How Is Osteoporosis Treated?

Treatment of osteoporosis aims to stop bone loss and rebuild bone. Along with making lifestyle changes, there are several medication choices. Some will slow your rate of bone loss, and others will actually rebuild bone. These are:

Estrogen. Doctors sometimes prescribe estrogen to replace the hormones lost during menopause, to slow the rate of bone loss, and to increase bone mass in the spine and hip. When estrogen alone is used, this treatment is called estrogen replacement therapy (ERT). Post-menopausal women who still have a uterus and who choose to take estrogen should receive hormone replacement therapy (HRT), taking both estrogen and progestin. Experts do not know all the risks of long-term use of these hormones. Each woman should discuss possible benefits, risks, and side effects of ERT or HRT with her doctor. (NOTE: There are new facts about estrogen/progestin hormone therapy, July 2002. For more information see "http://www.nhlbi.nih.gov/whi/hrtupd/ep_facts.htm".
Raloxifene. This new drug is approved to prevent osteoporosis. It is known as a SERM (selective estrogen receptor modulator). Like estrogen, this SERM prevents bone loss, but may cause blood clots in some women. Unlike estrogen, it may cause hot flashes, but should not increase your chance of developing cancer of the endometrium (the lining of the uterus or womb).

Alendronate and risedronate. These medicines are bisphosphonates, drugs that slow the breakdown of bone and may even increase bone density. They can lessen your chance of breaks in the spine and hip. Side effects may include nausea, heartburn, and pain in your stomach, muscles, or bones. These drugs must be taken in a certain way—when you first get up, before you have eaten, and with a full glass of water. You should not lie down or eat for at least one-half hour after taking the drug.

Calcitonin. This is a naturally occurring hormone that increases bone mass in the spine and may lessen the pain of fractures there. It comes in two forms—injection or nasal spray. The injection may cause an allergic reaction and has some unpleasant side effects. The only side effect of the nasal spray form is a runny nose in some people. It is most useful for women who are 5 years past menopause.
In the future. Other SERMs and bisphosphonates are being studied as improved treatments for osteoporosis. Also promising as possible therapies are sodium fluoride, parathyroid hormone (PTH), and some forms of vitamin D.
What About Falls?

When bones are weakened by osteoporosis, a simple fall can cause a fracture or break. This can result in a trip to the hospital, surgery, and possibly a long-term disabling condition. Osteoporosis is the cause of 1.5 million fractures each year. This includes more than 300,000 hip fractures. These fractures may put an end to independent living for as many as 1 out of 4 people with a broken hip.

It is important to prevent falls. Some things you can do include:

Use glasses or a hearing aid if needed.
Ask your doctor if any of the drugs you are taking may make you dizzy or unsteady on your feet.
Use a cane or walker if your walking is unsteady.
Wear rubber-soled and low-heeled shoes.
Make sure all the rugs and carpeting in your house are firmly attached to the floor.
Keep your rooms well lit and the floor free of clutter.
Use nightlights.
What About Osteoporosis in Men?

Osteoporosis is not just a woman’s disease. Men have it also, although not as often as women do. This is probably because most men have more bone mass than women do. Also, they lose bone more slowly as they age because the amount of testosterone they have drops much more gradually. Women have a quick decrease in estrogen with menopause. Men have only ¼ as many hip fractures as women. However, men over the age of 75 are three times more likely to die after a hip fracture than are women.

The disease has not been as well studied in men as in women. So, some prevention and treatment recommendations come from studies in women. The risk factors for men are similar to those for women—smoking, not enough calcium or vitamin D, too much alcohol, family history, too little exercise, and taking certain drugs. Low levels of testosterone in older men seem to increase their loss of bone and chance of hip fracture.

Older men who fracture a bone easily, who show bone loss on a normal x-ray, or have risk factors should get a DEXA-scan. If the scan shows osteoporosis, treatment, with the exception of estrogen and raloxifene, is similar to that suggested for older women. This includes getting enough calcium and vitamin D, doing weight-bearing exercise, not smoking, and limiting alcohol. The only drugs available for men are alendronate, risedronate, and calcitonin. Some men with low levels of testosterone may find testosterone supplements helpful.