Osteoporosis

Care & Treatment

Osteoporosis treatment can:

  • Slow down bone loss or 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 reducing the risk of a bone fracture. Improving exercise and diet are important first steps. 

The Importance of Exercise

Exercise makes bones stronger. Consider:

  • Exercising three times a week at a moderate to high intensity.
  • Doing weight bearing exercise, like walking and strength training.
  • Doing balance exercises, which can reduce both falls and fractures.
  • Exercising or moving around as soon as possible after being on bed rest
  • Doing a rehabilitation program, if needed.

If you have osteoporosis, talk to your healthcare provider before starting any type of exercise so you don’t get hurt. You may need to see a physical therapist to learn the exercises that work for you.

Weight-Bearing Exercises

This type of exercise works against gravity to strengthen muscles and put healthy stress on your bones. Try to do 30 minutes of this exercise most days of the week. You do not need to do it all at once. Breaking up the 30 minutes throughout the day works just as well.

There are two types of weight-bearing exercises:

  • High-impact weight-bearing exercises are especially helpful. They include dancing, climbing stairs, jogging, hiking, playing tennis, or other active sports. However, if you have osteoporosis or have broken a bone, check with your healthcare provider about safety first. High-impact exercise could 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

These exercises work against gravity or against another form of resistance. They can use weights, 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. If your bones have lost significant mass, these forms of exercise may harm you.

Check with your healthcare professional or physical therapist to make sure that your exercise choices will not harm you.

Non-Impact Physical Activities

Other types of exercises can help prevent falls and fractures. These exercises need to be done daily. They 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 do your daily activities in the safest way possible (which can help to avoid a fall)

Importance of Diet

Calcium

Bones and teeth need calcium more than any other mineral because it is their main building block. 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. This is often because milk, cheese, or yogurt become harder to digest. Older adults are more likely to have problems digesting  lactose (a sugar found in milk). Many lactose-free dairy products are now available, including milk and ice cream. Certain aged cheeses (such as very sharp cheddar) and yogurts are naturally low in lactose.

Most healthcare professionals recommend getting at least 1,200 mg of calcium every day. The best way to get enough calcium is to eat calcium-rich foods such as dairy and leafy, dark greens. Many other foods can also have a lot of calcium. They include.

  • Sardines in oil with bones and Canned salmon with bones
  • Yogurt and milk
  • Kale and broccoli
  • Tofu

Calcium supplements are inexpensive and readily available. The supplements are absorbed best in divided doses (for example, 600 mg at a time).

  • Calcium citrate can be absorbed efficiently without food
  • Calcium carbonate is best taken with food

You should not take more than 2,500 mg of calcium daily from supplements. If you do, you raise your risk of developing kidney stones, especially women who have had menopause. Dietary sources of calcium may lower your risk of kidney stones.

Vitamin D

Your body needs this “sunshine” vitamin to be able to use calcium. Normally, the body makes vitamin D when skin gets direct exposure to sunlight. Risks of not getting enough vitamin D are related to:

  • Increased sunscreen use
  • Not enough skin exposure to sunlight
  • Skin changes as we age that reduce production of vitamin D
  • Spending less time outdoors with age

You can get extra vitamin D by:

  • Eating foods with added vitamin D such as fortified milk, bread, and juices.
  • Taking supplements. The current recommended daily dose of vitamin D is 800-1,000 international units (IU). 
  • Your health care professional may recommend higher amounts if your vitamin D levels are too low.
  • Your healthcare provider may ask you to take a blood test to check the vitamin D level in your blood.

Medication Treatments

Treatment with medications is appropriate for older adults who have:

  • Already had a broken hip or a bone in the spine.
  • A bone mineral density (BMD) T-score of less than -2.5.
  • A BMD T-score between -1 to -2.5, which is considered osteopenia. Medication treatment may be appropriate. This depends on a combination of the T-score and a person’s evaluation by the fracture risk assessment tool (FRAX).

Several medications are available to treat bone loss.

You need to talk to your healthcare professional if you have any side effects. If you develop new jaw, groin, or thigh pain, you need to report this to your healthcare professional. 

Bisphosphonates

These medications slow bone breakdown and preserve bone density. They may increase bone density in some cases. Some examples of biophosphonates include: alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva) and zoledronic acid (Reclast). They come in pill and IV forms.

Side effects from this medication include nausea, abdominal pain, difficulty swallowing, and an irritation or ulcer in the esophagus (the “swallowing tube” that connects the throat to the stomach).

  • To reduce side effects, stay upright for at least half an hour after taking the pill, without eating during that time. It is better if you take the pills weeklyor monthly instead of every day. The intravenous forms of these drugs are given every 4 months or once a year.

Rare side effects of biphosphonates include osteonecrosis (bone breakdown) of the jaw and thigh fracture. These side effects can happen if you take a high dose of the drug.

Denosumab

This medication is a monoclonal antibody. It works to slow bone breakdown and increase bone mineral density. It comes in a shot, usually given once every 6 months.

Side effects can include a reaction at the injection site, low calcium levels, and eczema. Very rare side effects include osteonecrosis (bone breakdown due to infection) of the jaw and thigh fracture. These side effects generally happen at high doses.

Parathyroid Hormone Analogues

Teriparatide (Forteo) and Abaloparatide (Tymlos) are forms of parathyroid hormone. They are used to treat people with severe osteoporosis who are at high risk of fractures.

These are the only treatments that encourage new bone growth. They are injected under the skin daily for a maximum of two years. Possible side effects include high calcium levels, injection site reaction, nausea, and fatigue.

Selective Estrogen Receptor Modulators (SERMs)

SERMS such as raloxifene (Evista) act like estrogen to some degree but do not carry estrogen’s risks of uterine and breast cancer. One of the FDA-approved uses of SERMs is to treat osteoporosis in postmenopausal women.

These drugs are taken by mouth daily. Side effects can include hot flashes, blood clots, leg cramps, swelling of the legs, and, rarely, stroke.

Calcitonin

Calcitonin (Miacalcin or Fortical) is a thyroid hormone that slows bone breakdown. However, it is not as effective as bisphosphonates or denosumab. It is taken as a nasal spray, or less commonly as a shot. It is sometimes used for pain relief after a spine fracture.

Follow all directions when taking osteoporosis medications. This will reduce the risk of side effects.

Problems with Taking Estrogen for Osteoporosis

Women reaching menopause used to take the female hormone estrogen (alone or combined with progesterone) to prevent bone loss. However, research shows that estrogen is linked to health problems including:

  • Deep vein thrombosis (blood clots)
  • Endometrial and breast cancer
  • Heart disease

If you are considering taking hormone therapy, or are already taking it, discuss the risks with your healthcare provider.

Osteoporosis and Treatment for Other Health Problems

Long-Term Corticosteroid Treatment

A common cause of osteoporosis is long-term treatment with oral corticosteroids, especially high levels of the inhaled version of the drugs.

Bone loss happens quickly 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 on BMD tests.

If you need long-term corticosteroid therapy (3 or more months), the best strategy is to maximize bone health.

  • Use the lowest possible dosage of corticosteroids.
  • Get enough calcium and vitamin D.
  • Have your BMD monitored regularly.
  • Start prescription osteoporosis therapy when you start long-term corticosteroid therapy.

The FDA approved bisphosphonates, denosumab, and teriparatide for preventing and treating bone loss due to use of corticosteroids.

Androgen Deprivation Therapy

Men who have treatment for prostate cancer may take medication that lowers their testosterone levels. This is called androgen deprivation therapy. This therapy causes a man’s testicles to operate at a lower level than normal (hypogonadism). This raises the risk of osteoporosis in men.

Treatments for men who have a high risk for fractures include bisphosphonates or denosumab.  These drugs should begin when androgen deprivation therapy begins.

 

Last Updated December 2022