What is the role of Cissus quadrangularis in supporting bone health and weight management?

Cissus Quadrangularis in Bone Health and Weight Management

Cissus quadrangularis shows promising evidence for supporting bone fracture healing and may have a role in weight management, but it is not part of any established clinical guidelines for osteoporosis treatment or prevention, and should be considered only as an adjunctive or alternative approach when conventional therapies are not suitable.

Role in Bone Health

Evidence for Bone Fracture Healing

• Animal studies demonstrate that Cissus quadrangularis effectively inhibits bone loss in ovariectomized mice, protecting trabecular number, thickness, and connectivity density in the distal femoral metaphysis and proximal tibia 1
• In ovariectomized rats, CQ protected bone mass and microarchitecture of trabecular bone in the distal femoral metaphysis and proximal tibial metaphysis over 3 months of treatment 2
• A pilot clinical study in maxillofacial fractures showed that patients receiving 500 mg of CQ three times daily for 6 weeks had reduced pain, swelling, and fragment mobility compared to controls, with accelerated bone healing visible by day 21 3

Proposed Mechanisms of Action

• CQ appears to modulate bone turnover by increasing serum P1NP (a bone formation marker) while decreasing Trap5b and CTX (bone resorption markers) 2
• In vitro studies show CQ increases osteocalcin expression and upregulates certain miRNAs that regulate bone turnover through BMP and Wnt signaling pathways 2
• The herb may work partly through modulation of inflammatory markers and increased estradiol levels in ovariectomized animals 2

Bioavailability Considerations

• Conventional oral tablet formulations of CQ have poor bioavailability 4
• Self-emulsifying drug delivery systems (SEDDS) show approximately 76% enhancement in bioavailability of CQ's active constituents in preclinical studies 4

Role in Weight Management

• Several human studies support the use of Cissus extracts in weight management, though the review notes these require better standardization and more well-controlled trials 5
• The specific mechanisms and optimal dosing for weight management effects remain poorly defined 5

Safety Profile

• Based on available studies, Cissus extracts appear to be exceedingly safe and free of adverse effects at commonly used doses 5
• No significant side effects were reported in the clinical fracture healing study using 500 mg three times daily for 6 weeks 3
• Animal studies showed no adverse effects with chronic administration over 3 months 2, 1

Clinical Context and Limitations

Why This Is Not Standard Care

• No guideline support: The ACR Appropriateness Criteria for osteoporosis (2022) and other major osteoporosis guidelines make no mention of Cissus quadrangularis 6
• Limited human data: Only one small pilot study (n=9 total patients) has been conducted in humans for fracture healing 3
• Lack of standardization: A wide variety of chemical constituents have been isolated from CQ extracts (steroids, flavonoids, stilbenes, iridoids, triterpenes, gallic acid derivatives), but specific physiological effects have rarely been related to identifiable constituents 5

Established Standard of Care

• DXA remains the gold standard for osteoporosis screening and diagnosis, with treatment decisions based on T-scores and FRAX calculations 6, 7, 8
• Pharmacologic treatment is recommended for postmenopausal women and men >50 years with T-scores ≤-2.5 or high FRAX scores 6
• QCT serves as a secondary imaging modality in specific situations (severe obesity, extensive spinal degeneration, extreme body heights) 6, 7

Practical Recommendations

When to Consider CQ

• As an adjunctive therapy in patients with fractures who are already receiving standard orthopedic care 3
• In patients seeking complementary approaches to bone health who understand the limited evidence base 5
• When conventional osteoporosis therapies are contraindicated or refused by the patient 2

Dosing Based on Available Evidence

• For fracture healing: 500 mg three times daily for 6 weeks was used in the clinical trial 3
• Duration of treatment for osteoporosis prevention in animal models was 3 months 2, 1

Critical Caveats

• Do not substitute for proven therapies: CQ should never replace DXA screening, calcium/vitamin D supplementation, or FDA-approved osteoporosis medications in high-risk patients 6
• Product variability: Without standardized extracts, the active constituent content may vary significantly between commercial preparations 5
• No long-term human data: Effects beyond 6 weeks in humans are unknown 3
• Unproven claims: Despite traditional use, no studies demonstrate anabolic or body-building activities 5