A Novel Use for Nitroglycerin: Osteopenia and Osteoporosis Treatment!
“Nitroglycerin applied topically increases bone formation and reduces bone resorption in women with osteopenia, and it might prove to be an effective and inexpensive agent to prevent osteoporosis, according to the results of a 2-year randomized controlled trial presented here at the American Society for Bone and Mineral Research 2010 Annual Meeting. ”
“Our data have demonstrated that nitroglycerin uncouples bone turnover,” said Sophie Jamal, MD, director of the Osteoporosis Clinic at Women’s College Hospital, University of Toronto, in Ontario. “We saw an increase in bone formation and a decrease in bone resorption, as well as evidence that nitroglycerin improves bone mineral density [BMD], bone geometry, and bone strength. ”
The study done on this drug included 126 women on 15 mg of nitroglycerin ointment per day, administered at bed time instead of the usual every 6-8 hours for angina patients.
“Compared with the women in the placebo group, those in the nitroglycerin group had significant increases in BMD at the lumbar spine (6.7%), femoral neck (7.0%), and total hip (6.2%) at 24 months (P < .001 for all measures). ”
“The group that got the nitroglycerin had huge improvements in bone geometry, density, and strength, so I’m pretty excited,” Dr. Jamal said. “The other thing about nitrates is that they’ve been around for a long time, there are lots of generic forms, they’re cheap, and they’re widely available. ”
The main side effect seen, in this study, was headaches, which prompted 7 women to withdraw from the study.
This drug has not been approved yet for this use, but I’m very interested to see what the outcome will be with fracture prevention in moving forward to FDA approval.
Since this drug has been on the market, for a very long time, we know what the long term side effects are, which is something we can’t say about most of the osteoporosis medications currently being used. This drug has a long track record with minimal side effects. Nitroglycerine is also very inexpensive, easy to use in either gel, tablets or cream application, it does not have the diet and postural restrictions the oral bisphosphonates (BP) have, and none of the worrisome side effects now being seen with BPs, like osteonecrosis of the jaw (ONJ), atrial fibrillation, femur fractures, gastrointestinal side effects or possible esophageal cancers, and the bone and joint pain reported by some taking these medications. Bisphosphonates include Actonel, Reclast (IV) Boniva (IV and oral), and Fosamax for the treatment of post-menopausal osteoporosis.
Since off-label uses of drugs are considered before approval by the FDA, it’s possible that some doctors very knowledgeable in its use, may wish to prescribe it before the FDA approves this particular treatment.
We are always looking for drugs with long term side effect data, so we’ll know the relative risk of what we might consider to take. However, with nitroglycerine, we already know the long term effects, which are listed below.
Nitroglycerin Side Effects:
- Severe low blood pressure with accompanying dizziness and lightheadedness
- Flushed skin
- Heavy sweating
- Worsening angina (chest pain) 
Precautions for Nitroglycerin:
- Allergy to any of its ingredients
- Notify physician of recent head injury
- Low blood pressure
- Limit alcohol intake
- Recent heart attack
- Nitroglycerin may interfere with laboratory tests for cholesterol 
- Erectile dysfunction drugs ( sildenafil, tadalafil and vardenafil)
- Rosidlitazone (used for type 2 diabetes)
- Migraine drugs (ergotamine)
- Blood pressure lowering drugs including (alpha blockers: tamsulosin) 
Other drugs that interact with nitroglycerin from Drugs.com.
This is not a complete list of side effects, precautions or drug interactions, so be sure to check with your physician before considering the use of this drug, and keep in mind it has not been approved for this use yet.
The next step in this evaluation of nitroglycerin for osteoporosis and osteopenia will be fracture studies to see if this application can prevent the occurrences of broken bones.
As soon as there is more information on this we’ll keep you informed on its progress for the treatment/prevention of osteoporosis.
Medscape Medical News Topical Nitroglycerin Builds Bone October 21, 2010 Fran Lowery. http://www.medscape.com/viewarticle/730943
American Society for Bone and Mineral Research (ASBMR) 2010 Annual Meeting
WebMD, Side Effects, Precautions and Drug Interactions for Nitroglycerin, Retrieved February 14, 2011.
Nitroglycerin Drug Interaction from Drugs.com
Pam wrote for HealthCentral as a patient expert for Osteoporosis.