September 2008 - Vol 3 Issue 9

I Have Osteoporosis – Now What?
Exploring osteoporosis treatment
by Michelle Gibeault Traub, R.D.

Learning you have a disease is frustrating, overwhelming, and even scary. This is especially true for those who are diagnosed with osteoporosis, a disease that develops gradually over time with very few symptoms or warning signs. Frequently patients are shocked to learn that a routine bone density scan has uncovered the weak, porous bones that characterize this disease. Although this initial shock and fear can be somewhat paralyzing, if you have been diagnosed with osteoporosis or osteopenia it is important to understand that you must take action because early treatment prevents further bone loss.

The Biology of Bone Loss

Any diagnosis is bound to have you asking “How did this happen?” Although there are many osteoporosis risk factors, to fully understand how bone loss occurs it helps to understand how bones work. Bone cells are surprisingly active. Bone tissue is constantly being broken down in a process called resorption and also being rebuilt. In childhood the rebuilding process is more active as our bones grow and our bone density increases. However, as we age, the resorption (breakdown) process tends to take over. This is especially true in women who have decreased estrogen levels due to menopause. When resorption occurs at a rapid pace one of the only ways to stop it is through medication.

Osteoporosis Medications

The primary class of medications prescribed to treat osteoporosis is called “antiresorptive medication.” This means that the drugs in this category hinder the bone resorption or breakdown process. There are several types including:   

• Bisphosphonates - These are the most commonly prescribed osteoporosis drugs with well-known brand names such as Fosamax, Boniva, Actonel, and Reclast. Although these medications all work in a similar fashion they have different modes of delivery varying from daily, weekly, or monthly pills, to a yearly infusion. Side effects also vary depending on how the medication is delivered, but can include bone, joint, or muscle pain, nausea, difficulty swallowing, gastric ulcer, and in rare cases death of jaw tissue. 



• Calcitonin – This is a hormone responsible for regulating calcium levels in the body. It is recommended for women who are at least 5 years past menopause, and has been shown to slow down bone loss and increase bone density in the spine. Sold as Calcimar or Miacalcin it is available as an injection or a nasal spray. Injections can cause allergic reactions, flushing, nausea, and a rash, while the nasal spray can result in bloody nose, headache, or back pain.



• Estrogen – Due to its protective role in maintaining bone density, estrogen seems to be an obvious treatment option for postmenopausal women. However, estrogen increases the risks for endometrial cancer. As a result, it is only a viable option for women who have had a hysterectomy. (For more on hormone replacement see “The Maddening State of Menopause”)



• Selective Estrogen Receptor Modulators (SERMs) – Raloxifene (Evista) seems to offer the benefits of estrogen without many of the risks. It has been shown to increase bone density and reduce the risk of spinal fractures. Side effects are uncommon but can include hot flashes, leg cramps, or blood clots. Women who have had a stroke or heart attack should not take Raloxifene. (For more information on Raloxifene see “The Breast Cancer / Bone Health Connection”)    

While the majority of osteoporosis drugs focus on preventing bone loss, one in particular works on bone formation. It is in the drug class “anabolic medication” and is called:

• Parathyroid Hormone (Teriparatide/Forteo) – Generally reserved for individuals with advanced osteoporosis or anyone who has had fractures, this is the only medication that can actually rebuild bone. Patients on this treatment must give themselves a daily injection of the hormone. Side effects include leg cramps and dizziness.

The Ultimate Plan for Preventing Bone Loss

While medication may be essential for reversing or slowing osteoporosis, a healthy lifestyle is just as crucial to preventing bone loss. The following tips will insure you are maximizing your bone health:

• Get plenty of calcium and vitamin D every day through calcium supplements or calcium-rich foods, and vitamin D supplements or sun exposure.


• Participate in daily exercise such as walking, yoga, dancing, or strength training.


• Limit alcohol since more than 1 drink per day can take calcium from the bones and also impair balance which can lead to falls.


• Quit smoking to prevent further bone loss.

Although osteoporosis may seem scary at first, by working with your physician, taking osteoporosis medications when needed, and making valuable lifestyle changes, you can prevent further bone loss and decrease your risk for fractures.

References

Mayo Clinic Staff. Osteoporosis treatment puts brakes on bone loss. MayoClinic.com. retrieved 9/8/08. LINK

National Osteoporosis Foundation. Medications To Prevent & Treat Osteoporosis. NOF.org. retrieved 9/8/09. LINK

Healthwise. Osteoporosis Health Center: Osteoporosis – Medications. WebMD.com. retrieved 9/8/08. LINK

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