Treatment for Osteoporosis

Breaking a bone is not only painful, but can be debilitating. For an older person, it may mean a hospital stay, long-term disability and the loss of independence. The goals of treatment for osteoporosis are to stop or slow bone loss and prevent bone fractures. Osteoporosis does not have a cure, but can be managed through medication, exercise and lifestyle.

If you have osteoporosis, your doctor may recommend:

• Moderate weight-bearing exercise
• More calcium-rich foods in your diet
• Calcium supplements
• Vitamin D
• Medications

Drugs approved by the U.S. Food and Drug Administration (FDA) can treat this disorder. They can help preserve or increase bone density and maintain bone quality. But if you stop taking one of these drugs, your bones will again begin to lose density and become thinner.

All drugs can cause side effects. Your doctor can give you more information about the potential risks and benefits of these drugs. Here are medications that your doctor may recommend:

• Bisphosphonates
  These medications include alendronate sodium (Fosamax) and risedronate sodium (Actonel). They are used to prevent and treat osteoporosis by reducing bone loss, increasing bone density and reducing the risk of fractures. Oral bisphosphonates should be taken with water on an empty stomach. These medications can irritate the esophagus (tube leading to your stomach), so it's important to remain upright (standing or sitting up) for one hour after taking them. Side effects are not common, but may include abdominal pain, nausea, heartburn or irritation of the esophagus. There is also a biphosphonate called zoledronic acid (Reclast) that is given as an injection once a year. Side effects may include flu-like symptoms, joint pain, kidney damage and jaw problems.
• Calcitonin
  Miacalcin and calcimar are two synthetic forms of calcitonin, a hormone that naturally occurs in the body. It increases bone density and strength. Calcitonin can be taken as an injection or nasal spray. The injectable form may cause an allergic reaction or other side effects. These may include flushing of the face and hands, urinating more often, nausea, and a skin rash. Side effects for the nasal spray are not as common, but may include nasal irritation, back pain, bloody nose and headaches.
• Selective estrogen receptor modulators (SERMs)
  Raloxifene (Evista) prevents and treats postmenopausal osteoporosis. SERMs have the helpful effects of estrogen therapy without the potential disadvantages. Raloxifene increases bone mass and reduces the risk of spine fractures. However, it does not reduce the risk of hip fractures. Side effects are not common, but may include hot flashes and deep vein thrombosis (a blood clot in the legs). People who have had previous blood clots can't take this drug.
• Hormone Therapy
  The role of hormone therapy for osteoporosis is controversial. A large clinical trial (called the Women's Health Initiative) showed that estrogen alone - or in combination with the hormone progesterone - decreases bone loss and the risk of fracture. But it also slightly increases the risk of heart attacks, strokes and blood clots. It also can increase the risk of breast cancer. Currently, short-term use of hormone therapy at the lowest effective dose is approved only for prevention. It is not approved for treatment of osteoporosis in women who have recently gone through menopause. Before taking hormone therapy, carefully consider the risks.
• Parathyroid hormone Teriparatide (Forteo) is a synthetic form of a natural human hormone. It is the first osteoporosis medication to increase the rate of bone formation in the bone remodeling cycle. The drug forms new bone and increases bone mineral density and bone strength. The drug can be used by people who have had an osteoporosis-related fracture or who cannot use other osteoporosis treatments. Side effects include nausea, leg cramps and dizziness. It also has caused an increased risk of osteosarcoma, a type of bone cancer, in animal studies.

The role of diet and exercise

Diet and exercise are the cornerstones of treatment for osteoporosis. Even after you are diagnosed with osteoporosis, good habits can slow bone loss and the progression of the disease.

• Calcium. Your body depends on calcium from the diet to build healthy new bone and to avoid loss of calcium when it is used for properly functioning nerves, heart and skeletal muscle. Adults need 1,000 milligrams of calcium each day. The recommendation increases to 1200 milligrams after age 50. Talk to your doctor about taking a calcium supplement or multivitamin. Your total daily intake should not exceed 2500 milligrams.
• Vitamin D. You need vitamin D to absorb calcium from your intestine. Vitamin D is made in your skin after 15 minutes of sun exposure. You also get vitamin D from fatty fish (fish oils) and from fortified milk and cereal. The recommended daily intake is 400 IUs for men and women age 51 to 70 and 600 IUs for men and women over 70.
• Exercise. You can also help keep your bones healthy by doing at least 30 minutes of weight-bearing exercise each day. Do exercise that works the muscles and bones against gravity, such as jogging, stair climbing or dancing. Walking for exercise also works. Ask your doctor what type of exercise is right for you.