Aging & Health A to Z

Osteoporosis

Care & Treatment

Osteoporosis treatment can:

• slow down bone loss or even improve bone density
• lower the risk of fractures
• reduce the risk of falls.
• reduce the pain of osteoporosis and help in pain management.

Non-Drug Strategies for Treatment and Prevention

When we think of treatment for age-related bone loss, the best approach is always prevention and the main goal is a to decrease the chance of a fracture. You can keep your bones strong by by getting your BMD tested when your healthcare professional recommends a scan and taking steps to decrease your risk of osteoporosis through exercise and diet.

The Importance of Exercise
Research has shown that moderate to vigorous exercise at least three times a week makes bones stronger. Exercise it can increase bone mass (BMD) and reduce fractures. Weight-bearing exercises such as walking, weight lifting and other forms of strength and resistance training strengthen hip bones and improve muscle and balance in women after menopause. Balance exercises can also reduce both falls and fractures.

Lack of exercise (from an illness or a long period of bed rest) can make your bones weaker. It is important to start exercising as soon as possible after being bedridden, and going into  a rehabilitation program whenever one is available.

Weight-bearing exercises: In this type of exercise, you remain upright, working against gravity to strengthen muscles and put healthy stress on your bones. Try to do 30 minutes total of weight-bearing exercise most days of the week. Breaking up the 30 minutes works just as well.

• High-impact weight-bearing exercise, such as dancing, climbing stairs, jogging, hiking, playing tennis or other active sports are especially effective. However, you’ve already been diagnosed with osteoporosis or have broken a bone, check with your healthcare professional first. This type of exercise may be too hard and may actually cause a fracture.
• Low-impact weight-bearing exercises include fast walking (including treadmill walking), low-impact aerobics, or using an elliptical training machine or a stair-step machine. This type of exercise will also strengthen bones and does not increase the risk of a fracture during exercise. 

Muscle-strengthening or “resistance” exercises: In this type of exercise, you use weights or weight machines, elastic exercise bands, or your own body to work against gravity or against another form of resistance. The exercises should be done two or three times per week. Yoga and Pilates use many resistance techniques, and may be very helpful. However, if your bones have lost significant mass, these programs may be harmful. Check with your healthcare provider or physical therapist to make sure that your exercise is the right kind for your type of bones.

Non-impact physical activities: Other exercise approaches can help prevent falls and fractures. These exercises should be done every day. These include:

• balance exercises including Tai Chi and yoga
• posture exercises that reduce the risk of spine fractures by straightening rounded shoulders
• functional exercises for carrying out your daily activities in the safest way possible to avoid the chance of a fall.

Importance of Diet

Calcium
Our bones need calcium more than any other mineral. Calcium is the main building block for our bones and teeth. Our bodies lose calcium every day, so it is important to eat foods high in calcium

Many older people tend to eat fewer calcium-rich foods. As you get older, it is harder to digest high-calcium dairy products (milk, cheese, yogurt, ice cream) because of an increased milk sugar (lactose) intolerance that often comes with aging.

Most healthcare professionals recommend taking at least 1,200 mg of calcium every day if you are over age 50. The best way to reach this total is to consume calcium-rich foods such as dairy products, but many other foods can supply significant amounts of calcium. If you can’t get enough in your diet you can also take calcium supplements as well, which are inexpensive and readily available. These supplements may be in the form of calcium carbonate (more common) or calcium citrate (slightly more expensive but more easily digested).

The following is a list of some foods that are high in calcium, with their calcium content:

• Sardines in oil with bones: 370 mg per 3 oz
• Orange juice with added calcium: 300 mg per cup
• Yogurt: 320 mg per cup
• Milk: 300 mg per cup
• Swiss cheese: 260 mg per slice
• Kale: 200 mg per cup (cooked)
• Canned salmon with bones: 190 mg per 3 oz
• Broccoli: 170 mg per cup
• Tofu (soybean curd): 150 mg per 4 oz 
• Ice cream: 100 mg per cup
• Egg: 55 mg per medium-size egg
• Powdered nonfat milk: 50 mg per teaspoon.

Many lactose-free dairy products are now available, including lactose-free milk (Lactaid™), and ice cream. Certain old cheeses (such as very sharp cheddar) and yogurts are also lactose-free. Some varieties of orange juice and cranberry juice are fortified with calcium and provide the same amount of calcium as a glass of milk.

Vitamin D
Your body needs this “sunshine” vitamin in order to absorb calcium. Normally, vitamin D is formed in our skin from to direct exposure to sunlight. But there are a number of factors that prevent adequate skin production of vitamin D:

• increased sunscreen use
• inadequate skin exposure during the winter
• skin changes as we age that reduce vitamin D formation
• less time spent outdoors as we get older.

You can make up for the lack of adequate production in your skin by consuming foods with added vitamin D such as  fortified milk, bread, and juices and through supplements. The current daily recommended dose of vitamin D  is 800-1,000 international units (IU) of vitamin D3 (cholecalciferol) or vitamin D2 (ergocalciferol) but higher amounts may be prescribed if your vitamin D levels are found to be low.  Your healthcare professional may recommend a blood test to check the vitamin D level in your blood. A serum level below 30 ng/ml (75 nmol/L) is usually considered a minimum level for keeping bones healthy.

Drug Treatments

Drug treatment is appropriate for the older adults who have:

• already suffered a fracture of the hip or a bone of the spine
• a  BMD T-score of less than -2.5 when measured by bone density x-ray
• a  BMD T-score between -1 to -2.5 (osteopenia classification) plus more than 3% probability of a hip fracture or more than 20% risk of any fracture over the next 10 years (following the World Health Organization’s model for osteoporotic fracture risk).

Recommended drugs to treat bone loss
A variety of medications are now available to treat bone loss. Your healthcare professional will prescribe a medication regimen based on your degree of disease, other risk factors, and your medical status. The drugs that are often prescribed include:

• Bisphosphonates: These drugs inhibit bone breakdown, preserve bone mass, and even increase bone density in some cases. They include alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva) and zolendronic acid (Reclast).  These drugs may cause nausea, abdominal pain, difficulty swallowing, and an irritated or ulcerated esophagus (swallowing tube). To reduce such side effects, you need to remain upright for at least half an hour after taking the pill, and do not eat for that time. Taking it weekly, monthly, or intravenously instead of every day may also increase your tolerance. Other reported side effects include osteonecrosis (bone breakdown) in the jaw, thigh fracture, irregular heartbeats or fainting and visual disturbances.
• Selective estrogen receptor modulators (SERMs) such as raloxifene (Evista) mimics estrogen to some degree but does not carry estrogen’s risks of uterine and breast cancer. It is normally only recommended for women. It is taken by mouth, and may cause hot flashes. If you have had blood clots, you must avoid this medication.
• Teriparatide (Forteo) is a form of parathyroid hormone and is used to treat men or women at high risk of fractures. Teriparatide is the only treatment that encourages new bone growth, and is injected under the skin daily for a maximum of two years.
• Calcitonin: (Miacalcin or Fortical). This hormone that is naturally produced in your thyroid gland can slow down bone loss, reduce spine fractures, and may manage the pain of spinal fractures, although it is not as effective as the bisphosphonates. It is taken as a nasal spray or less commonly as a shot. 

Estrogen: no longer generally recommended

The female hormone, estrogen (alone or combined with progesterone) used to be prescribed to most women upon reaching menopause to prevent bone loss. However, it is now rarely used because of recent findings linking it to increased risks of blood clots (deep vein thrombosis), endometrial cancer, breast cancer, and possibly heart disease. The drugs listed above are now considered “first-line” osteoporosis treatments instead. If you are considering taking hormone therapy, or are already taking it, discuss the risks with your healthcare provider.

Other Drug Treatments

Although no other drugs have been approved to treat osteoporosis, research is ongoing. One recent report suggested that nitroglycerin, available as a skin patch, may stimulate bone growth. This drug has been available for many years as a treatment for heart disease and is known to be safe when used appropriately. More research is needed in its use in treating osteoporosis. But, early research findings are encouraging.

Updated: March 2012
Posted:  March 2012