Osteoporosis Treatment

What is Osteoporosis?

Osteoporosis is characterized by decreased bone density and increased fragility.  This condition most often affects postmenopausal women but may also occur in elderly men and in the setting of other diseases.  Osteoporosis usually does not cause symptoms in of itself, but can lead to an increased risk for bone fractures.

In fact, elderly patients with osteoporosis often develop hip fractures after falls – this is a very debilitating complication of osteoporosis that can result in impaired mobility and inability to carry out daily activities.  Patients with hip fractures are also at an increased risk for blot clot development in the legs – which can travel to the lungs and result in death.

Since this is such a common condition and may affect quality of life, it is important to become educated about its causes, diagnosis, and treatment.  By the end of this article, you will be able to answer the following important questions:

What causes Osteoporosis?

Osteoporosis occurs due to decreased bone mineral density.  This may occur in postmenopausal women as a result of decreased estrogen levels.  It may also affect elderly men with low testosterone levels.  The disease often runs in families and has a genetic basis. Other conditions that may lead to osteoporosis include:

  • Smoking
  • Chronic alcohol use
  • Overactive thyroid (hyperthyroidism)
  • Nutritional deficiencies – low calcium and vitamin D
  • Medications – long-term use of corticosteroids (eg. prednisone) or proton-pump inhibitors (e.g. Prilosec)

When the bones become thin and fragile, they are susceptible to fracture – this is especially common in the hip, spine, and arms.

How common is Osteoporosis?

Osteoporosis is a very common condition that mostly affects postmenopausal women.  Approximately 16% of American women aged 50 or greater have osteoporosis of the hip or lower spine.  In contrast, about 4% of men aged 50 or greater have hip or low back osteoporosis.

The risk of hip fracture in patients with osteoporosis increases with age. African American persons have higher bone density and a lower risk of fractures compared to Caucasian, Hispanic, or Asian populations.

What are the symptoms and signs of Osteoporosis?

Osteoporosis usually does not produce symptoms in of itself.  However, people are at risk for bone fracture since the bones are more fragile – this is especially common after trauma or falls.  This most common sites of osteoporosis include the:

  • Spine – compression fracture of the vertebrae
  • Hip – fractures of the hip/thigh, especially after falls
  • Forearms – radial bone fracture (Colle’s fracture) when falling on an outstretched arm

In severe cases, osteoporosis may result in bone fractures in the setting of seemingly mild trauma or overuse of the joint.

How is Osteoporosis diagnosed?

Osteoporosis is diagnosed based on a DEXA scan (dual-energy x-ray absorptiometry).  This is a type of bone scan that evaluates bone density.  Patients will receive a T-score based on their bone density in comparison to young health controls.  Scores between negative 1.5-2.5 are diagnostic of osteopenia – or mild thinning of the bone.  Scores less than -2.5 are diagnostic of osteoporosis.

Plain x-rays may also show evidence of bone thinning and osteopenia, although this is not the preferred study to make the diagnosis.

Your doctor will likely order blood tests, including a comprehensive metabolic panel, calcium, phosphate, vitamin D, PTH (parathyroid hormone), TSH (thyroid stimulating hormone), and thyroid hormone levels.  They may also check testosterone levels in men.

How is Osteoporosis treated?

Osteoporosis is first treated by reversing its secondary causes.  This includes smoking cessation, avoiding alcohol, and treating disease such as hyperthyroidism.

Patients are also encouraged to perform weight-bearing activity such as walking – this promotes bone formation and improves bone density. Non-weight bearing exercise is not particularly beneficial for osteoporosis.

Your doctor will also likely recommend adequate intake of calcium and vitamin D to maintain proper bone health.  The recommended daily intake of calcium is about 1000mg.  Most experts recommend that patients also receive about 800-1000 U of vitamin D daily.  Vitamin D is usually supplemented in the form of vitamin D3 (ergocalciferol).

There are many over-the-counter supplements that include a combination of calcium and vitamin D.  However, if you have vitamin D deficiency, your doctor will likely prescribe a higher dose of ergocalciferol – one common prescription is 50,000 IU per week for 6 weeks.

Patients with low bone mineral density may also benefit from a class of medications called bisphosphates.  Bisphosphates are usually reserved for patients with osteoporosis and those with osteopenia and other risk factors (eg. family history, prior history of hip fracture, long term corticosteroid use).

These medications work by promoting bone growth and increasing bone density. Some of the most commonly prescribed drugs include:

Your doctor may also recommend a newer medication called Prolia (denosumab).

Oral bisphosphonates should generally be used with caution in patients with gastrointestinal reflux disease as it can worsen reflux symptoms.  Studies show that a minority of patients using bisphosphonates can develop an increased risk of atypical fractures and jaw necrosis.  The benefits of bisphosphonate therapy – reduced risk of hip fracture – likely outweighs the risk of its use, especially in patients with severe disease.

Osteoporosis Patient Summary:

  • Osteoporosis is a highly prevalent condition, particularly in postmenopausal women
  • The disease is characterized by decreased bone mineral density and a higher risk for bone fractures
  • Osteoporosis typically affects the elderly and is caused by genetic and environmental factors – smoking, alcohol use, certain medications (eg. corticosteroids)
  • The most commonly involved sites include the spine, hip, and arms – although any bone can be affected
  • Patients may have no symptoms but can develop pain and functional disability in the setting of bone fractures
  • Hip fractures are particularly concerning as they are associated with increased mortality.
  • The treatment of osteoporosis includes reversing its secondary causes (eg. hyperthyroidism) and discontinuing certain medications (eg. corticosteroids).
  • Patients are also encouraged to avoid smoking and significant alcohol use.
  • Osteoporosis is also usually managed with weight bearing activity and supplementation with calcium and vitamin D to promote bone health – patients with low vitamin D may require prescription doses of ergocalciferol
  • Many patients with osteoporosis benefit from treatment with bisphosphonates such as Fosamax (alendronate), Reclast (zoledronate), or Actonel (risedronate).
  • Your doctor may also recommend a newer medication called Prolia (denosumab).

References:

  1. Bernabei R, Martone A, Ortolani E, et al. Screening, diagnosis and treatment of osteoporosis: a brief review. Clin Cases Miner Bone Metab. 2014 Sep-Dec; 11(3): 201–207.
  2. Kling J, Clarke B, Sandhu N. Osteoporosis Prevention, Screening, and Treatment: A Review. J Womens Health (Larchmt). 2014 Jul 1; 23(7): 563–572.

Popular Osteoporosis Medications

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.