TUESDAY, Feb. 22 (HealthDay News) -- Nitroglycerin ointment,
usually prescribed to relieve chest pain, may also counter bone
loss, a new study suggests.
As the population ages, the number of women with osteoporosis is
increasing. Nitroglycerin appears to increase bone density and
prevent bone loss, and it may have advantages over newer and more
costly drugs, the researchers noted.
"Nitrates are widely available and inexpensive," said lead researcher Dr. Sophie A. Jamal, an assistant professor of medicine at Women's College Research Institute and University of Toronto. "Our study demonstrates that nitrates are able to increase bone size and strength, which may reduce the incidence of fractures worldwide."
However, whether or not this treatment actually reduces
fractures is unknown. "These are promising early findings. Further,
larger studies need to be done to confirm our findings and to
determine if nitrates can reduce fractures," Jamal said.
The treatment seems to work by producing nitric oxide, which may
aid in stimulating bone growth, the researchers noted. The report
is published in the Feb. 23 issue of the
Journal of the American Medical Association.
For the study, Jamal's team randomly assigned 243 postmenopausal
women to nightly doses of nitroglycerin ointment or placebo. The
ointment was spread on a one-inch strip on the upper arm.
To test the effectiveness of the treatment, the researchers
measured bone density at the spine, thigh and hip. The trial ran
for two years.
Compared with women receiving a placebo, women who received
nitroglycerin ointment had a 6.7 percent increase in bone density
in the spine, a 6.2 percent increase in the hip and a 7 percent
increase at the top of the thigh bone, the researchers found.
The most common side effect of the nitroglycerin ointment was
headache. Among those receiving the ointment, 35 percent reported
headaches, compared with 5.4 percent among women receiving placebo,
the report indicated.
Dr. Sundeep Khosla, a professor of medicine at the Mayo Clinic
and author of an accompanying journal editorial, said that "while
there are a number of drugs available to prevent or treat
osteoporosis, most work to prevent further breakdown of bone,
rather than build new bone."
However, nitroglycerin can actually stimulate the formation of
new bone, he added. "Here's a drug that's been in use for decades
to treat chest pain due to angina, that prevents bone loss and
increases bone mass," he said.
Khosla thinks these findings are promising, but a large-scale
study looking at whether the treatment prevents fractures is needed
before nitroglycerin ointment can be recommended as a standard
"There are a lot of steps between what this study has shown before patients should ask for it or doctors should prescribe it specifically for osteoporosis," he said.
The study was funded by the Canadian Institute of Health
Research and the Physicians' Services Incorporated.
Nitroglycerin ointment is fairly inexpensive and depends on how
much one buys. For example, 30 grams of nitroglycerin ointment
costs about $30 and that's good for about 2,000 applications at the
dose used in the study.
Another report in the same journal found that older women taking
drugs called bisphosphonates, such as Fosamax or Boniva, to prevent
bone loss were at risk for rare fractures of their thigh bone.
This finding has been shown before and caused the U.S. Food and
Drug Administration to start monitoring these rare fractures.
The risk appeared highest among women taking the drugs for five
years or more. However, the absolute risk is very small and these
drugs do prevent more common types of fractures, according to study
author Dr. Laura Y. Park-Wyllie, of the Li Ka Shing Knowledge
Institute of St. Michael's Hospital in Toronto.
"These findings also highlight the need for a thoughtful assessment of individual risk of fracture when considering extended bisphosphonate therapy, and that long-term use of these drugs may warrant reconsideration, especially in patients at relatively low risk of fracture. It may be appropriate to consider a drug holiday for selected patients, particularly as the cumulative duration of bisphosphonate therapy surpasses five years," Park-Wyllie and colleagues wrote.
However, they added that their study "confirms the known
benefits of bisphosphonate treatment for typical osteoporotic
fracture, and evidence suggests that bisphosphonate therapies are
underused in individuals at high risk of fracture despite their
For more information on osteoporosis, visit the
U.S. National Library of Medicine.