Osteoporosis Treatment

  • Treatment

    Call your doctor immediately if you have sudden back pain or a broken bone.

    It is especially important to get immediate treatment for a hip fracture. Patients with significant osteoporosis may have major fractures with little or no trauma. Hip fractures are especially critical; 20% of patients over the age of 50 die during the year of their fracture; men have a 26% higher death rate than women within a year of fracturing a hip. These fractures are often debilitating, and can require long-term care. A woman's risk of developing a hip fracture is equal to her risks of developing breast, uterine, and ovarian cancer combined.

    Eat a calcium-rich diet to build strong bones. If you find it hard to get the daily-recommended amount of calcium, you should take calcium supplements Table 05. Eat a balanced diet with plenty of calcium. Foods rich in calcium include: dairy products such as milk, yogurt, and cheese; calcium-fortified foods such as orange juice, bread, and cereals; canned fish with edible bones such as sardines and salmon; leafy dark green vegetables such as kale, collard greens, spinach, and broccoli. Before the age of 40, you should get about 1,000 mg of calcium a day. If you are a woman past menopause, you should consider increasing your daily intake to 1,500 mg of calcium a day (one cup of low-fat milk contains 300 mg of calcium). After about age 40 or 50, you should take calcium supplements in divided doses of not more than 500 to 600 mg per dose. Milk and milk products remain the safest and most effective source of calcium.

    Calcium supplements can be found in different forms; calcium carbonate and calcium citrate are both acceptable. Calcium carbonate should always be taken with food to improve absorption. Calcium citrate can be taken at any time, with or without food. Some patients find calcium citrate to be less constipating.

    Although there has been a lot of concern over lead contamination in calcium supplements in the past, several recent studies have shown that there is little to no significant lead contamination in the major calcium supplements.

    In addition, there is no increased risk for kidney stones from increasing calcium intake as long as it is combined with an adequate intake of vitamin D. Anyone with a history of kidney stones should maximize fluid intake to at least three to four quarts of water a day.

    Make sure you get enough vitamin D, as your body needs it to absorb calcium. Your body can't readily absorb calcium without sufficient amounts of vitamin D. Vitamin D is also required for proper bone metabolism. Spending time outdoors, even for ten minutes each day, will help you get the vitamin D you need, but may still be insufficient. If you live in the northern half of the U.S. (or further north), you are unlikely to be able to get enough vitamin D to help you maximize your peak bone density, or adequately suppress bone loss with age. Dairy products can be a good source for vitamin D if you consume three or more servings each day. You may wish to consider supplementation with 400 U (units) of vitamin D per day from childhood through age 40 (particularly in the winter); especially if your dairy intake is limited. After about age 40 or 50 you should consider increasing your vitamin D intake to 600 to 800 U per day as the production and effectiveness of vitamin D declines with age. If you are being treated for low bone density, you should consider taking 800 U per day of vitamin D supplementation unless other major sources of vitamin D are available. Many calcium supplements come with vitamin D, usually at a dose of 125 to 200 U per pill. Some fortified foods, such as cereals and breads, contain limited amounts of vitamin D.

    To ensure your safety, you should always discuss vitamin intake with your clinician—especially if you have a history of chronic diseases or organ problems (liver or kidney, etc.), or if you are on any prescription medications.

    Fluoride may be useful for maintaining bone. Fluoride is known to fight cavities and has been postulated to help build bone. However, studies show that the new bone stimulated by large amounts of fluoride intake is weak and abnormal, and is prone to increased fracture risk. The relatively tiny amounts of fluoride typically found in water, toothpaste, or other sources do not seem to have any significant positive or negative effect on bone.

    Table 5.  Supplements Used to Prevent Osteoporosis

    Drug name Dosing Special considerations
    Calcium supplements
    Calcium carbonate, Calcium citrate Premenopausal women and men who have normal bone density: 1,000 mg a day.Men over age 60 who have normal bone density: 1,200 mg a dayPostmenopausal women and anyone (men or women) with low bone density: 1,500 mg a dayElderly: 1.2 g per day Calcium carbonate: Always take with food. May cause constipation.Calcium citrate: may take with or without food. May cause dyspepsia if taken alone (rare). May help constipation.Always divide doses greater than 500 to 600 mg. Best taken after noon; avoid taking with caffeine or soda
    Vitamin D supplements
    Vitamin D 400-800 U per day Side effects are rare

    Both calcium and vitamin D supplementation can result in kidney stones or symptoms related to high calcium levels (for example, constipation, loss of appetite, or nausea) in elderly patients with underlying or undiagnosed metabolic disease, or in patients with severe osteoporosis if not taken with appropriate medications to suppress bone reabsorption.

    Weight-bearing exercises build stronger bones. When your legs, arms, and other parts of the body meet resistance, you build bone. Weight-bearing exercises include weight lifting, gentle running, walking, stair-climbing, and gardening. Swimming and bicycling are not, even though they have benefits for aerobic and cardiac fitness. If done regularly, weight-bearing exercises help to prevent osteoporosis. These types of exercises also help to improve balance, decreasing the chance of a fall. If you have bone loss, you will need to choose exercises that not only help build bone, but are also safe and unlikely to result in falls.

    Standing from a chair without pushing off is a simple exercise that can be repeated in sets of five. This exercise has been shown to help decrease bone loss and also improve balance in the elderly.

    Exercises that strengthen the back will help to prevent or treat osteoporosis. Exercises that strengthen the back help you maintain or improve posture. A strong back and good posture will help you avoid fractures. Weight-lifting programs using relatively light weights (2-10 lbs) can result in less upper back pain, and, when carefully supervised, can greatly facilitate response to any osteoporosis treatment plan. Weight lifting beyond 10 lbs should be considered only with careful supervision to avoid the increased risk of injury associated with heavier weights. Rowing machines may also be useful in a back-strengthening program, although their direct effect on bone density has not been studied.

    If you smoke, quit. Smoking lowers estrogen levels; smokers have been found to reach menopause more than three years earlier than non-smokers. Smoking significantly decreases response to hormone-replacement therapy, while also increasing the risks of serious side effects such as blood clots or heart attacks. In addition, smoking may impede calcium absorption, and also impedes the formation of collagen that forms the protein structure of bone and skin.

    Consuming excessive alcohol has multiple negative effects on bone density and fracture risk. People who drink excessively (more than 2 drinks in 24 hours and/or more than 6 drinks per week) often suffer from poor nutrition, resulting in bone loss as well as an increased risk of falls and injuries when intoxicated. Studies have shown a major correlation between alcoholism and osteoporosis in men.

    Your doctor is the best source of information on the drug treatment choices available to you.

    Practice the Chinese martial art of tai chi to improve balance and prevent a fall. If you have osteoporosis, avoiding a fall is important. About 33% of people over the age of 65 experience a fall. Broken bones at this age can mean long-term rehabilitation or even death. Although there are no scientific studies to prove it, practicing the ancient Chinese martial art of tai chi may be beneficial. The exercise uses slow, flowing movements that increase flexibility and strength, and improve balance. Studies have shown that 30 minutes of daily of practice significantly improves balance.

    If you do suffer a broken bone, you may need physical therapy. To recover from a broken bone such as the hip, wrist, or spine, you may need to see a physical therapist. He or she can help devise a therapy plan to fit your degree of bone loss. Talk to your clinician for referrals.

    Wearing hip protectors may prevent a fracture if you fall. Hip protectors are hand-sized cups that fit into a special pair of underwear. The hip protector sits over the hip bone, and is held in place by pockets in the underwear. If worn consistently, hip protectors can prevent a hip fracture due to a fall. Hip protectors are available over the internet, or through medical supply stores.

    Although still not widely available, a specialized therapy called kyphoplasty may immediately relieve pain and prevent debilitating deformities caused by collapsed vertebrae. Kyphoplasty is an invasive procedure that involves expanding the collapsed vertebrae using “balloons” and injecting “bone-like” material into the crushed vertebrae. The material hardens, and the entire process brings the vertebrae back up to near its original shape. Most patients who have undergone kyphoplasty have immediate relief from most of the fracture-related pain.

    Some people use soy and other plants to increase their bone density. However, no studies have confirmed that these substances have a significant effect on bone density. Although soy and other plants contain significant amounts of estrogen-like plant substances (phytoestrogens), there have been no studies to confirm that any substances have a significant effect on increasing bone density. The activity of phytoestrogens is thought to be 20 to 50 times less than the most common human estrogen, estradiol. However, soy and other plants that contain phytoestrogens often do contain calcium and protein, and are generally a good source of nutrition for patients with osteoporois. It remains to be proven if a high daily intake can help prevent osteoporosis.

    Talk to your clinician about matters that affect your gait and balance. Bad vision, poor balance, chronic diseases that impair your mental or physical performance, and certain medications (such as sedatives) can all lead to a fall. If you are on any of the following medications, you should talk to your clinician about the use of these medications and other concerns that may affect your balance and the way you walk:

    • Amitriptyline or Nortriptyline
    • Benzodiazipines such as Valium, Xanax, or Ativan
    • Over-the-counter medications containing Benadryl
    • Sleep medications such as Ambien

    Avoid a fall by practicing safe living habits Table 06. Take precautions while outdoors to prevent a fall: try using a four-pronged cane for stability; use rubber-soled shoes or strap-on treads for traction, avoid slippery sidewalks or carry salt in your pocket to spread onto walkways, and avoid wet polished floors. While indoors, use carpet runners, keep your floors clutter-free, remove loose wires, and do not walk in socks, slippers, or hose. Be sure lighting is adequate and light switches are accessible. Area rugs should be tacked to the floor or have slip-proof backing; make sure stairs have handrails; make sure bathrooms have handrails in the shower, tub, and near the toilet; use a rubber bath mat; only use wide step stools with handrails; keep a cordless phone with you to avoid rushing to answer it; keep a flashlight and batteries at your bedside and consider automatic dial emergency services.

    Table 6.  Safe Living Habits to Prevent a Fall

    While outdoors While indoors
    Use a four-pronged cane for stability Wear rubber-soled shoes or strap on treads for traction Avoid slippery sidewalks or carry salt in your pocket to spread on walkways Avoid wet polished floors Use carpet runnersKeep floors clutter-freeRemove loose wiresDo not walk in socks, slippers, or hose Tack area rugs to the floor or use slip-proof backing Make sure stairs have handrails Make sure bathrooms have handrails in the shower, tub, and near the toilet Use a rubber bath mat Use only wide step stools with handrail Keep a cordless phone with you to avoid rushing to answer it Keep a flashlight and batteries at your bedside Make sure your house is well-lit and that light switches are easy to access.

    Osteoporosis can be life-threatening. Women who fracture a hip have a 20% risk of death in the first year after the fracture. Men have a 33% chance of death in the first year after hip fracture. If you survive a hip fracture, you will still need to make major lifestyle changes. For example, you may not be as independent as you had previously been, or you may even need long-term care.

    While there is no cure for osteoporosis, it can be treated. To manage your osteoporosis, it's important to take preventive measures such as consuming plenty of calcium and vitamin D, doing weight-bearing exercises, and avoiding excessive alcohol and smoking. These same measures can also increase your response to any medication treatment plan by more than 20%. Osteoporosis can also be treated, and may even be avoided or delayed by adequate drug therapy. Extensive studies of the quality of bone formed with osteoporosis have suggested that this bone is identical to younger bone in structure and response to stress.

    Return to your doctor for regular bone density tests. Your doctor can monitor your rate of bone loss, and thus head off low bone density with drug therapy and supplements. It's never too late—a bone density test is also recommended for older woman who can benefit from different therapies. The tests measure bone density in various parts of the body, and can detect osteoporosis before a fracture occurs. If done regularly once a year, the DEXA bone density test can monitor the results of your treatment. There are also several urine and serum tests that can detect your rate of bone turnover. These tests may also be used to evaluate early treatment response (4 months).

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I'm Shereen A. Gharbia, PharmD. Welcome to PDR Health!

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