Both research and clinical practice suggest the benefits of cannabis and cannabinoids in treating a long list of diseases. The focus of this article will be on their potential to prevent and treat bone fractures or diseases such as osteoporosis and osteoarthritis: an area of clinical practice in which recent research offers promising results.
Phytocannabinoids have been under close scientific scrutiny for the last two decades for their therapeutic potential. One such scientific enquiry has been regarding the role that phytocannabinoids play in bone health, fracture, and repair. In addition to speeding up the recovery from bone fractures, at least in rats, researchers have found that CBD makes bones even stronger than they were before the fracture.
Data has long indicated that there is a connection between cannabinoids and bone health. What has not yet been fully elucidated is the exact and precise role that endocannabinoids, the cannabinoids produced by our own body, play a role in bone development.
What seems possible, is that the endocannabinoid system plays an important role in maintaining bone health. It may fulfill an important task in its development, preservation, and strengthening by enabling a process known as bone metabolism or bone remodelling. The endocannabinoid system is also expressed throughout the immune system, which is known to have frequent interactions with the skeletal system.
Our bones and their tough life
Over the course of our lives, a highly regulated process of bone remodelling takes place. Old bone material is constantly replaced with new material, ensuring that bones remain healthy and strong. This process also plays an essential role in the release and regulation of certain nutrients into the bloodstream. Interestingly, an adult’s body replaces around 10% of its bone structure every year.
In addition to age-related changes in the skeletal system, we may experience other types of bone problems, such as a bone fracture or fissure caused by injury, and osteoporosis, which we will discuss later in this article.
The following is a review of some of the most relevant and interesting scientific literature from recent years. The research helps to better understand how cannabinoids affect bone health, and how cannabis can help in the prevention and treatment of bone injuries and diseases.
How can cannabis help bone fractures?
The way the body responds to a bone fracture is very similar to the way it responds to soft tissue injuries, at least in the initial phase. In the event of a fractured or broken bone, there is a discontinuity between its two ends. In the initial phase of bone healing, a hematoma is formed to coagulate in between and around the ends of the fracture or break.
In the second healing phase of a fracture, the “fibrous corn” is formed. This is the first regenerative response of the bone and also the moment where the first bond between its broken ends is formed. In the third phase, the hard corn or bone callus is formed, providing stability to the fracture. In the fourth phase or remodelling phase, the bone returns to its natural shape.
In 2015, a very influential and popular study, within and outside the cannabis sector, was published by the Tel Aviv University and the Hebrew University of Jerusalem. The data obtained by the researchers showed that cannabis’s main non-psychoactive cannabinoid, CBD, can help fractured bones recover quicker.
The research team used two groups of mice that had suffered the same femoral fracture. One group was injected with a CBD-based mixture, while the other group received a combination of CBD and THC, the main psychoactive compound in cannabis. Eight weeks later, the results surprised the researchers.
Rodents that had only been injected with CBD not only healed faster, but the fractured bone also became 35-50% stronger. However, in the group of mice that received a combination of CBD and THC, no impact in terms of accelerating the rodents’ own healing mechanisms was observed.
It has long been established that our skeleton contains cannabinoid receptors that react to the cannabinoids contained in the cannabis plant and that they can help regulate and activate bone formation. Moreover, in this specific case, they were also shown to help strengthen the bond between broken bones.
As Dr. YankelGabet, an Israeli researcher, put it, “our organism is equipped with a cannabinoid system, which regulates vital and non-vital systems. We respond to cannabis because we are made up of receptors that can be activated by cannabis plant compounds.”
The skeletal endocannabinoid system
Since the first research papers on the skeletal endocannabinoid system were published around 2005, there has been increasing scientific interest in the role of cannabinoids in the regulation of bone mass and remodelling. A scientific review, in which Gabet is also involved, describes that to date, more than 1,000 basic, translational and clinical research articles have been published on the subject.
The review focuses on the role of the endocannabinoid system in skeletal biology through the cannabinoid receptors CB1 and CB2. Since endocannabinoids play an important role in bone formation, reabsorption and growth, possible therapeutic approaches targeting the endocannabinoid system and its relation to skeletal disorders were analyzed.
In a study published in the British Journal of Pharmacology in 2011, it was shown that fatty acid amides (AAG or FAA) help regulate the process of bone metabolism through interaction with cannabinoid receptors. In the skeleton, FAAs activate both the CB1 receptor in the sympathetic nerve terminals and the CB2 receptor.
According to the study, thanks to CBD, “inhibition of fatty acid amide hydrolase (FAAH), the degrading enzyme of FAAs, may be a useful therapeutic strategy to treat osteoporosis and perhaps other skeletal deficiencies”. This conclusion was drawn because CBD is a known inhibitor of the FAAH enzyme. The paper also calls for more studies focusing on the entire profile of these lipids and their receptors in bone tissue to elucidate their function and mode of action.
How can cannabis help patients with bone disease?
Bones are an integral part of the anatomy of the human body’s skeletal system. While some bones are hard and compact, others are light and porous. Bones and cartilage, that is, fibrous connective tissue, constitute the internal hard framework of the body.
For good bone health, bones need to have enough minerals, such as calcium and phosphorus, and a protein known as collagen. Otherwise, bone disease may develop. In addition, bone disorders may have a genetic origin, or they may develop degenerately over time.
Ailments such as osteoporosis or osteoarthritis, which is more prevalent in the aging population, cause the patient a great deal of inflammation and potential for pain. They may also weaken the bones making them prone to fracture; hip fractures being the most frequent.
Recent research has implied that there may be a role for cannabinoids in the treatment of osteoporosis and osteoarthritis. Let’s see how cannabis can help patients suffering from these conditions.
Osteoporosis treatment and cannabis: How can CBD help?
Osteoporosis is a progressive disease that causes bones to become brittle because of either ageing or lack of adequate nutrients. It is characterized by a loss of bone mass at a faster rate than bone deposition. This balance generally remains stable during youth, and it is somewhat controversial as to whether osteoporosis is a pathology or simply a part of aging. It tends to be more frequent in women, especially after the age of 60.
Non-psychoactive cannabinoids such as CBD and CBG are currently being researched for how they may help bone diseases such as osteoporosis. In fact, the famous British company GW Pharmaceuticals has patented a cannabis-derived drug containing CBG as a possible osteoporosis treatment.
As mentioned above, over the last few decades, CB1 and CB2 receptors have been proven to play an important role in bone health. For example, blockage of the CB2 receptor is reported to protect from bone loss in mice. The same mechanism may also promote cell death of osteoclasts, which are the cells responsible for breaking down bone tissue.
Since CBD has shown great potency as an antagonist of CB2 receptor agonists, it may act as an inhibitor to bone loss. Although it does not directly block the CB2 receptor, it can inhibit the kinds of ligands that do activate the CB2 receptor.
This literature review also highlights the potential of pharmacological inactivation of the CB2 receptor as a potential target for osteoporosis treatment. The authors argue in favour of exploiting cannabinoid receptors as a novel treatment for this bone disease.
The cannabinoid receptor CB1 activity has also been shown to protect against the development of age-related osteoporosis. The study found that rodents lacking CB1 receptors developed thicker bones, although they remained osteoporotic. Researchers concluded that the CB1 receptor regulates peak bone mass through an effect on osteoclast activity.
The paper argued that the CB1 receptor regulates the amount of mature bone material that is disintegrated and reused in the body. In addition, the CB1 receptor controls the amount of fat that accumulates inside the bone, along with the formation of new bone cells.
Another study, conducted by the Hebrew University of Jerusalem, examined the involvement of cannabinoids in reversing bone loss. The results confirmed the existence of a connection between CB2 receptors and bone density in mice with mutated CB2 receptors, which had lower bone density than non-mutated ones.
It appears that the main physiological role of CB2 receptors, the authors reported, relates to maintaining balanced bone remodelling, thus protecting the skeleton against age-related bone loss. In fact, the study also found that alterations in the CNR2 gene, responsible for encoding CB2 receptors, can cause postmenopausal osteoporosis.
All these results show that cannabis, cannabinoids and the endocannabinoid system are a promising therapeutic goal when treating bone diseases, especially age-related ones such as osteoporosis in menopausal women.
Using Cannabis to Treat Osteoarthritis: How does Cannabis Help Reduce Symptoms?
Arthrosis, also called osteoarthritis, is among the most common forms of chronic rheumatic disease. In brief, it is a chronic, degenerative disease caused by the wear and tear of cartilage, the tissue that cushions and protects the bone ends and facilitates joint movement.
When the cartilage surface is broken and worn, progressively and gradually, the most common symptoms are pain and stiffness in the affected joints. Although osteoarthritis can affect any joint, it most often affects the knees, hips, and small joints in the hands and at the base of the big toe, the “bunion joint”.
For thousands of years, cannabis has been used to help treat the symptoms of a multitude of medical conditions, including chronic pain. Anecdotal reports and patient data indicate that medical cannabis is often used to control arthritis pain. Moreover, the evidence supporting the analgesic potential of cannabinoids to treat arthritis pain is growing.
The review in question, published last year, summarizes the components of the endocannabinoid system (ECS) and provides details of the latest research related to the use of cannabinoids in the treatment of arthritic pain. In addition, “there is recent preclinical evidence supporting the role of ECS in controlling osteoarthritis pain, as well as current clinical evidence of the efficacy of cannabinoids in the treatment of osteoarthritis pain in mixed patient populations”.
Findings from another recent study showed that topical administration of CBD may have long-lasting beneficial and therapeutic effects for the relief of pain and inflammation, without psychoactive side effects. Thus, topical use of CBD has potential as an effective treatment of arthritic symptomatology and is a good candidate for developing improved therapies for these debilitating diseases.
Almost two decades ago, the effects of CBD on osteoarthritis were studied in collagen-induced arthritis rodents. When the symptoms began to appear, they were given an oral treatment based on pure CBD, which literally stopped the progression of osteoarthritis in their bodies.
Another interesting study published almost a decade ago discusses how cannabinoids may help in tissue engineering, here for cartilage. The study suggests that cannabinoids prolong the life of mesenchymal stem cells or MSCs, which can be used to create new cartilage, making cannabinoids a very important option for future treatments of osteoarthritis.
In a more recent study on human cartilage and cannabinoids, in vitro cartilage samples containing arthrosis-related proteins were treated for the first time with the synthetic cannabinoid WIN-55. A new mechanism was discovered whereby cannabinoids can help prevent cartilage wear in osteoarthritis by deactivating arthrosis-related enzyme proteins and slowing the disease.
And, as a final example of what recent research has brought to light, another relevant study examines the role of the endocannabinoid system in the emotional and cognitive alterations associated with arthritic pain. The results confirmed that the endocannabinoid system plays a fundamental role in osteoarthritis and represents both a pharmacological target and a biomarker of this disease.
Science has stopped questioning the clinical potential of cannabinoids
There is no doubt that further research is needed to accurately determine the efficacy and safety of cannabinoids in the treatment of rheumatic diseases such as osteoarthritis. The lack of in vivo human studies also demonstrates a lack of understanding in the role of the ECS in certain pathologies such as osteoporosis.
However, scientists no longer question the clinical potential of cannabinoids, nor their potential benefits in the treatment of a multitude of diseases and disorders. Rather, they insist that further research is needed to develop appropriate therapies in the field of bone injuries and disease, and many believe that human clinical trials are the next logical step.
Today there is growing evidence to show that the active compounds in cannabis might help prevent bone fragility and preserve bone health. They also may help broken bones heal faster, as well as treat pain and inflammation caused by bone fractures or disease. Hopefully, international cannabis regulations will soon allow science to take the next logical and necessary step.
Are you one of the many people who suffer, or have suffered, a bone injury, fracture or disease? Have you ever used medicinal cannabis or any other cannabis byproduct, such as CBD oils or creams, to help you treat the symptoms of bone ailments? Tell us in the comments!
- Disclaimer:This article is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with your doctor or other licensed medical professional. Do not delay seeking medical advice or disregard medical advice due to something you have read on this website.