If your bone loss is linked to your hormone levels, treatments addressing your health on a hormonal level can positively impact your bone strength and your osteoporosis risks.
For women, the biggest factor is estrogen. This sex hormone has a protective effect on your bone density, which is why osteoporosis rates skyrocket after menopause when a woman's estrogen levels plummet.
Raloxifene hydrochloride (brand name Evista) is an estrogen agonist/antagonist, which essentially means your body responds to it as if it were natural estrogen. Studies have found that in postmenopausal women, this medication can help to build bone mass when taken once a day as an oral tablet.
It's critical that you avoid this drug if you have risk factors for a stroke, as it may be linked to increased rates of having a stroke. Other side effects include a risk of blood clots, as well as symptoms similar to having a hot flash.
Injectable teriparatide (brand name Forteo) is a bone-building agent made up of a synthetic form of parathyroid hormone (PTH). PTH plays a critical role in regulating how your body absorbs and uses calcium. Unlike many medications that work to slow or stop bone loss, teriparatide has been found to help to increase bone density and even cause new bones to grow. Interestingly enough, it's one of the few treatments effective for loss of bone in your jaw.
Teriparatide is given to postmenopausal women or men with osteoporosis via injection once a day. The requirement for regular shots of this medication may deter some people.
Side effects can include depression, heartburn, cramping in your legs, and itching and/or redness at the spot where you get the daily shot.
Finally, there's hormone replacement therapy. The use of HRT to treat osteoporosis has been studied widely, and it's been shown to be effective at reducing your risk of fractures (in some cases, by up to 25% in adults where low estrogen is linked with poor bone health:
- Women who are going through early menopause
- Women who have a poor score on their bone density test AND are presenting symptoms of menopause
- Women who have numerous risk factors of osteoporosis, such as a family history of bone loss and a small, petite frame
How you get your HRT varies across the board. It's available either as estrogen alone, or a combination of progesterone and estrogen, and can be taken as an oral pill, an injection, a topical cream, or a skin patch that you wear that slowly "drips" estrogen into your system. However, statistically, most women opt for a pill or a patch.
Daily estrogen pills used for osteoporosis treatment include the brand names Premarin, Menest and Estrace, while skin patches used once or twice a week include the brand names Climara, Vivelle-Dot and Minivelle.
The side effects of estrogen prevent many women from using this option depending on their lifestyle and other health factors. Common side effects include a greater risk of cancer in your uterus, an increased risk of cardiovascular health problems (including stroke), a higher risk of cancer in your ovaries, and more.
Thus, for many, HRT is the option they go to when all other options don't work effectively. If you're considering using HRT to treat osteoporosis, be sure to review all of your personal risk factors for things like breast cancer and heart attack, as there may be other treatments you want to try first.
Questions to Ask Your Doctor
Trying to decode the above and make a decision is no easy feat, which is why it's critical to work closely with your doctor and have open, honest communication to ensure you understand how your different options work, and how they may impact other areas of your health and wellbeing.
However, some people find it intimidating to talk to their doctor. Bring the following list of questions with you to your next visit to help you get all the information you need to feel comfortable with your treatment decisions:
- What are some of the underlying causes of my osteoporosis?
- What can I do to prevent this from getting worse?
- What are the results of my bone density test?
- How often should I get this bone density test done?
- What are the medications available to me to treat my form of osteoporosis?
- What are the side effects of these medications?
- Which medication do you think would work best for me and my current risk factors, as well as my family medical history and other health factors?
- What else can I do in terms of diet and lifestyle to improve my bone health and slow, stop or reverse my bone loss?
Things to Do No Matter What Medication You and Your Doctor Choose
Regardless of what specific medication you choose, increase how effective your treatment is by looking at all factors that play a role in your bone health.
This includes eliminating or reducing things that directly lead to bone loss. After all, why take a drug to slow bone loss while also doing other things that speed up the bone loss? This includes risk factors like smoking and drinking too much alcohol.
Next, look at ways to support the medications and improve your bone strength.
Start with calcium. Eat more calcium-rich foods (you'll want 1,000 milligrams of calcium a day if you're a woman aged 50 and under, or a man aged 70 and under). If you're older than this, you'll want to strive for 1,200mg of this bone-building mineral a day. Great options to consider include soy and dark, leafy greens.
Finally, find ways to increase the amount of physical activity you enjoy. Regular exercise has been shown in dozens of studies to actually improve bone density and slow bone loss. For the best results, try weight-bearing and strength-training workouts, such as biking, jogging and lifting weights.
By reducing your risk factors and increasing the lifestyle factors that build your bones, you help ensure that whatever medications you're on can achieve maximum results.