Isoflavones and bone: animal and human evidence of efficacy

Previous reports of soy extracts and isoflavone-enriched preparations studied in animals and humans have found that these molecules, when given at appropriate doses, have positive effects on the skeleton, including improvements in bone mineral content (BMC) and bone mineral density (BMD). A reduction in fracture risk of human subjects has not yet been shown in a prospective trial. Isoflavones, which exist in significant amounts only in soybeans, exert estrogen-like effects in human bone cells because of their unique organic structures that are similar to that of estradiol. The discovery of the b isoform of the estrogen receptor (ER) suggests that the molecular regulation of bone remodeling by estrogens, or estrogen-like molecules, including isoflavones, is more complex than previously thought. Depending on the type of ER present in a particular tissue, isoflavones may act as weak estrogen agonists or as weak estrogen antagonists. For example, isoflavones act as weak estrogen agonists in osteoblasts, but in reproductive cells, such as in the breast and uterus, they behave as weak estrogen antagonists. Weak agonistic effects of the isoflavones include stimulation of osteoblast proliferation and differentiation and increasing the production of cytokines that may inhibit osteclastic activity. The selective beneficial effects of estrogen-like molecules in bone tissues, compared to the anti-estrogenic effects in cells of reproductive tissues, make isoflavones attractive for the promotion of bone health. Relatively greater values of BMC and BMD of Asian populations with high consumption of soy isoflavones throughout life, compared to those with lower intakes, indirectly support the skeletal benefits of this pattern of intake of these estrogen-like molecules.