• How Is Osteoporosis Treated?
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|How Is Osteoporosis Treated?
Treatment for osteoporosis generally involves the use of medications, with drugs being used for both treating and preventing a worsening of the disease. Some medicines can slow down the rate of bone loss and even increase bone thickness. There are benefits in even small amounts of new bone growth as this can help reduce the risk of fractures. Those taking medications for osteoporosis will still need to take vitamin D and calcium supplements to maximize success of treatment, as well as follow a healthy eating plan and take some exercise (see alternative treatment for osteoporosis). The most popular type of medication prescribed for treating osteoporosis is bisphosphonate. Where a patient cannot take bisphosphonates, calcitonin is considered an alternative but is not as effective. Until the introduction of bisphosphonates there was no known way to reverse osteoporosis or to restore bone to its original strength. After significant bone loss however, no current treatment can yet restore normal bone density. This is one of the reasons why an early osteoporosis diagnosis is very important.
Back aches and muscle spasms caused by fractures can be relieved with painkillers such as aspirin or heat, massage and orthopedic supports. Where a hip joint becomes severely damaged (hip fracture), it may be replaced with an artificial joint requiring surgery (arthroplasty). One recent study showed that spinal compression fractures, which can be quite painful, can be treated by minimal invasive surgery. One type of surgery is called vertebroplasty whereby a needle inserted into the broken bone and cement injected. Kyphoplasty is another method where a tiny balloon expands the disk back to its original height before cement is injected. In both cases symptoms are relieved within a matter of hours or days. Physical therapy may also be recommended after a fracture to help mobility return. Those who have suffered a fall should try to make their home as accident proof as possible to avoid other incidents, for example by securing any rugs and decluttering furniture.
The two most common situations are when:
1. Osteoporosis is diagnosed by a bone density test (such as a DXA scan).
These are the most popular form of medications prescribed to prevent and treat symptoms of osteoporosis in postmenopausal women. Bisphosphonates (also known as diphosphonates, just to confuse everyone) are a type of antiresorptive drug which not only helps prevent bone loss but also builds bone density. Actonel, Fosamax and Boniva are the 3 bisphosphonate pills approved for America. They are taken orally once a week or once a month. Taking these medications can improve bone density in the hip by 3 percent and the spine by 5 percent. Changes can be noted within the first 12 months of treatment and the rates of fractures are nearly halved. Side effects can vary from person to person, and you may find that one medication works better than another. Do talk to your doctor about switching between the medications if you are having an adverse reaction to one. Studies are currently being carried out on another bisphosphonate, zoledronic acid (brand name Zometa) which has been widely prescribed to those with bone cancer. Initial findings show that a Zometa injection once a year considerably improves bone density and markers of bone turnover. However, the use of this drug for osteoporosis has not yet been approved.
How Are They Administered?
All bisphosphonates should be taken first thing in the morning with a full glass of water (6-8oz). Juice or other liquids will interfere with drug absorption in the stomach, so stick to water. Avoid eating or drinking anything for 30 minutes after taking your pill. You will also need to stand for half an hour after taking the pill to minimize possible stomach irritation. Those taking this medication also need adequate amounts of calcium (1,500mg) and vitamin D (800 IU) a day. If you are planning to combine bisphosphonates with homeopathic natural remedies, do inform your doctor.
When Are Bisphosphonates Prescribed?
Therapy is prescribed by a doctor based on the T-score results of a bone density test, such as a DEXA scan. Bisphosphonates are usually prescribed when:
1. T-Score is -2.5
How Long Can I Take Bisphosphonate?
There is consensus that 5 years is safe. Beyond this doctors are not sure but this is more to do with lack of long-term research. One fact however is known: even when we stop taking bisphosphonates the positive effects of the drugs still persist. This is mainly because the drug builds up over time in the bones and residues remain. For this reason, some women consider taking a break after 5 years. If this is something you would like to consider, discuss the options with your doctor. Experts vary on their opinion about whether or not to continue taking the medication indefinitely.
When Not to Take Bisphosphonates
Some people find that their system cannot tolerate the drug as it causes too much stomach irritation and/or muscle pain. Women with GERD (gastroesophageal reflux disease) can find it difficult to tolerate and it should also be avoided by those with kidney disease, esophageal strictures and a vitamin D deficiency.
This was one of the first drugs produced for the treatment of osteoporosis, but is now considered less effective than bisphosphonates. However one of calcitonin’s advantages is that it sometimes helps relieve pain from bone fractures. For this reason doctors sometimes prescribe it to patients who have experienced a fall or fracture. It has very few side effects and may be considered a stand-by for those who are unable to take bisphosphonates or estrogens. Usually calcitonin is taken by nasal spray once a day. Less commonly it is taken as a daily injection.
The FDA approved the use of estrogen replacement therapy (ERT) for treating osteoporosis in 1972. However, since the introduction of bisphosphonates it is rarely considered as a stand-alone treatment today. Bisphosphonates only act on bone tissue and do not have an effect on any other part of the body. ERT in comparison is considered to have too many side effects. Researchers found that the use of estrogen raised the risk of uterine cancer, so they starting combing it with progesterone. Then new information showed that 5 years or more of estrogen and progesterone treatment slightly increased the risks of breast cancer. However, as estrogen does help slow down bone loss, it may still be recommended to women with both osteoporosis and severe menopause symptoms such as hot flushes, insomnia and vaginal dryness. The ideal candidate for estrogen therapy is a woman with osteoporosis and who is going through early menopause as a result of a hysterectomy, so there is no fear of uterine cancer. If you are considering HRT for osteoporosis prevention, do discuss the pros and cons with your doctor.
Scientists have developed a new class of drugs called designer estrogens which have an effect on the bone but do not interfere with the breast or uterus. Raloxifene (brand name Evista) has been approved by the FDA for the treatment of osteoporosis in postmenopause women. Initial findings show that it may even lower the risk of breast cancer and heart disease. It can reduce the risk of spinal fractures by 50 percent although it does not appear to prevent any other fractures, including hip ones. It is for this reason that bisphosphonates are still the first drug of choice for osteoporosis. The most serious side effect of raloxifene is blood clots in the leg veins, so notify your doctor immediately if you notice pain or swelling of the legs, sudden shortness of breath or changes in vision.
Teriparatide (brand name Forteo) is one of the newest drugs on the market and is approved for postmenopausal women who have severe osteoporosis and who are at high risk of having a fracture. Doctors and researchers still have very little experience with this drug so it is not often recommended. The main disadvantage is that is has to be taken daily via injection under the skin. It is very expensive and few insurance companies are covering it at this time.
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