Osteoporosis Treatment Options

The key to good osteoporosis care is understanding the causes of osteoporosis and knowing the risks of bone fractures. Having a DEXA bone mineral density test reveals important information on your risk for osteoporotic fractures (see Osteoporosis Symptoms).

Osteoporosis treatment  includes exercise and the right amount of calcium in the diet. Calcium supplements may be necessary if your diet is not providing enough calcium to keep your bones strong. Taking too much calcium, however, may increase the risk of kidney stones. Vitamin D helps your body absorb calcium. Older men and women probably should take vitamin D supplements. Younger men and women may need to take vitamin D supplements, too. It is very important to consult a physician on Vitamin D usage since serious problems can result from unwise use.

A well-balanced diet with calcium-rich foods, plus calcium and vitamin D supplements, however, may not be enough to protect bones and prevent the development of osteoporosis symptoms in all people. Each individual’s health and family history are different so the risk profile for breaking bones differs for each individual. Some people may need to take medications for osteoporosis treatment.

For Women:

The U.S. Food and Drug Administration (FDA) has approved several medications for preventing and treating osteoporosis. These drugs include:

Bisphosphonates: Alendronate, Risedronate, Ibandronate, Zoledronic acid

Bisphosphonates — which inhibit the breakdown and removal of bone — are used to prevent and treat post-menopausal osteoporosis by slowing bone loss while increasing bone mass. Alendronate and risedronate have been shown in clinical trials to reduce the risk of spine, non-spine, and hip fractures. Ibandronate has been shown to reduce only the risk of spine fractures. Zoledronic acid reduces the risk of spine, nonvertebral and hip fractures.

Alendronate and risedronate have also been approved for the treatment of steroid-induced osteoporosis in men and women who require long-term use of medications to treat inflammatory conditions (the use of such medications are one of the causes of osteoporosis in some individuals).  Alendronate and risedronate have been approved to treat osteoporosis in men, as well.

If you are taking a bisphosphonate, you should take the drug upon arising in the morning after an overnight fast, with one full glass of water. Stay in an upright position after taking the dose.

If you are taking alendronate or risedronate, do not drink or eat anything else for the following 30 minutes to permit your body to absorb the medication. If you are taking ibandronate, you must wait 60 minutes to eat or drink anything for the same reason.

Side effects for bisphosphonates are uncommon, but may include abdominal, bone, or muscle pain. These medications may also cause nausea or heartburn. Irritation of the esophagus may occur with the tablet forms of this medication.

Relatively high-dose, long-term bisphosphonate therapy by vein, which might be administered during cancer treatment, for example, has been linked to osteonecrosis or degeneration of the jaw bone. This problem tends to arise most frequently after dental operations. There is some concern that degeneration of the jaw may also develop after relatively low-dose, long-term bisphosphonate treatment by mouth. This is an area of active research investigation. Bisphosphonates are not recommended for pre-menopausal women who may become pregnant.

Calcitonin

Calcitonin is a naturally-occurring hormone made by specialized cells in the thyroid gland. Together with parathyroid hormone, calcitonin helps to regulate calcium levels in the body. This hormone can be given as a medication and, as such, it has been shown to reduce the risk of spinal fractures — but not the risk of non-spinal or hip fractures.

Most commonly, this medication is used as a nasal spray. Calcitonin’s actions are highly specific for the bone. It does not affect other organs or systems in the body. Side effects from nasal calcitonin are uncommon, but may include nasal irritation, backache, bloody nose, and headaches. If given as an injection, calcitonin may cause an allergic reaction and side effects including flushing in the face and hands, urinary frequency, nausea, and a skin rash.

Selective Estrogen Receptor Modulators (SERMs): Raloxifene

Raloxifene is approved for preventing and treating osteoporosis in post-menopausal women. It is from a class of drugs called selective estrogen receptor modulators (SERMs). These estrogen-like medications were developed to benefit the bone, while avoiding the potential risks associated with estrogen.

Raloxifene increases bone density and reduces the risk of spine fractures, but it has not been shown to decrease the risk of non-spinal fractures. Some studies have shown that raloxifene may also decrease the risk of breast cancer, but the issue is still under active investigation.

Raloxifene is taken in pill form, once a day, with or without meals. While uncommon, side effects may include hot flashes, leg cramps, or blood clots in the legs or lungs. Raloxifene hormone therapy is not recommended for pre-menopausal women.

Teriparatide

Teriparatide is a fragment or portion of the full parathyroid hormone molecule. This is a naturally-occurring hormone that is involved in calcium regulation. Teriparatide treatment stimulates new bone formation, rather than simply preventing bone breakdown. It is approved for men and women with severe osteoporosis, who have a high risk of a fracture.

Teriparatide is given as a daily, self-administered injection for up to two years. Side effects are uncommon but may include leg cramps, headaches, and dizziness. This medication is not recommended for pre-menopausal women.

Estrogen

Estrogen can be taken alone or in combination with a progestin.

Estrogen hormone therapy prevents bone loss and reduces the risk of fracture in the spine and hip. It can also relieve other symptoms of menopause, such as hot flashes and vaginal dryness. Estrogen is usually given in pill form, although it may be given as a skin patch, combined with a progestin, to reduce the risk of cancer of the uterus.

If your uterus has been surgically removed, you do not need to take a progestin with the estrogen. If you are at risk for breast cancer, however, or have had cancer of the uterus, estrogen may not be right for you. Based on recent studies, estrogen should be used in as low a dose, for as short a time, as necessary, to relieve menopause symptoms.

When estrogen is prescribed solely for post-menopausal osteoporosis, a woman and her doctor should carefully consider approved non-estrogen treatments. According to the FDA, estrogens and combined estrogen-progestin products should only be considered for women with a significant risk of osteoporosis that outweighs the risks of the drug. In addition to increasing the risk of blood clots in the legs or lungs, as mentioned earlier, estrogen may also trigger vaginal bleeding, breast tenderness, mood disturbances, and gall bladder disease.
Each of these medications has certain benefits and side effects. You should work with your doctor to find the treatment that is right for you. To find an endocrinologist, please visit our physician referral directory.

For Men:

Alendronate, risedronate, and teriparatide have been approved to treat osteoporosis in men. Although there are fewer studies in men, the effects of these agents on bone mass indicate they may be helpful in treating men with osteoporosis.

The question of whether testosterone supplementation is useful for treatment of osteoporosis in men remains controversial. In men who clearly have low levels of testosterone, treatment with testosterone appears to increase bone density.

Because testosterone levels tend to decline with age, many older men have testosterone levels that are low. Testosterone supplements may improve bone mineral density in these men as well, but the doses necessary and the best way to administer this osteoporosis treatment are unclear. There is no information about whether testosterone treatment in men is effective in reducing fracture risk.

Finally, the risks of long-term testosterone treatment in older men are unknown. At present, it is generally not recommended that testosterone be used as the primary osteoporosis treatment for men. It is important to remember that the approved osteoporosis treatments for men (alendronate, risedronate, and teriparatide) seem to be effective in men with low testosterone levels.