How Shilajit's Hip Bone Gains Compare to the Leading Osteoporosis Drugs

What does "femoral neck" mean, and why is it the fair comparison point?

The femoral neck is the narrow part of the thighbone just below the ball-and-socket hip joint. It is one of two sites, along with the lumbar spine, that a DXA scan measures to diagnose osteoporosis, and it is the site every major trial discussed here reported a number for.

That matters for a simple reason. A cross-trial comparison is only honest when every trial measured the same thing, the same way. Bone mineral density by DXA at the femoral neck is that common unit. One limit comes before any number does. Each trial still ran on its own timeline, with its own comparison group.

What this comparison is, and is not

Four quick ground rules, before any number appears.

• It compares each drug's own trial result to its own no-treatment or placebo group, never one trial's patients directly against another trial's patients
• It uses each trial's own published percent-change-from-baseline figures, read from the papers themselves
• It is not a head-to-head trial. No study has ever put shilajit and Fosamax, Prolia, or Evenity in the same room
• It covers one site, the femoral neck. The spine tells a different story, covered further down

How did shilajit's 48-week trial measure up at the hip?

The shilajit data comes from a 2022 trial published by Pingali and colleagues in the journal Phytomedicine. See the full trial breakdown. It enrolled 60 postmenopausal women, randomized to placebo, 250 mg, or 500 mg of shilajit daily for 48 weeks. At baseline, the women's average femoral neck T-score was -2.5, which the paper's own results section labels osteoporosis, not the milder osteopenia its title mentions.

At the 500 mg dose, femoral neck bone density rose about 4.8% from baseline by week 48. The placebo group's femoral neck density fell about 2.6% over that same stretch, still losing bone the way untreated postmenopausal women typically do. The gap between those two numbers, roughly 7.4 percentage points, is the figure being compared below.

Here is how the three drug trials compare, using each one's own published numbers.

Read plainly, that is the entire claim. At the femoral neck, shilajit's 48-week gap was the largest of the four, and it got there in less time than any of the three drugs needed for theirs.

Why does the spine tell a completely different story?

The hip is not the only site these trials measured, and the spine result runs the other way entirely. This is the part a selective reading would leave out, and it should not be left out.

At the lumbar spine, shilajit's 500 mg group gained about 3.8% from baseline by week 48, against a placebo group that fell about 4.4%, for a gap of roughly 8.2 points. That sounds competitive on its own. It is not, once the drugs are added back in.

Here is the same comparison, run at the spine instead of the hip.

The spine numbers, stated the same honest way

1. Fosamax's 3-year spine gap was 8.8 points, ahead of shilajit's 8.2
2. Prolia's 3-year spine gap was also 8.8 points, also ahead
3. Evenity's 12-month spine gap was 12.7 points, well ahead
4. Shilajit's 48-week spine gap was about 8.2 points, behind all three

So the "pulled furthest ahead" claim is scoped on purpose. It is a hip-only statement. Anyone repeating it as an unscoped "shilajit beats every osteoporosis drug" claim would be saying something the data does not say, at the one site that matters most for hip fracture risk in particular.

What was different about how each group of women got there?

A trial's result is never just the drug or the compound being tested. It is the drug plus everything else the protocol allowed. Here is what each group actually took on top of the study treatment.

• In the Fosamax trial, every woman, in every group including placebo, received 500 mg of calcium daily throughout the study
• In the Prolia trial (the FREEDOM study), every woman received at least 1,000 mg of calcium and 400 IU of vitamin D daily
• The Evenity trial's published registry results do not confirm a calcium background, so none is assumed here
• In the Pingali shilajit trial, women were specifically not allowed to take calcium or vitamin D supplements during the study

That last point cuts two ways. It means shilajit's hip gain happened without the mineral support the bisphosphonate and denosumab trials built in, which is a point in its favor. It also means this is not drug-versus-drug under identical conditions. It is drug-versus-drug under each protocol's own design.

Does a bigger gap mean shilajit built more bone than Evenity?

Not at the hip, and this is the distinction that matters most to get right. "Pulled furthest ahead" measures the gap against each trial's own comparison group. It does not measure the raw size of the gain a woman's own body made from where she started.

Those are different numbers. Evenity's own femoral neck gain from baseline was 5.5%. Shilajit's own femoral neck gain from baseline was about 4.8%. By that measure, from her own starting point, Evenity's group gained more bone than shilajit's group did. What flips the comparison is that Evenity's placebo group barely moved (about 0.3%), so Evenity's gap over its own comparison is smaller than shilajit's gap over a placebo group that was actively losing bone.

Both numbers are real, and they answer different questions. One asks how far ahead of doing nothing a trial's treatment pulled. The other asks how much bone a woman actually gained. A comparison built on the first number should never be read as proof of the second.

What does this comparison not prove?

The honest ceiling on all of this needs stating before the FAQ. None of what is above means the osteoporosis drugs failed, that they are the wrong choice for a given woman, or that shilajit should replace a prescribed treatment. These are four separate trials, run years apart, in different patient populations, measuring a surrogate marker, bone density, rather than fractures directly in every case.

What it does show is specific and real. At one measured site, using each trial's own published numbers, shilajit's 48-week gap was the largest of the four. That is a genuine research finding worth knowing, read exactly as far as it goes and no further. For the wider body of bone research behind it, see the shilajit bone research hub.

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Optimum Shilajit is sourced from the Altai mountains and standardized to the formula used in the Pingali trial. See Optimum Shilajit.

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