Osteoporosis Treatment

Getting enough calcium and vitamin D is key to keeping bones strong as you age.

Treating osteoporosis involves a combination of a balanced diet rich in calcium and vitamin D, regular exercise, medication, and fall prevention. Quitting smoking and drinking alcohol in moderation are also important to keep bones strong.

Nutrition/Diet

Getting enough calcium and vitamin D is important to build strong, dense bones when you're young, as well as to keep them strong and healthy as you age. Recommendations from the National Osteoporosis Foundation are for most adults to aim for 1,000 milligrams of calcium per day. For women over age 50, as well as men over the age of 70, you should increase your intake to 1,200 milligrams daily (note that getting too much calcium in your diet, defined as upwards of 2,000 milligrams a day in people over the age of 50, can have negative effects on the body including kidney stones and possibly an increased risk of heart disease).

The National Osteoporosis Foundation also recommends that men and women get 400 to 800 international units (IUs) a day of vitamin D before the age of 50. After 50, you should up your intake to 800 to 1,000 IUs (The Institute of Medicine [IOM] reports that it’s safe to ingest as much as 4,000 IUs of vitamin D a day if needed). If your vitamin D levels are too low, your doctor may ask you to increase your daily amount over the short term.

Good food sources of calcium include:

  • dairy products such as low-fat and non-fat milk, yogurt, and cheese
  • vegetables such as spinach, kale, okra, and collards
  • soybeans and white beans
  • fish including sardines, salmon, perch, and rainbow trout
  • calcium-fortified foods such as orange juice, oatmeal, and certain breakfast cereals.

Foods that provide vitamin D include:

  • fatty fish such as tuna, mackerel, and salmon
  • foods fortified with vitamin D such as some dairy products, orange juice, soy milk, and cereals
  • beef liver
  • cheese
  • egg yolks.

Exercise

The best exercise for bone health includes strength training or resistance training. This can help strengthen your bones and can reduce bone loss. While experts suggest beginning a regular exercise program when you’re young, it’s never too late to start making exercise a regular part of your day. Exercise can also reduce your risk of falling by increasing muscle mass, improving your coordination and balance.

However, those with osteoporosis should avoid high-impact exercises. A physical therapist or rehabilitation specialist can show you specific exercises that are best for you.

Treating osteoporosis involves a combination of a balanced diet and regular exercise, amongst other practices. (Source: 123RF)

Medications

  • Bisphosphonates (eg, alendronate, risedronate, ibandronate, and zoledronic acid) are drugs that slow bone loss, reduce the risk of fractures, and may in some cases increase bone density. These drugs come in different forms, including pills (taken daily, weekly, monthly, or quarterly) and intravenously (IV).
  • Estrogen is approved for the prevention of osteoporosis in hypogonadal, or post-menopausal, women, but it is not effective for the treatment of already-established osteoporosis. Further, the US Food and Drug Administration (FDA) recommends that women take the lowest effective dose for the shortest period possible, as some studies have found that women who take estrogen may be at an increased risk of breast cancer, strokes, blood clots, and heart attacks.
  • Raloxifene is a non-hormonal drug taken daily in tablet form that has estrogen-like effects on bones, but blocks estrogen effects in the breast and uterus. It slows bone loss and reduces the risk of spinal fractures.
  • Teriparatide is a form of human parathyroid hormone that stimulates new bone formation. It is given as a daily injection for up to 24 months. Teriparatide increases bone tissue and bone strength, and has been shown to reduce the risk of fractures. It is approved for use in postmenopausal women and men who are at high risk of fractures.
  • Abaloparatide is an osteoporosis treatment option used for more severe cases of osteoporosis. It’s similar to teriparatide but is a lab-made copy of the parathyroid hormone, given by daily injection.
  • Denosumab slows the formation and action of cells called osteoclasts, which naturally break down bone. By slowing down the osteoclasts, denosumab allows bones to become denser. It is available as an injection every six months for men and postmenopausal women.
  • Calcitonin is another treatment for post-menopausal women, but due to concerns over a possible increased risk of cancer, it is not recommended as a first-line treatment option.
  • Romosozumab was approved by the FDA in April 2019 to treat osteoporosis in postmenopausal women at high risk of fracture, with a history of osteoporotic fracture, or those who have failed or are intolerant to other osteoporosis therapies.

Preventing Falls

If you have osteoporosis, it is very important to reduce your risk of falls, both inside the home and while outside.

At home:

  • Make your home safer by removing potential tripping hazards such as boxes, newspapers, and electrical cords from passageways
  • Take a closer look at your footwear. Choose sturdy shoes with nonskid soles, and avoid high heels, slippers, and shoes with slick soles
  • Use double-faced tape or a slip-resistant backing to secure loose rugs (or remove altogether)
  • Use nonslip mats in the shower or bathtub, and use nonskid floor wax
  • Only use a stable stepladder that has a handrail
  • Make sure your home is brightly lit, to help avoid tripping on objects that are difficult to see. Put nightlights in the bedroom, hallways, and bathroom, and have a lamp within easy reach of your bed for getting up in the middle of the night.
  • Consider having a personal emergency response system that you can call for help if necessary.

When you are outside your home:

  • Use a cane or walker for added stability
  • Wear shoes with thin, non-slip soles that give you good support
  • Walk on grass when sidewalks are slippery; during the winter, sprinkle salt or kitty litter on slippery sidewalks and driveways outside your home
  • Be careful on highly polished floors, especially when they are wet
  • Stop at curbs and check their height before taking steps.
Updated on: 04/11/19
Continue Reading:
Osteoporosis Overview
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