Aging & Health A to Z
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
The best approach for treating age-related bone loss is always prevention. The main goal is to decrease the chance of a fracture. You can help keep your bones strong by getting your BMD tested when your healthcare provider recommends a scan. Exercise and diet are also important steps to take to decrease your risk of osteoporosis.
The Importance of Exercise
Research has shown that exercise makes bones stronger. It should be moderate to vigorous exercise done at least three times a week. Exercise can increase bone mass (BMD) and reduce fractures. It has been shown that women after menopause can strengthen hip bones and improve muscle and balance though weight-bearing exercises. These include walking, weight lifting, and other forms of strength and resistance training. Balance exercises can also reduce both falls and fractures.
Lack of exercise can make your bones weaker. This can be from an illness or a long period of bed rest. It is important to start exercising as soon as possible after being on bed rest, and to go into a rehabilitation program whenever one is available.
If you have osteoporosis, talk to your healthcare provider before starting any type of exercise program, to make sure it won’t be harmful. You may be referred to a physical therapist to help you learn exercises designed for you.
Weight-bearing exercises: In this type of exercise, you remain upright and work 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 exercises are especially effective. These include dancing, climbing stairs, jogging, hiking, playing tennis, or other active sports. However, if you’ve already been diagnosed with osteoporosis or have broken a bone, check with your healthcare provider 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 work against gravity or against another form of resistance. You can use weights or weight machines, elastic exercise bands, or your own body. 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 straighten rounded shoulders and reduce the risk of spine fractures
- exercises that help you carry out your daily activities in the safest way possible (which can help to avoid a fall)
Importance of Diet
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 foods rich in calcium. As you get older, it is harder to digest high-calcium dairy products such as milk, cheese, yogurt, or ice cream. This is because aging may increase the chance of developing lactose intolerance (when your body can’t process the sugars that are naturally part of dairy products).
If you are over age 50, most healthcare professionals recommend taking at least 1,200 mg of calcium every day. The best way to reach this total is to consume calcium-rich foods such as dairy products. Many other foods can also supply significant amounts of calcium. If you can’t get enough calcium in your diet you can also take calcium supplements, 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 supplements are absorbed best in divided doses (for example, 600 mg at a time).Calcium citrate can be absorbed efficiently without food, whereas calcium carbonate is best absorbed with food.
The following is a list of some foods that are high in calcium, including their calcium content:
- Sardines in oil with bones: 370 mg in each 3 ounce serving
- Orange juice with added calcium: 300 mg in each cup
- Yogurt: 320 mg in each cup
- Milk: 300 mg in each cup
- Swiss cheese: 260 mg in each slice
- Kale: 200 mg in each cup (cooked)
- Canned salmon with bones: 190 mg in each 3 ounce serving
- Broccoli: 170 mg in each cup
- Tofu (soybean curd): 150 mg in each 4 ounce serving
- Ice cream: 100 mg in each cup
- Egg: 55 mg in a medium-size egg
- Powdered nonfat milk: 50 mg in each teaspoon
Many lactose-free dairy products are now available, including milk (Lactaid™), and ice cream. Certain aged cheeses (such as very sharp cheddar) and yogurts are naturally low in lactose. Some varieties of orange juice and cranberry juice have added calcium and provide the same amount of calcium as a glass of milk.
You should not take more than 2,000 to 2,500 mg of calcium a day in the form of supplements. This raises your risk of developing kidney stones, especially for postmenopausal women. However, dietary sources of calcium may lower your risk of kidney stones.
Your body needs this “sunshine” vitamin in order to absorb calcium. Normally, vitamin D is formed in our skin from direct exposure to sunlight. But there are a number of factors that prevent enough skin production of vitamin D:
- increased sunscreen use
- not enough skin exposure during the winter
- skin changes as we age that reduce vitamin D formation
- spending less time outdoors as we get older
You can make up for the lack of adequate production in your skin by getting extra vitamin D. You can do this by eating foods with added vitamin D such as fortified milk, bread, and juices. You can also take supplements. The current daily recommended dose of vitamin D is 800-1,000 international units (IU). However, higher amounts may be prescribed if your vitamin D levels are found to be low. Your healthcare provider may recommend a blood test to check the vitamin D level in your blood. At the minimum, a serum level of 30 ng/ml (75 nmol/L) is usually considered optimal for keeping bones healthy.
Treatment with medications is appropriate for older adults who have one of the following:
- already suffered a fracture of the hip or a bone of the spine
- a BMD T-score of less than -2.5
- a BMD T-score between -1 to -2.5, which is considered osteopenia. Treatment with medications is appropriate if this T-score is accompanied by more than 3% probability of a hip fracture or more than 20% risk of any fracture over the next 10 years
Recommended medications to treat bone loss
A variety of medications are now available to treat bone loss. Your healthcare provider will prescribe medications based on your medical status, the degree of your disease, and other risk factors. The medications that are often prescribed include:
- Bisphosphonates. These medications slow 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 (the “swallowing tube” that connects the throat to the stomach). To reduce these side effects, you need to remain upright for at least half an hour after taking the pill, without eating during that time. It also may increase your tolerance if you take the medications weekly, monthly, or intravenously, instead of every day. 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) act like estrogen to some degree but do 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. It is used to treat men or women at high risk of fractures. Teriparatide is the only treatment that encourages new bone growth. It is injected under the skin daily for a maximum of two years.
- Calcitonin (Miacalcin or Fortical). This hormone is naturally produced in your thyroid gland. It can slow down bone loss, reduce spine fractures, and may manage the pain of spinal fractures. However, it is not as effective as the bisphosphonates. It is taken as a nasal spray or less commonly as a shot.
Follow directions exactly for taking osteoporosis medications. This will reduce the risk of side effects.
Osteoporosis and long-term corticosteroid treatment
A common cause of osteoporosis is long-term treatment with oral corticosteroids. (Inhaled corticosteroids have not been as well studied. However, high doses of high-potency inhaled steroids can also result in bone loss.) Bone loss is most rapid during the first 6 to12 months of corticosteroid therapy. The increase in fracture risk begins within 3 months of starting therapy. This is before there is any noticeable decline in BMD. At higher BMD values, fractures occur.
If you need long-term corticosteroid therapy (3 or more months), the best strategy is to maximize bone health. A variety of interventions can help:
- Use the lowest possible dosage of corticosteroids.
- Make sure you get enough calcium and vitamin D.
- Have your BMD monitored regularly.
- Start prescription osteoporosis therapy when you start corticosteroid therapy.
The U.S. Food and Drug Administration (FDA) has approved medications for the prevention and treatment of corticosteroid-induced bone loss. The only medications approved for this are bisphosphonates and the anabolic steroid teriparatide.
Osteoporosis and androgen deprivation therapy
Men who are in treatment for prostate cancer may be prescribed androgen deprivation therapy. This therapy causes hypogonadism, which means that the man’s testicles function at a lower level than normal. Hypogonadism is a recognized risk factor for osteoporosis in men. Men who are at high risk for fractures should be prescribed a treatment called anti-resorptive therapy. These include the medications bisphosphonates or denosumab. They should be prescribed at the beginning of androgen deprivation therapy.
Estrogen: no longer generally recommended
Women reaching menopause used to be prescribed the female hormone estrogen (alone or combined with progesterone). This was to prevent bone loss. However, it is now rarely used because of recent findings linking it to increased risks of health issues. These include deep vein thrombosis (blood clots), endometrial cancer, breast cancer, and possibly heart disease. The medications 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 Medication Treatments
Although no other medications 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 medication 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: November 2017
Posted: March 2012