Treatment:

The goals of osteoporosis treatment are to:

• Control pain from the disease
• Slow down or stop bone loss
• Prevent bone fractures with medicines that strengthen bone
• Minimize the risk of falls that might cause fractures

There are several different treatments for osteoporosis, including lifestyle changes and a variety of medications.

Medications are used to strengthen bones when:

• Osteoporosis has been diagnosed by a bone density study.
• Osteopenia (thin bones, but not osteoporosis) has been diagnosed by a bone density study, if a bone fracture has occurred.

BISPHOSPHONATES

Bisphosphonates are the primary drugs used to both prevent and treat osteoporosis in postmenopausal women.

• Bisphosphonates taken by mouth include alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel). Most are taken by mouth, usually once a week or once a month.
• Bisphosphonates given through a vein (intravenously) are taken less often.

CALCITONIN

Calcitonin is a medicine that slows the rate of bone loss and relieves bone pain. It comes as a nasal spray or injection. The main side effects are nasal irritation from the spray form and nausea from the injectable form.

Calcitonin appears to be less effective than bisphosphonates.

HORMONE REPLACEMENT THERAPY

Estrogens or hormone replacement therapy (HRT) is rarely used anymore to prevent osteoporosis and are not approved to treat a woman who has already been diagnosed with the condition.

Sometimes, if estrogen has helped a woman, and she cannot take other options for preventing or treating osteoporosis, the doctor may recommend that she continue using hormone therapy. If you are considering taking hormone therapy to prevent osteoporosis, discuss the risks with your doctor.

PARATHYROID HORMONE

Teriparatide (Forteo) is approved for the treatment of postmenopausal women who have severe osteoporosis and are considered at high risk for fractures. The medicine is given through daily shots underneath the skin. You can give yourself the shots at home.

RALOXIFENE

Raloxifene (Evista) is used for the prevention and treatment of osteoporosis. Raloxifene is similar to the breast cancer drug tamoxifen. Raloxifene can reduce the risk of spinal fractures by almost 50%. However, it does not appear to prevent other fractures, including those in the hip. It may have protective effects against heart disease and breast cancer, though more studies are needed.

The most serious side effect of raloxifene is a very small risk of blood clots in the leg veins (deep venous thrombosis) or in the lungs (pulmonary embolus).

EXERCISE

Regular exercise can reduce the likelihood of bone fractures in people with osteoporosis. Some of the recommended exercises include:

• Weight-bearing exercises -- walking, jogging, playing tennis, dancing
• Resistance exercises -- free weights, weight machines, stretch bands
• Balance exercises -- tai chi, yoga
• Riding a stationary bicycle
• Using rowing machines

Avoid any exercise that presents a risk of falling, or high-impact exercises that may cause fractures.

DIET

Get at least 1,200 milligrams per day of calcium and 800 - 1,000 international units of vitamin D3. Vitamin D helps your body absorb calcium.Your doctor may recommend a supplement to give you the calcium and vitamin D you need.

Follow a diet that provides the proper amount of calcium, vitamin D, and protein. While this will not completely stop bone loss, it will guarantee that a supply of the materials the body uses to form and maintain bones is available.

High-calcium foods include:

• Cheese
• Ice cream
• Leafy green vegetables, such as spinach and collard greens
• Low-fat milk
• Salmon
• Sardines (with the bones)
• Tofu
• Yogurt

STOP UNHEALTHY HABITS

Quit smoking, if you smoke. Also limit alcohol intake. Too much alcohol can damage your bones, as well as put you at risk for falling and breaking a bone.

PREVENT FALLS

It is critical to prevent falls. Avoid sedating medications and remove household hazards to reduce the risk of fractures. Make sure your vision is good. Other ways to prevent falling include:

• Avoiding walking alone on icy days
• Using bars in the bathtub, when needed
• Wearing well-fitting shoes

MONITORING

Your response to treatment can be monitored with a series of bone mineral density measurements taken every 1 - 2 years.

Women taking estrogen should have routine mammograms, pelvic exams, and Pap smears.

RELATED SURGERIES

There are no surgeries for treating osteoporosis itself. However, a procedure called vertebroplasty can be used to treat any small fractures in your spinal column due to osteoporosis. It can also help prevent weak vertebrae from becoming fractured by strengthening the bones in your spinal column.

The procedure involves injecting a fast-hardening glue into the areas that are fractured or weak. A similar procedure, called kyphoplasty, uses balloons to widen the spaces that need the glue. (The balloons are removed during the procedure.)

Expectations (prognosis):

Medications to treat osteoporosis can help prevent fractures, but vertebrae that have already collapsed cannot be reversed.

Some persons with osteoporosis become severely disabled as a result of weakened bones. Hip fractures leave about half of patients unable to walk independently. This is one of the major reasons people are admitted to nursing homes.

Although osteoporosis is debilitating, it does not affect life expectancy.

Complications:

• Compression fractures of the spine
• Disability caused by severely weakened bones
• Hip and wrist fractures
• Loss of ability to walk due to hip fractures

Calling your health care provider:

Call your health care provider if you have symptoms of osteoporosis or if you wish to be screened for the condition.