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Therapy Profiles: Osteoporosis

By Northern Green Canada

How Medical Cannabis can be used to treat bone loss

Osteoporosis is a common bone mineralization disorder commonly due to an inadequate bone mass acquisition or bone loss. Often seen in premenopausal and postmenopausal women, osteoporosis is characterized by low bone mass, micro-architectural disruption, and skeletal fragility. This results in decreased bone strength and increased risk of bone fractures.

Osteoporosis is a disease that makes the bones so weak that a functional fracture is possible from even a minor fall. Osteoporosis alone has no apparent clinical manifestation until a fracture occurs or there is a clinical diagnosis by measuring an individual’s Bone-Mineral Density (BMD). Postmenopausal women are particularly predisposed to osteoporosis, and in prospective studies, it has been shown that bone loss begins before menopause.

However, osteoporosis is also not uniquely specific to menopause. Secondary causes of osteoporosis in premenopausal women include: anorexia nervosa, gastrointestinal issues (celiac disease, postoperative states), Vitamin D and/or calcium deficiency, hyperthyroidism, hyperparathyroidism, Cushing’s syndrome, Hypogonadism, hypercalciuria, rheumatoid arthritis/inflammatory conditions, alcoholism, renal disease, liver disease, genetic disorders, homocystinuria, hereditary hemochromatosis, thalassemia major, HIV infection/medications, diabetes (Carolyn Becker, MD and Adi Cohen, MD).

Recent studies have demonstrated the potential in using cannabinoids to reverse bone loss and the potential application in women suffering from osteoporosis. The active compound found in marihuana is cannabinoids, specifically Delta-9-Tetrahydrocannabinol. Cannabinoids bind to receptors in the body called CB1 and CB2. CB1 receptors expression has been identified on skeletal sympathetic nerve terminals known to regulate bone formation and reabsorption, depending on its tonic stimulation. CB2 receptors are also expressed in osteoblasts and osteoclasts, known to stimulate bone formation and inhibit bone resorption.

These receptors, when activated, are involved. Osteoblasts and osteoclasts produce endocannabinoids which work on CB2 receptors and studies have shown in CB2-deficient mice markedly accelerated age-related bone loss. As such, the active compounds like cannabinoids that act on CB2 receptors through an agonistic effect is a promising novel target for anti-osteoporotic therapy.

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