Medical Treatment for Osteoporosis
Osteoporosis treatment combines nutrition, exercise, safety measures and medications.
Osteoporosis & Nutrition
Getting adequate amounts of calcium, vitamin D and phosphorus in a healthy diet is important to encourage bone growth and maintain health. Vitamin D supplements are used in the treatment of osteoporosis.
Weight-bearing exercise (e.g., walking, jogging, hiking, dancing) has several positive effects, the foremost being an increase in bone density. Exercise also increases strength, coordination, and balance, thereby reducing the risk for falls. Twenty minutes of exercise 3 or 4 times per week is recommended. Women should consult their physicians when beginning an exercise program.
Osteoporosis & Safety
Taking measures to prevent falls also is important:
- Avoid slippery surfaces
- Install hand rails
- Keep surfaces smooth and uncluttered
- Provide adequate lighting
- Use a cane or walker
- Wear rubber-soled, flat shoes
- Wear eyeglasses
Osteoporosis & Medications
Approved osteoporosis treatments include oral medications, transdermal medicines (skin patches), nasal sprays, injections, and intravenous (IV) medications. These treatments include the following:
- Estrogen replacement therapy (oral, skin patch)
- Alendronate (oral; e.g., Fosamax®, Fosamax Plus D, Binosto) and risedronate (oral; e.g., Actonel®, Actonel® with Calcium)
- Raloxifine (oral; e.g., Evista®)
- Calcitonin-salmon (nasal spray, injection; e.g., Fortical®, Miacalcin®)
- Synthetic parathyroid hormone (injection; e.g., Forteo®)
- Zoledronic acid (intravenous injection; e.g., Reclast®, Zometa®)
- Ibandronate (oral, intravenous injection; e.g., Boniva®)
- Denosumab (injection; e.g., Prolia)
Estrogen replacement therapy
Estrogen replacement therapy (ERT) is recommended for women at high risk for osteoporosis or who have osteoporosis. Women who have had a hysterectomy or an oophorectomy (removal of the ovaries) before age 50, have experienced natural menopause and have multiple risk factors for osteoporosis, or have below normal bone mass for their age are good candidates for ERT.
Estrogen reduces osteoclast activity. When taken by postmenopausal women, there is a slower rate of bone loss and increased bone mass in the spine and hip. With 10 or more years of use, a postmenopausal woman's risk for fractures can be reduced 50% to 75%.
Typically, physicians prescribe a low dosage (.3 mg - .625 mg daily) to reduce side effects and encourage women to continue the therapy. ERT is available in two forms:
- Oral medication (Premarin®, Estrace®, Estratest®)
- Skin patch (Estraderm®, Vivelle®)
Possible side effects include the following:
- Breast tenderness
- High blood pressure
- Vaginal bleeding
- Weight gain
Alendronate and risedronate
Bisphosphonates are used in the treatment of bone loss associated with the use of glucocorticoids. Both alendronate (Fosamax®) and risedronate (Actonel®) increase bone density and decrease bone loss associated with osteoporosis. Studies of postmenopausal women report a substantial decrease in the risk for fractures in the spine and hip.
Alendronate and risedronate must be taken on an empty stomach (no food or drink for 30 minutes before or after). In addition, patients should not lie down for half an hour after taking the drug. Bisphosphonates may cause gastrointestinal disturbance such as nausea and heartburn. Pain in the stomach and in muscles has also been reported. Dosage depends on whether the medication is prescribed for prevention (5 mg daily or 35 mg / week) or treatment (10 mg daily or 70 mg / week).
Raloxifine (Evista®), a selective estrogen receptor modulator (SERM), produces some of the same benefits as ERT without the side effects. Raloxifine is used both to prevent and to treat osteoporosis. Studies show it prevents bone loss and reduces the risk for spinal fractures. In addition to small increases in bone mass in sites typically associated with osteoporosis, raloxifine encourages bone density throughout the body.
Raloxifine is given in daily doses of 60 mg. Possible side effects include DVT, blood clots, and hot flashes.
Calcitonin-salmon (Calcimar®, Miacalcin®) is a synthetic compound that is chemically identical to the calcitonin found in salmon. Human calcitonin is a hormone secreted by the thyroid gland that helps regulate calcium and bone remodeling. Calcitonin-salmon has been shown to slow bone loss, increase spinal bone mass, and reduce the risk for spinal fractures in postmenopausal women.
Because calcitonin cannot be properly digested, it is given as an injection or nasal spray. Dosages of injectable calcitonin-salmon range from 50100 IU daily. Dosage of the nasal spray is 200 IU daily. The injectable form may cause nausea and vomiting, and allergic reactions such as flushing, urinary frequency, and skin rash. The nasal spray may cause a runny nose, nasal soreness, itching, dryness, and crusts.
Synthetic parathyroid hormone
Injectable synthetic parathyroid hormone (Forteo®) is used to treat postmenopausal women at high risk for fracture. A 29 mcg dose is self-injected once daily for up to 24 months. The injection is made under the skin of the thigh or abdominal wall. This drug acts on bone-building cells (osteoblasts) to stimulate new bone growth and increase bone mineral density.
Combination therapy with HRT has been shown to be effective. Possible side effects include the following:
- Angina pectoris (chest pain)
In August 2007, the Food and Drug Administration (FDA) approved zoledronic acid (Reclast® Injection, Zometa® Injection) for the treatment of osteoporosis in postmenopausal women. Reclast is given through an IV (i.e., intravenously) once a year. In rare cases, women receiving this treatment have experienced deterioration (osteonecrosis) of the jaw. Prior to treatment, an oral examination should be performed. Side effects include fever, muscle pain, and headache.
In June 2008, the FDA expanded approval of Reclast to prevent new fractures in postmenopausal women with osteoporosis who had already experienced low-trauma hip fracture.
With treatment, osteoporosis can be slowed, but it cannot be corrected.