Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Estrogen: For newly menopausal women, estrogen replacement is one way to prevent bone loss. Estrogen can slow or stop bone loss. And if estrogen treatment begins at menopause, it can reduce the risk of hip fracture up to 50%. It may be taken orally or as a transdermal (skin) patch (for example, Vivelle, Climara, Estraderm, Esclim, Alora).
Many women past menopause also choose estrogen replacement therapy because of its proven usefulness in slowing the progression of, or preventing, osteoporosis.
Recent studies question the safety of long-term estrogen use. Women who take estrogen have an increased risk for developing certain cancers. Although it was once thought that estrogens confer a protective effect on the heart and blood vessels, recent studies have shown that estrogens cause an increase in coronary heart disease, stroke, and venous thromboembolism (blood clots). Many women who take estrogens have side effects (such as breast tenderness, weight gain, and vaginal bleeding). Estrogen's side effects can be reduced with proper dosing and combination. If you have had a hysterectomy, estrogen alone is needed. For women with an intact uterus, progestin is always part of hormone replacement therapy. Ask your doctor whether estrogen is right for you.
SERMs: For women who are unable to take estrogen or choose not to, selective estrogen receptor modulators (SERMs) such as raloxifene (Evista) offer an alternative. For example, many women who have first-degree relatives with breast cancer will not consider estrogen. The effects of raloxifene on bone and cholesterol levels are comparable to those of estrogen replacement. There appears to be no estrogen stimulation of the breasts or uterine lining, which reduces the risk profile of hormone replacement. Raloxifene may cause hot flashes. Its risk of blood clots is at least comparable to the risks with estrogen. Tamoxifen (Nolvadex), commonly used in the treatment of certain breast cancers, also inhibits bone breakdown and preserves bone mass.
Calcium: Calcium and vitamin D are needed to increase bone mass in addition to estrogen replacement therapy.
A daily intake of 1,200-1,500 mg (through diet and supplements) is recommended. Take calcium supplements in doses of less than 600 mg. Your body can only absorb so much at one time. The best way may be to take one supplement with breakfast and another with dinner.
A daily intake of 800-1,000 IU of vitamin D is needed to increase bone mass.
Bisphosphonates: Other treatments for osteoporosis are available. Bisphosphonate
medications taken by mouth include alendronate, risedronate, etidronate; intravenous
medications include bisphosphonate, zoledronate (Reclast). These drugs slow down bone loss, and in some cases,
they actually increase bone mineral density. Doctors can measure the effects of these drugs by obtaining DXAs every year or two and comparing the measurements.
When taking these drugs, it is important to stand or sit upright for 30 minutes after swallowing the medication. This helps decrease the risk of heartburn and ulcers in the esophagus. After taking bisphosphonates, you must wait 30 minutes to ingest food, beverages (except water), and other medications, including vitamins and calcium.
Before beginning to take a bisphosphonate, your doctor will determine if you have enough calcium in your blood and if your kidneys are functioning well.
Alendronate (Fosamax): This medication is used to treat osteoporosis and to prevent bone loss in women. In clinical trials, alendronate has been shown to reduce the risk of new spinal and hip fractures by 50%. Gastrointestinal problems, such as nausea, acid reflux symptoms, and constipation, are the most common side effects. You must take this medication first thing in the morning with a large glass of water and not lie down or eat for 30 minutes. Some women find this restriction difficult. This medication is taken daily or once a week.
Risedronate (Actonel): This medication is used for the treatment and prevention of osteoporosis. Gastrointestinal upset is the most common side effect. Women with severe kidney impairment should avoid this drug. Results from a recent study showed that daily risedronate use can lead to a significant reduction in new vertebral fractures (62%) and multiple new vertebral fractures (90%) in postmenopausal women with osteoporosis, compared with a similar group who did not take this medication.
Etidronate (Didronel): This drug has been approved by the U.S. FDA
for the treatment of Paget disease, another bone condition. Doctors have been using this drug successfully in clinical trials to treat women with osteoporosis.
Ibandronate (Boniva): This drug is the most recently FDA-approved bisphosphonate and is used to prevent or treat osteoporosis in postmenopausal women.
Zoledronate (Reclast): This is a powerful intravenous bisphosphonate that is given once a year. This can be especially beneficial for patients who cannot tolerate oral bisphosphonates or are having difficulty with complying with the required regular dosing of oral medications.
Other hormones: These hormones help regulate calcium and/or phosphate levels in the body and prevent bone loss.
Calcitonin (Miacalcin): Calcitonin is a hormone (extracted from salmon) that slows bone loss and may increase bone density. You may be given this drug as an injection (every other day or
two to three times a week) or as a nasal spray.
Teriparatide (Forteo): Teriparatide contains a portion of human parathyroid hormone. It primarily regulates calcium and phosphate metabolism in bones, which promotes new bone formation and leads to increased bone density. This drug is given as a daily injection.
