Treatment of Osteoporosis – What’s Available?
If you’re reading this, chances are you have osteoporosis. You probably already understand that osteoporosis has no cure. However, lifestyle modifications and medications can slow its progress. Some treatments for osteoporosis may even reverse it slightly and allow the bone to rebuild to some degree.
And you’re not alone! According to the International Osteoporosis Foundation (IOF), osteoporosis affects over 200 million women worldwide. Osteoporosis is the cause of 8.9 million fractures annually, which equates to an osteoporotic fracture every three seconds.
Also, osteoporosis is costly – according to the National Osteoporosis Foundation (NOF), fractures related to osteoporosis cost families and the healthcare system an estimated $19 billion annually. And this number is only expected
Medication Options by Gender
Some medications are hormonal and are only approved for women. These medications include calcitonin (Fortical and Miacalcin), estrogen, and estrogen agonists/antagonists (Evista).
Other medications are available for men and women. These include bisphosphonates (Actonel, Atelvia, Fosamax, and Reclast), denosumab (Prolia) and teriparatide (Forteo).
Bisphosphonates can be given to both men and women, and they work by slowing bone loss. Depending on the drug, they may be given once weekly or once monthly.
This drug class is the most commonly prescribed for osteoporosis. According to News Medical, “Bone is constantly undergoing a turnover process in which osteoblasts create bone and osteoclasts destroy it. Bisphosphonates inhibit the actions of osteoclasts by promoting their apoptosis (programmed cell death), which, in turn, slows bone loss.”
The benefit of bisphosphonates, aside from the fact that they slow down bone loss, is that they can also decrease bone pain associated with osteoporosis. Also, in cancer patients with bone damage, bisphosphonates are known to reduce the need for radiation and lower the risk of fracture.
Bisphosphonates can be broken down into two subclasses, which differ based on their mechanism of action:
- Nitrogenous bisphosphonates: pamidronate, alendronate, and zoledronate.
- Non-nitrogenous bisphosphonates: etidronate, clodronate and tiludronate.
The downside to bisphosphonates is that they must be taken correctly — if they are not taken correctly, they are known to cause esophageal ulcers.
Estrogen agonists/antagonists have a mechanism of action similar to estrogen when it comes to protection of bone, but without some of the side effects of hormonal therapy.
Evista is known to build bone mass, similar to estrogen. Unlike estrogen, it does not increase the risk of breast or uterine cancer. However, it does increase the risk of blood clots.
Evista belongs to a drug class called selective estrogen receptor modulators (SERMs); SERMs are FDA-approved for the prevention and treatment of osteoporosis in postmenopausal women, as well as reduce the risk of invasive breast cancer in postmenopausal women at risk or with osteoporosis.
SERMs act like estrogen, but without the potential side effects. Evista helps to protect bone density but does not affect the uterine lining – meaning it does not cause uterine cancer. It was also shown to lower LDL cholesterol.
As discussed, those taking Evista are at increased risk of blood clots, including deep vein thrombosis and pulmonary embolism – but this side effect affects less than 1% of women without a prior history of blood clots. The most notable side effect is hot flashes.
Forteo is a synthetic form of parathyroid hormone (PTH). PTH is responsible for regulating calcium metabolism in the body. Thus, Forteo increases bone density and causes new bone to grow. It is the only FDA-approved medication that is approved to rebuild new bone.
Forteo is given only to men with osteoporosis, or to women who are postmenopausal. It is given via injection. The downside to this medication is that the injection is daily, as opposed to some of the other medications, which are much less frequent. Long-term studies have not been performed, so it can only be prescribed for up to 24 months.
Side effects include itching and redness at the injection site, heartburn, depression, and leg cramps.
Hormonal Replacement Therapy (HRT)
The use of HRT to treat osteoporosis has been studied vastly, from observational studies, case-control studies, randomized clinical trials, and meta-analyses. The same conclusion has been met – HRT is highly effective at decreasing the risk of fractures (in some research, a reduction in fracture risk up to 25%!) and discontinuing HRT shows a loss of the anti-fracture efficacy as well as a decreased risk of colon cancer.
However, the studies also indicate that there are other health risks associated with HRT. For example, the use of HRT increases the risk of endometrial cancer. It also increases the risk of cardiovascular events such as unstable angina (USA), venous thromboembolism, and thromboembolic stroke. It can also increase the risk of myocardial infarction, ovarian cancer, and overall cognitive function.
HRT should be considered if other treatment modalities are not tolerated or are contraindicated, and then at the lowest dose possible.
What Else Can Be Done?
As with all drugs, there are pros and cons to medication therapy. You should weigh the pros and cons carefully with your doctor when selecting a medication for your osteoporosis treatment.
That being said, there are a variety of other self-care measures that can be undertaken to preserve bone density.
Perhaps one of the best things you can do for yourself is quit smoking. Along with increasing the risk of a variety of types of cancers and chronic conditions, wreaking havoc on your skin and your blood vessels, it also speeds up bone loss.
If you need one more reason to quit, this is it: studies indicate that current smokers lose bone at a much faster rate than non-smokers.
This means by the age of 80; a smoker can have up to 6 percent less bone density than a non-smoker! According to the World Health Organization, “Hip fracture risk among smokers is greater at all ages but rises from 17 percent greater at age 60 to 71 percent at age 80, and 108 percent at age 90.”
Start an Exercise Routine
Your exercise routine should include weight-bearing exercises for osteoporosis that promote balance and posture. These types of activities can reduce your risk of a fall, which in turn can decrease your risk of a fracture. They can also strengthen your bones.
Modify Your Diet to Ensure You’re Getting Enough Calcium
Calcium in food maintains bone. It is recommended that adults aged 19 to 50 get 1,000mg of calcium per day, and over the age of 50 get 1,200mg of calcium per day.
Calcium should ideally be taken in from food sources as research is showing that oral supplements may increase the risk of heart disease, but more research needs to be done. Foods that contain calcium include dairy products such as milk, yogurt and cheese, tofu, salmon, broccoli, cauliflower, and leafy green vegetables.
Ensure You’re Getting Enough Vitamin D
Vitamin D helps the body to absorb calcium better. We can get vitamin D from food sources or supplementation.
Doctors recommend the following amounts of vitamin D each day, for the average person:
- Age 1-70: 600 IU
- Age 71 and older: 800 IU
Your needs may be higher if you aren’t taking in enough vitamin D through diet or supplementation. Your physician will let you know if you need to ingest more vitamin D – but it doesn’t hurt to ask!
Food sources of vitamin D include:
- Egg yolks
- Fatty fish, such as tuna, mackerel, and salmon
- Fortified foods, such as milk, cereal, and orange juice
- Beef liver