Supplements for Bone Health

A prescription anabolic bone-building drug — the recombinant N-terminal fragment of human parathyroid hormone, PTH(1-34), sold as Forteo. Honest appraisal: this is one of the few peptides on this site with genuinely strong evidence. The pivotal 1637-woman NEJM trial (Neer 2001) cut new vertebral fractures by about two-thirds and nonvertebral fragility fractures by about half, and the head-to-head VERO trial beat risedronate for new vertebral fractures. It is NOT a supplement: it is an FDA-approved, daily subcutaneous injection reserved for osteoporosis patients at high fracture risk. It carried a boxed warning for osteosarcoma (based on rats) and a 2-year lifetime-use limit; the FDA REMOVED both in 2020-2021 after long-term human surveillance found no increased osteosarcoma risk.

A prescription anabolic (bone-building) osteoporosis drug — the medicine Tymlos — a synthetic analog of parathyroid-hormone-related peptide PTHrP(1-34), FDA-approved in 2017 for postmenopausal women at high fracture risk and later for men. Honest appraisal: unlike most peptides sold online, this one has a REAL pivotal phase-3 fracture RCT (ACTIVE) plus a sequential-therapy extension (ACTIVExtend) and several network meta-analyses — strong evidence for its narrow osteoporosis indication, with a slightly smaller trial base than its older sibling teriparatide. It is a daily subcutaneous injectable prescription drug, not a dietary supplement. It raises bone density and cuts vertebral and nonvertebral fracture risk, but it carries a HISTORICAL rat-based osteosarcoma signal (the boxed warning and 2-year cumulative-use limit were REMOVED by the FDA in 2020-2021), causes hypercalcemia (less than teriparatide) and orthostatic dizziness, and must be obtained and supervised by a prescriber.

A second-generation selective estrogen receptor modulator (SERM) approved for postmenopausal osteoporosis and for reducing the risk of invasive breast cancer in high-risk and osteoporotic postmenopausal women. In the pivotal MORE trial it cut vertebral-fracture risk and reduced invasive (largely ER-positive) breast cancer by ~70%; CORE extended the breast-cancer benefit to 8 years, and the STAR trial showed it roughly matched tamoxifen for invasive-breast-cancer prevention with less uterine cancer. It is used OFF-LABEL by some men for gynecomastia (a small pediatric series found it shrank pubertal breast tissue). The honest limits are non-negotiable: the RUTH trial found NO reduction in coronary events but a significant increase in FATAL STROKE and venous thromboembolism, raloxifene does NOT reduce hip or non-vertebral fractures, and it commonly causes hot flushes and leg cramps. It is NOT a supplement and NOT a longevity drug.

A once-yearly intravenous bisphosphonate for osteoporosis that drew geroscience attention because, in a major fracture trial, it reduced not just fractures but all-cause MORTALITY — a benefit larger than bone effects alone explain. Emerging work suggests immune-modulating and possibly senescence-related effects. The mortality signal is real but not fully understood; human longevity is unproven. A prescription drug, not a supplement.

The primary male androgen and an FDA-approved prescription drug for diagnosed male hypogonadism — and a Schedule III CONTROLLED SUBSTANCE. For men with genuinely low testosterone, randomized trials show real benefits: the Testosterone Trials (TTrials) improved sexual function, mood, anemia and bone density in older hypogonadal men, and the large TRAVERSE trial found TRT non-inferior to placebo for major cardiac events. But those benefits were modest and indication-specific, NOT a longevity or anti-aging result. It is prescription-only; non-medical, supraphysiologic, and 'anti-aging' use is illegal and carries serious harms — erythrocytosis, suppressed sperm production/fertility, cardiovascular and psychiatric risk. This is a harm-reduction reference, not a recommendation, and testosterone is NOT a dietary supplement.