OSTEOPOROSIS: TREATMENT
Follow a three-pronged regimen of medication, weight-bearing exercise and diet.
BY:MARGARET FARLEY STEELE
Osteoporosis prevention and treatment have advanced significantly in the past 15 years, and doctors today have more effective ways of slowing bone loss and building bone mass.
Treatment typically includes a three-pronged regimen of medication, weight-bearing exercise and diet.
Estrogen therapy once was the mainstay of osteoporosis treatment for post-menopausal women, but because of concerns about possible cancer and cardiovascular risks, it is no longer the first choice of physicians. However, estrogen is still used in small doses or in combination with progesterone but usually only when other treatments have failed.
Bisphosphonates are the first line of defense for preventing the breakdown of bone tissue and promoting bone density. Bone resorption is another term for bone loss, and these drugs inhibit bone resorption. Depending on dosage they may be taken daily, weekly, monthly or, in the case of one medication, annually by infusion. For cancer patients and others who can't tolerate taking bisphosphonates orally, doctors might recommend intravenous infusions of bisphosphonates.
Although effective, their side effects can be significant and include stomach pain, nausea, and esophageal irritation. Bisphosphonates that are taken weekly or monthly tend to be easier on the stomach.
More extreme but rare side effects include bone, joint and/or muscle pain, and also osteonecrosis of the jaw (breakdown of the jaw bone). A few cases of osteonecrosis have been reported, usually after a tooth extraction or cancer treatment. Because of this, your dentist needs to know if you take bisphosphonates.
Raloxifene is a selective estrogen receptor modulator (SERM) that provides estrogen's beneficial effects on bones in post-menopausal women but without the risks. Hot flashes are a possible side effect, and women with a history of blood clots should not take Evista.
Calcitonin is a hormone that is usually administered as a nasal spray. It reduces bone loss, and some evidence suggests that it prevents spine, but not hip, fractures. Because it is less potent than other medications, it is reserved for patients who can't tolerate other drugs.
Teriparatide stimulates new bone growth in people at high risk of fractures, but because of a possible link to a rare bone cancer, osteosarcoma, the Food and Drug Administration recommends its use for only two years or less.
Tamoxifen is a synthetic hormone. Its estrogen-like effect on bone cells seems to reduce the risk of fractures. Side effects can include hot flashes, nausea, and vaginal dryness or discharge.
Weight-bearing exercise, such as walking or stair-climbing, plays a key role in osteoporosis treatment. Aim for 30 minutes a day, either all at once or broken into three 10-minute sessions. Also important are resistance and strength-training exercises, such as lifting weights or working with elastic exercise bands, two or three times a week.
Staying active and learning the correct way to move are also beneficial, says the National Osteoporosis Foundation. Good posture and body alignment relieve stress on the spine and help reduce the likelihood of falls. Physical therapists or fitness trainers can help you achieve better posture and alignment.
Pay attention to diet, too. Limit soda and excess caffeine, which is thought to interfere with calcium absorption, and consume lots of calcium. Good sources are: dairy products, broccoli, cooked kale, sardines with bones, and romaine lettuce. Read nutrition labels to see if you are meeting your minimum daily needs. Because most people don't consume enough calcium and Vitamin D in their meals, supplements may be advisable.