Treatment of Osteoporosis

Facts on the Treatment of Osteoporosis

Osteoporosis (porous bone) is a disease whereby bones become weak and, therefore, are more likely to break. Without prevention or treatment, osteoporosis can progress without pain or symptoms until a bone breaks (fractures). Fractures commonly occur at the hip, spine, and wrist.

Osteoporosis is not just an "old woman's disease." Although it is more common in white or Asian women older than 50 years of age, osteoporosis can occur at any age. Osteoporosis can affect men, particularly after the age of 65. Building strong bones and reaching peak bone density (maximum strength and solidness) before the age of 30 can be the best defense against developing osteoporosis. Also, a healthy lifestyle can keep bones strong, especially for people older than 30 years of age.

While treatments are available for osteoporosis, currently, no cure exists. Treatment of osteoporosis involves several aspects, including proper screening and diagnosis, medication, nutrition, exercise, and lifestyle changes.

What Tests Do Health-Care Professionals Use for Osteoporosis Screening and Diagnosis?

The Importance of Early Diagnosis

Early detection of low bone mass (osteopenia) or osteoporosis is the most important step for treatment to be effective. If osteopenia or osteoporosis is diagnosed, a person can take action to stop the progression of bone loss. Knowing the risk factors for osteoporosis in order to begin effective prevention or treatment is important.

Certain factors, such as female sex, family history of osteoporosis, small body size, and an inactive lifestyle, are associated with an increased risk of developing osteoporosis. Take the one-minute osteoporosis risk test from the International Osteoporosis Foundation to find out more. If any of these risk factors or other signs of osteoporosis exist, the doctor may recommend measuring bone mass. Because the most common sites of fractures due to osteoporosis are the spine, wrist, and/or hip, bone mineral density (BMD) tests often measure the solidness and mass of bone (bone density) at those sites, as well as in the heel or hand. Bone mineral density tests are performed like X-rays. They are painless, noninvasive, and safe.

Bone mineral density test results are helpful to do the following:

  • Detect low bone density (osteopenia), which can predict the chance of developing a fracture
  • Confirm a diagnosis of osteoporosis
  • Determine the rate of bone loss and monitor the effects of treatment (tests done to monitor treatment are usually conducted every two years or so)

Methods of Diagnosis

Several tests are available to assess bone density. These tests are not painful, and they are noninvasive (meaning that they do not involve surgery). The most common types of tests are listed below:

  • Dual energy X-ray absorptiometry (DXA or DEXA) scanning is a special low radiation X-ray that can detect even very small amounts of bone loss. DXA scans are the most commonly used method of bone mineral density measurement. They often are used to measure spine and hip bone densities. Two other types of scans are the following:
    • Peripheral dual energy X-ray absorptiometry (pDXA) measures the bone density in the forearm, finger, and heel.
    • Single-energy X-ray absorptiometry (SXA) measures the bone density in the heel.
  • Quantitative computed tomography (QCT) scanning measures the bones of the lower spine, which change as a person ages. The peripheral QCT scan can measure the forearm bone density.
  • Quantitative ultrasound (QUS) uses sound waves to measure bone density at the heel, shin, and finger.

What Medications Treat Osteoporosis?

Medications are available to treat bone loss in those diagnosed with osteoporosis or osteopenia. A goal of treatment is to prevent the development of osteoporosis (if decreased bone mass or other risk factors exist) and to prevent further bone loss (especially if osteoporosis has already been diagnosed). Preserving or increasing bone mass and density decreases the risk of broken bones (osteoporotic fractures) and disability. Many treatments available today have been shown to work quickly (within one year), and they may reduce the risk of fracture by up to 50%. The choice of treatment should fit a person's specific medical needs and lifestyle. A doctor can help determine what treatment choice will work.

There are two main types of drugs: antiresorptive drugs that slow the progression of bone loss and bone-building agents that help increase bone mass. Antiresorptive drugs are already widely available. Bone-building drugs are being developed by researchers and are just becoming available.

Antiresorptive Drugs
Drug TypeActionDrugs
BisphosphonatesInhibit the body from breaking down bone (a process called resorption)

Act directly on the bone structure, reducing the rate of bone loss
Alendronate (Fosamax)

Risedronate (Actonel)

Ibandronate (Boniva)

Zoledronate (Reclast annual infusion)
Selective estrogen receptor modulators (called SERMS or estrogen analogs)Mimic estrogens in some tissues and antiestrogens in others; cause the body to retain the bone it has by working like estrogen, but without some unwanted side effectsRaloxifene (Evista, postmenopause)

Bazedoxifene (in development)

Lasofoxifene (in development)
Hormone replacement therapy (HRT)Prevents osteoporosis when taken during and after menopause by replacing the sex hormones (for example, estrogen, progesterone) that the body stops producing during menopauseMany formulations exist that contain estrogen or a combination of estrogen and progesterone such as Cenestin, Premarin, Prempro, etc., for oral use; also available as topical patches, such as Alora, Esclim, Estraderm, and Vivelle
Non-sex hormoneSuppresses resorption of bone by inhibiting osteoclasts, a type of cell that "digests" bone to release calcium and phosphorus into the bloodCalcitonin (Miacalcin Nasal Spray), not very effective for postmenopause prevention; also can relieve bone pain due to osteoporosis-induced fracture.
RANK Ligand inhibitorSuppresses resorption of bone by blocking RANK ligand osteoclast formation, function and survivalDenosumab (Prolia) injections every six months

Bone-Forming Drugs
Drug TypeActionDrugs
Parathyroid hormone (PTH)Stimulates new bone formation in both the spine and hip and reduces the risk of fractures of the spine (vertebral fractures) and nonvertebral fractures in postmenopausal women (effects on nonvertebral fractures in men unknown)Teriparatide (Forteo), used for advanced osteoporosis; administered by daily injection; common adverse effect includes a sudden decrease in blood pressure (may cause fainting or dizziness)
Strontium ranelateDecreases breakdown of bone and increases bone formationStrontium ranelate (Protos), investigational oral product in Europe, Australia, and Japan
Low-fat diary products help strengthen bones.

Foods That Help Prevent Osteoporosis

Many foods can help prevent osteoporosis. A number of scientific studies have shown that eating more fruits and vegetables leads to stronger bones. Low-fat dairy products are high in calcium, and many are fortified with vitamin D and help strengthen bones. Fatty fish such as salmon, mackerel, tuna, and sardines are high in vitamin D. Canned sardines and salmon (with bones) are high in calcium.

What Specialists Treat Osteoporosis?

Several different specialties of medical specialists diagnose and treat osteoporosis, including family medicine doctors, internists, endocrinologists, gynecologists, geriatricians, and rheumatologists. Orthopedic surgeons are involved in the treatment of osteoporosis when a fracture requires surgery, such as a hip fracture or certain wrist fractures. Physical therapists help patients' recovery after certain fractures.

What Role Does Diet Play in the Treatment of Osteoporosis?

Eating the right foods is essential for good nutrition. Our bodies need the right vitamins, minerals, and other nutrients to stay healthy. Getting enough calcium and vitamin D is important for strong bones, as well as for proper function of the heart, muscles, and nerves. The best way to get enough calcium and vitamin D is through a balanced diet.

Calcium and Vitamin D

A diet high in calcium is important to avoid broken bones and to strengthen bones. Good sources of calcium include low-fat dairy products, such as milk, yogurt, cheese, and ice cream; dark green leafy vegetables, such as broccoli, collard greens, and spinach; sardines and salmon with bones; tofu; almonds; and foods with added calcium, such as orange juice, cereals, and breads.

Vitamin D is also a necessary part of a healthy diet to treat osteoporosis. Without enough vitamin D, the body is unable to absorb calcium from the foods eaten and the body will take calcium from the bones to maintain normal blood calcium levels, making them weaker. Vitamin D comes from two sources. It is made in the skin through direct exposure to sunlight, and it comes from the diet. Many people get enough vitamin D naturally. It is also found in fortified dairy products, egg yolks, saltwater fish, and liver. However, vitamin D production decreases in older and elderly people, in people who are housebound, and during the winter. Supplements are available.

Calcium supplements (treatment dose is 1-1.5 grams per day, divided into 500 mg two to three times per day after meals) and low doses of vitamin D (treatment dose is 800 international units [IU] per day) have been shown to reduce the risk of hip fracture in elderly women living in nursing homes. Adequate calcium and vitamin D levels in the body are also essential for other drug treatments, such as bisphosphonates, to be effective. In addition, doctors often recommend calcium and vitamin D supplements as part of osteoporosis treatment plans for younger patients.

What Role Does Exercise Play in the Treatment of Osteoporosis?

Exercise is an important part of an osteoporosis treatment program. Although bones may seem like hard and lifeless structures, bones are more like muscle; bones are living tissue that respond to exercise by becoming stronger. Exercise improves bone health. An additional benefit is that exercise also increases muscle strength, coordination, and balance and leads to better overall health. Exercise is good for people with osteoporosis. However, discuss any exercise program with a doctor. A doctor may recommend certain exercises, such as those to strengthen the back and protect the spine from fractures. A doctor may also recommend not performing certain exercises because exercise may put sudden or excessive strain on the bones.

Regularly performing weight-bearing exercise (exercise that works against gravity) has been shown to help maintain and build up bone mass. Weight-bearing exercises include walking, hiking, jogging, climbing stairs, playing tennis, and dancing. The second type of exercise is resistance exercise. Resistance exercises include activities that use muscle strength to build muscle mass and strengthen bone. These activities include weight lifting, such as using free weights and weight machines found at gyms and health clubs. The added benefits of exercise, which are stronger muscles and better balance and coordination, can help prevent falls. Falls are a serious worry in anyone with weakened bones (such as from osteoporosis) because even a minor fall can cause a serious injury or even permanent disability.

What Lifestyle Changes Affect People With Osteoporosis?

Quit Smoking

Smoking is bad for the bones as well as for the heart, lungs, stomach, skin, teeth, and hair. Women who smoke have lower estrogen levels compared with women who do not smoke. Lower estrogen levels result in decreased bone mass. Smokers may also absorb less calcium from their diets, and calcium is necessary for strong bones. Finally, women who smoke and choose hormone replacement therapy after menopause may require higher doses of hormones and have more complications.

Limit Alcohol Intake

Regular consumption of 2-3 ounces of alcohol a day may be damaging to bones, even in young women and men. Heavy drinkers are more likely to have bone loss and fractures. This is related to both poor nutrition and increased risk of falling. However, some evidence indicates that moderate alcohol intake may have beneficial effects on bone mass.

Psychological and Practical Support for People With Osteoporosis

No cure exists for osteoporosis, but effective treatment plans are available. Support networks are important to successful treatment. Information on preventing falls and maintaining a healthy diet and exercise routine is widely available (see For More Information). Physical rehabilitation after fractures can be a long process, and psychological and practical support is important. Patient support groups can lessen feelings of isolation and depression. Support groups can also provide practical advice, including strategies to prevent falls and increase mobility.

For More Information on Osteoporosis

National Osteoporosis Foundation
1232 22nd Street NW
Washington, DC 20037-1292
202-223-2226

Osteoporosis Pictures

The image on the left shows decreased bone density in osteoporosis. The image on the right shows normal bone density.
The image on the left shows decreased bone density in osteoporosis. The image on the right shows normal bone density.

Arrow indicates vertebral fractures.
Arrow indicates vertebral fractures.

Normal spine, B. Moderately osteoporotic spine, C. Severely osteoporotic spine.
Normal spine, B. Moderately osteoporotic spine, C. Severely osteoporotic spine.

Hormone replacement therapy causes calcium to be retained in bone cells. Calcium increases bone strength.
Hormone replacement therapy causes calcium to be retained in bone cells. Calcium increases bone strength.

Reviewed on 11/21/2017

REFERENCE:

"Osteoporosis." National Osteoporosis Foundation. <https://www.nof.org/>.

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