Treatment of Osteoporosis

Depending on what the state of your physical health and bones is, your primary care physician can help direct you to the best regimen. Mild osteoporosis can be treated with oral calcium supplements and exercise. If you have low bone mass, it is imperative to protect your spine by avoiding exercises or activities that flex, bend or twist to avoid pulling or straining a muscle. Intense, high-impact exercise like step aerobics should also be avoided to lower the risk of breaking a bone.

Although a number of drugs and treatments exist that help people at risk for or who suffer from osteoporosis, being able to control the condition, to the degree that's possible, requires some kind of life pattern change. Teaching ourselves new behaviors and coaxing ourselves out of old tendencies in order to grab hold of the disease and force it to follow, not lead one's life is crucial. On many levels, very definite, concerted efforts to other than how we've been is one of the primary ways to live with the disease, regardless of how difficult its intricacies are. "If you go to the doctor and get a prescription, and that's all you do, you're probably not going to be helped very much," says Robert Recker, M.D., director of the Osteoporosis Research Center at Creighton University in Omaha, Nebraska.

There are many different medications on the market and that are being investigated for prevention and treatment of osteoporosis. Most of the approved medications are antiresorptive, which slows the destructive phase of bone turnover as well as reduces the risk of vertebral (spinal) fractures. Drugs in this category do not build bone beyond what is produced to help fill the remodeling spaces, according to Harvard Women's Health Watch. Specific medications that fall under the umbrella of antiresorptives are bisphosphonates, estrogen, selective estrogen receptor modulators (SERMs) and calcitonin. Antiresorptives are known to, according to the Harvard Women's Health Watch, known to produce a modest increase in bone density. Although only good for use over approximately 10 years; after that, the cumulative effects on bone aren't known and could potentially negate the work they'd done during prior years.

The first medicines that were prescribed for treating post-menopausal women were bisphosphonates alendronate (Fosamax) and risedronate (Actonel). They both reduce vertebral and non-vertebral fractures and have very few side effects. To prevent and treat osteoporosis, these drugs reduce the risk of vertebral, hip, and wrist fractures by 40-50%. They're well-tolerated when taken as advised by a physician, but can still cause nausea, heartburn, or esophageal or stomach irritation, according to Harvard Women's Health Watch. Because these drugs interfere with osteoclasts, cells that break bone down, the way it is ingested is important. It's usually taken first thing in the morning with a full glass of water 30 minutes (give or take) prior to eating anything.

Another set of medications that are used to prevent or treat osteoporosis are anabolic agents, which promotes new bone growth. Teriparatide, a form of human parathyroid hormone (PTH), commercially known as Forteo is used to treat osteoporosis; may double the rate of bone formation, and reduces vertebral fractures as much as 70% and nonvertebral fractures by nearly 50%. Forteo must be taken as a self-administered injection because the effects gradually wane, and the dearth of long-term safety data is still being compiled. It is not prescribed for more than 2 years at approximately $7,000 per year. Strontium ranelate incorporates the element strontium, which is found in trace amounts throughout the human skeleton, and is believed to decrease bone breakdown.

One SERM that has gathered much use has been Raloxifene, or Evista is actually the only SERM approved for osteoporosis prevention and treatment. It reduces spinal fractures just as well as bisphosphonates. It reduces vertebral fractures by 40-50% and has minor side effects of hot flashes, leg cramps, and blood clots. It increases bone density, but not at the same rate as bisphosphonates, and may help reduce the risk of breast cancer. Additionally, it lowers LDL (or bad) cholsterol.

Calcitonin is a naturally occurring hormone that helps promote bone density in several ways. It reduces the amount of calcium that is lost in the urine, keeps calcium in bones, and inhibits the action of the cells that break down bones (osteoclasts).

Calcitonin is for treatment of osteoporosis only, though it isn't widely used and contributes to a modest reduction in vertebral fractures. It is administered as/through a nasal spray, and has mild side effects such as stomach upset and flushing. Macalcin nasal spray can cause runny nose and respiratory symptoms.

Various agents constitute hormone therapy, and among them are Premarin, Prempro, Estrace, Estraderm, and Climara. The issue with hormone therapy is that it's for osteoporosis prevention only, which is not as widely known as it should be. It reduces vertebral and hip fractures by approximately 34% according to the Harvard Women's Health Watch, and should be started as close to menopause as possible to maximize effects. Premarin, a form of estrogen, increases the risk of stroke and uterine cancer according to the publication. Further, if it is paired with Prempro, a form of progestin, may increase the risk of heart attack, blood clots, breast cancer, and stroke.

While hormone replacement therapy was the first line prevention/treatment for bone density loss, results from large studies have shown that conjugated estrogens can dangerously increase the risk of heart attack, stroke, and breast cancer in older women. Therefore hormone replacement therapy is not usually used as an osteoporosis treatment.

The American College of Physician's guide to pharmalogic treatment recommends doctors prescribe bisphosphonates or other drugs to anyone with osteoporosis or who has had a fragility fracture. Doctors are also advised to consider treatment for people past age 62 or with low T-score.

Significant research has shown the estrogen slows bone remodeling, and low-dose Premarin paired with calcium has further revealed that it can protect bone mass. It can also increase HDL, or good cholesterol and triglycerides, thus capping heart disease risk.

The fact that osteoporosis is preventable allows many experts to hope that, with the appropriate amount of knowledge and exploration, men and women internationally will latch onto the most healthful way of life and incorporate tenets into their day-to-day in order to maintain and preserve their bone health and their longevity.

"The way I visualize the ideal future is that we'll be able to give drug X that builds up bone to where it's stronger and the risk, of fracture is no longer present, then drug Y maintains it by preventing breakdown," says Paula Stern, Ph.D., a pharmacologist at Northwestern University Medical School in Chicago.

The study of risk factors is very important, and still continues, says Sherry Sherman, Ph.D., of the National Institute of Aging, "We consider that to be the research that has the greatest public health significance."

For some patients with advanced osteoporosis, surgical techniques such as vertebroplasty and kyphoplasty are sometimes employed.

Research Reports

Denosumab for osteoporosis - Report on two drug company sponsored studies on the monoclonal antibody denosumab. This drug inhibits a cytokine that helps osteoclasts function. It seems to help patients maintain bone density. Denosumab is a monoclonal antibody and likely to be quite expensive. One benefit is that it does not cause phossy jaw.

The decline in hip fracture rates in the United States since the mid-90s is coincident with the introduction of bisphosphonates. The New York Times reports that bisphosphonates may lower breast cancer risk.