaries3,10. One study found that cannabinoids stimulated the production of human bone cells, which caused the researchers to conclude that modulating the endocannabinoid system with cannabinoids could be a therapeutic method for treating osteoporosis14.
Cannabidiol (CBD), another major cannabinoid found in cannabis, has been found to significantly improve the healing process of bones. In one study, rats with broken legs treated with CBD for eight weeks were found to have significantly stronger healed legs than rats that didn’t receive CBD treatments. CBD enhanced the maturation of collagen, the protein in the bone’s connective tissue that holds the bone together9.
States That Have Approved Medical Marijuana for Osteoporosis
No states have specifically approved medical marijuana for the treatment of osteoporosis.
Some states will, however, consider other conditions and may approve medical marijuana for osteoporosis. In California, “any debilitating disease where medical marijuana may be recommended by physician.” In Connecticut, “other medical conditions may be approved by the Department of Consumer Protection.” Massachusetts will approve “other conditions as determined in writing by physician.” The state of Washington allows medical marijuana for “any terminal or debilitating condition.” In Nevada, Oregon and Rhode Island, “other conditions subject to approval.” Additionally, Washington D.C. allows medical marijuana to be used for any debilitating condition as recommended by DC licensed doctor.
Recent Studies on Cannabis’ Effect on Osteoporosis
- Bab, I.A. (2007, November). Regulation of skeletal remodeling by the endocannabinoid system. Annals of the New York Academy of Sciences, 1116, 414-22. Retrieved from http://onlinelibrary.wiley.com/wol1/doi/10.1196/annals.1402.014/full.
- Bab, I., & Zimmer, A. (2008). Cannabinoid receptors and the regulation of bone mass. British Journal of Pharmacology, 153(2), 182–188. Retrieved from http://onlinelibrary.wiley.com/doi/10.1038/sj.bjp.0707593/full.
- Bab, I., Zimmer, A., and Melamed, E. (2009). Cannabinoids and the skeleton: from marijuana to reversal of bone loss. Annals of Medicine. 41(8), 560-7. Retrieved from http://www.tandfonline.com/doi/full/10.1080/07853890903121025?needAccess=true.
- Idris, A. I., van ‘t Hof, R. J., Greig, I. R., Ridge, S. A., Baker, D., Ross, R. A., & Ralston, S. H. (2005). Regulation of bone mass, bone loss and osteoclast activity by cannabinoid receptors. Nature Medicine, 11(7), 774–779. Retrieved from https://www.nature.com/nm/journal/v11/n7/full/nm1255.html.
- Idris, A. I. (2010). Cannabinoid Receptors as Target for Treatment of Osteoporosis: A Tale of Two Therapies. Current Neuropharmacology, 8(3), 243–253. Retrieved from http://www.eurekaselect.com/72288/article.
- Idris, A.I., and Ralston, S.H. (2010, October). Cannabinoids and bone: friend or foe? Calcified Tissue International, 87(4), 285-87. Retrieved from https://link.springer.com/article/10.1007%2Fs00223-010-9378-8.
- Idris, A. I. (2012). The promise and dilemma of cannabinoid therapy: lessons from animal studies of bone disease. BoneKEy Reports, 1, 224. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3868875/.
- Idris, A.I., Sophocleous, A., Landao-Bassonga, E., Canals, M., Milligan, G., Baker, D., van’t Hof, R.J., and Ralston, S.H. (2009, August). Cannabinoid receptor type 1 protects against age-related osteoporosis by regulating osteoblast and adipocyte differentiation in marrow stromal cells. Cell Metabolism, 10(2), 139-47. Retrieved from http://www.cell.com/cell-metabolism/fulltext/S1550-4131(09)00202-2?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1550413109002022%3Fshowall%3Dtrue.
- Kogan, N.M., Melamed, E., Wasserman, E., Raphael, B., Breuer, A., Stok, K.S., Sondergaard, R., Escudero, A.V., Baraghithy, S., Attar-Namdar, M., Friedlander-Barenboim, S., Mathavan, N., Isaksson, H., Mechoulam, R., Müller, R., Bajayo, A., Gabet, Y., and Bab, I. (2015), Cannabidiol, a Major Non-Psychotropic Cannabis Constituent Enhances Fracture Healing and Stimulates Lysyl Hydroxylase Activity in Osteoblasts. Journal of Bone and Mineral Research, (30)10, 1905-1913. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/jbmr.2513/full.
- Ofek, O., Karsak, M., Leclerc, N., Fogel, M., Frenkel, B., Wright, K., Tam, J., Attar-Namdar, M., Kram, V., Shohami, E., Mechoulam, R., Zimmer, A., and Bab, I. (2006). Peripheral cannabinoid receptor, CB2, regulates bone mass. Proceedings of the National Academy of Sciences of the United States of America, 103(3), 696–701. Retrieved from http://www.pnas.org/content/103/3/696.full.
- Osteoporosis. (2014, December 13). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/osteoporosis/basics/definition/con-20019924.
- Osteoporosis Overview. (2015, June). NIH Osteoporosis and Related Bone Diseases National Resource Center. Retrieved from http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/overview.asp.
- Rossi, F., Siniscalo, D., Luongo, L., De Petrocellis, L., Bellini, G., Petrosino, S., Torella, M., Santoro, C., Nobili, B., Perrotta, S., Di Marzo, V., and Maione, S. (2009, March). The endovanilloid/endocannabinoid system in human osteoclasts: possible involvement in bone formation and resorption. Bone, 44(3), 476-94. Retrieved from http://www.thebonejournal.com/article/S8756-3282(08)00866-1/fulltext.
- Whyte, L.S., Ford, L., Ridge, S.A., Cameron, G.A., Rogers, M.J., and Ross, R.A. (2012, April). Cannabinoids and bone: endocannabinoids modulate human osteoclast function in vitro. British Journal of Pharmacology. 165(8), 2584-97. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3423262/.