From the Guidelines
Nandrolone injection is not a recommended treatment for osteoporosis due to its unfavorable risk-benefit profile and the availability of safer, more effective alternatives. While nandrolone is an anabolic steroid that can increase bone mineral density, its use is no longer supported by current medical guidelines. According to the American College of Physicians guideline update from 2017 1, the recommended treatments for osteoporosis include bisphosphonates, denosumab, teriparatide, and selective estrogen receptor modulators, which have been shown to reduce the risk of fractures. More recent guidelines, such as the 2024 evidence-based guideline for the management of osteoporosis in men 1, also recommend oral bisphosphonates, denosumab, and zoledronate as first-line treatments, with a focus on ensuring vitamin D and calcium repletion. The use of nandrolone is not mentioned in these guidelines, highlighting its lack of support as a treatment option.
Key points to consider when evaluating the use of nandrolone for osteoporosis include:
- The potential benefits of nandrolone on bone mineral density are outweighed by its significant risks, including virilization, liver toxicity, and adverse cardiovascular effects.
- Safer, more effective alternatives are available, with stronger evidence supporting their efficacy in reducing fracture risk.
- Current osteoporosis treatment guidelines prioritize calcium and vitamin D supplementation alongside first-line medications that specifically target bone metabolism without the serious side effects associated with anabolic steroids.
- The 2024 guideline 1 emphasizes the importance of a balanced diet, physical exercise, and appropriate hormone replacement therapy in the management of osteoporosis, further highlighting the shift away from anabolic steroids like nandrolone.
In clinical practice, the decision to treat osteoporosis should be based on a discussion of patient preferences, fracture risk profile, and the benefits, harms, and costs of medications, as recommended by the American College of Physicians 1. Given the availability of safer, more effective treatments, nandrolone injection should not be considered a viable option for the treatment of osteoporosis.
From the Research
Nandrolone Injection for Osteoporosis
- Nandrolone decanoate has been shown to have a beneficial effect on clinical symptoms, bone mineral density, and biochemical parameters in patients with established osteoporotic vertebral fractures 2.
- The treatment with nandrolone decanoate increases bone mineral content, reduces bone resorption, and increases bone formation rate 3.
- Nandrolone decanoate therapy has been found to increase lumbar spine bone mineral content and trabecular bone volume in post-menopausal women with osteoporosis 3.
- In men with idiopathic osteoporosis, nandrolone decanoate has been shown to transiently increase bone mass, although careful monitoring is necessary due to potential side effects 4.
- In elderly women with osteoporosis, nandrolone decanoate has been found to increase bone mineral density, reduce the incidence of new vertebral fractures, and increase lean body mass and hemoglobin levels 5.
Mechanism of Action
- Nandrolone decanoate acts as an inhibitor of bone resorption, with a temporary increase in bone formation, followed by an absence of suppression of bone formation 6.
- This results in an increase in bone mineral content, calcium balance, and muscle mass, as well as a decrease in vertebral pain and an increase in spinal mobility 6.
Therapeutic Use
- Nandrolone decanoate is indicated for the treatment of osteoporosis in women, especially those with low muscle mass, associated debilitating disease, and in patients with corticosteroid-induced osteoporosis 6.
- The recommended dose is 50 mg every 3 to 4 weeks, and it should only be prescribed after the age of 65 to 75 years to minimize the occurrence of clinical adverse effects and increase its tolerability 6.