Osteoporosis
Treatment Overview
The process of bone thinning (osteoporosis) is a natural part of aging. However, if you receive treatment early, you may be able to stop or slow the progress of bone loss. Treatment is important to:10
- Prevent broken bones.
- Maintain or increase your bone thickness.
- Relieve pain caused by fractures and changes to bones.
- Maintain your ability to function physically.
Treatment for osteoporosis includes eating a diet rich in calcium and vitamin D, getting regular exercise, and taking medication to reduce bone loss and increase bone thickness. It's important to take calcium and vitamin D supplements along with any medications you take for osteoporosis. Even small changes in diet, exercise, and medication can help prevent spine and hip fractures. Adults who adopt healthy habits can slow the progress of osteoporosis.
See an illustration of healthy bone versus bone weakened by osteoporosis
.
Initial treatment
If you have been diagnosed with osteoporosis, your health professional probably will recommend lifestyle and diet changes. Eat foods rich in calcium, vitamin D, and phosphorus, all necessary for maintaining healthy, strong bones. Take supplements if you think you are not getting enough of these nutrients in your diet. The recommended daily intake for adults age 19 to 50 is 1,000 mg of calcium plus 400 IU of vitamin D each day. Men and women age 50 and older need 1,500 mg of calcium plus 800 IU of vitamin D each day.
Your bones need vitamin D to absorb calcium. One study showed that vitamin D may reduce an older person's risk of falling by 22%.11 The best source of vitamin D is exposure to sunlight. Vitamin D is also added to milk, some calcium supplements, and many multivitamin supplements.
Research studies do not agree about whether calcium plus vitamin D supplements can prevent fractures. Some studies show that calcium and vitamin D supplements reduce the risk of fracture.12 But other studies show little effect of supplements on fracture risk.13 The greatest benefit of supplements appears to be for people who have osteoporosis. Calcium and vitamin D supplements are recommended if you have been diagnosed with osteoporosis.
For more information on taking calcium, see:
Exercises, including weight-bearing exercise (walking, jogging, stair climbing, dancing, or lifting weights), aerobics, and resistance exercises are all effective in increasing bone mineral density and strength of the spine. Start out at an exercise level that you are comfortable with and work up gradually. To be most effective, weight-bearing exercises should be done for 45 to 60 minutes at least 4 days a week. If you stop exercising, your bones weaken and may be more likely to break. Walking also increases bone mineral density of the hip.14
Along with exercise and diet, your health professional will recommend that you not smoke and limit alcohol to 1 drink a day.
In some cases, medications are prescribed to protect against bone loss. These medications include raloxifene (Evista), bisphosphonates such as risedronate (Actonel) and alendronate (Fosamax), and parathyroid hormone (Forteo). It's important to take calcium and vitamin D supplements along with any medications you take for osteoporosis. For more information on taking bisphosphonates, see:
If you take corticosteroids longer than 6 months for asthma or other conditions, you may be at greater risk for developing steroid-induced osteoporosis. If you begin to have bone loss, you may need to take osteoporosis medications, such as bisphosphonates, while you are taking steroids.
In select cases, hormone replacement therapy (HRT) or estrogen replacement therapy (ERT) is given to women to slow bone loss from osteoporosis. The Women's Health Initiative (WHI) study found that HRT decreased the risk of hip fracture, but also led to small increases in a woman's risk of breast cancer, heart attack, stroke, blood clots (pulmonary embolism and deep vein thrombosis), and Alzheimer's disease and other dementias.15, 16 Estrogen alone (ERT), used for women who have had a hysterectomy, was found to increase a woman's risk of stroke, but it did not appear to affect rates of breast cancer or heart attack. Many experts recommend that long-term hormone replacement therapy only be considered for women with a significant risk of osteoporosis that outweighs the risks of taking HRT or ERT.17, 18
Ongoing treatment
Once you have been diagnosed with bone loss, whether it is mild or severe, you will need to have regular follow-up tests to monitor the disease. Osteoporosis is a progressive disease; both men and women lose approximately 0.4% of bone each year after age 30.1 It is never too late to develop and then maintain healthy habits that can slow progression of the disease.
- Eat a nutritious diet that includes adequate amounts of calcium and vitamin D. Both are necessary for building healthy, strong bones. Take supplements if you think you are not getting enough of these nutrients in your diet. The recommended daily intake for adults age 19 to 50 is 1,000 mg of calcium plus 400 IU of vitamin D each day. Men and women age 50 and older need 1,500 mg of calcium plus 800 IU of vitamin D each day. Your bones need vitamin D to absorb calcium. One study showed that vitamin D may reduce an older person's risk of falling by 22%.11 The best source of vitamin D is exposure to sunlight. Vitamin D is also added to milk, some calcium supplements, and many multivitamin supplements.
- Get regular exercise. Weight-bearing exercises such as walking, jogging, stair climbing, dancing, or lifting weights keep bones healthy by working the muscles and bones against gravity.
When you have osteoporosis, it is especially important to protect yourself from falling. When bones lose mass and become more brittle, they lose strength and break more easily. Women of European and Asian ancestry are more likely to have osteoporosis than those with African ancestry. An estimated 17% of white women will break a hip sometime after age 50, as will 6% of white men.4 To reduce your chances of breaking bones, take
steps to prevent falls, such as having your vision and hearing checked regularly and wearing slippers or shoes with a non-skid sole. Exercises that improve balance and coordination, such as tai chi, can also reduce your risk of falling.
If your tests indicate continuing bone loss, your health professional probably will recommend that you take medication to increase bone density and decrease your risk of spine and hip fractures. These medications include bisphosphonates, such as risedronate (Actonel) or alendronate (Fosamax). Zoledronic acid is a bisphosphonate that is given directly into a vein (intravenously) once each year, instead of being taken by mouth. It's important to take calcium and vitamin D supplements along with any medications you take for osteoporosis. For more information about taking bisphosphonates, see:
Calcitonin may be prescribed for women who are more than 5 years beyond menopause and who cannot take bisphosphonate medications, or for men who are not receiving testosterone treatment. Calcitonin has the added advantage of helping reduce pain from spinal fractures. However, studies show that calcitonin is less effective than bisphosphonate medications at stopping bone loss.19
Raloxifene (Evista) may be prescribed for women, especially if you are 55 to 65 years old. Raloxifene has been proven to reduce the risk of spinal fractures, but not hip fractures.19 Raloxifene may also reduce the risk of breast cancer, although it is not approved for this purpose. Raloxifene can cause hot flashes, so it is not often used in early menopause (45 to 55 years) when hot flashes are frequent.
In select cases, hormone replacement therapy (HRT) or estrogen replacement therapy (ERT) is given to women to slow bone loss from osteoporosis. The Women's Health Initiative (WHI) study found that HRT decreased the risk of hip fracture, but it also led to small increases in a woman's risk of breast cancer, heart attack, stroke, blood clots (pulmonary embolism and deep vein thrombosis), and Alzheimer's disease and other dementias.15, 16 Estrogen alone (ERT), used for women who have had a hysterectomy, was found to increase a woman's risk of stroke, but it did not appear to affect rates of breast cancer or heart attack. Many experts recommend that long-term hormone replacement therapy only be considered for women with a significant risk of osteoporosis that outweighs the risks of taking HRT or ERT.17, 18
Treatment if the condition gets worse
It is never too late to develop and then maintain healthy habits that can slow bone thinning.
- Eat a nutritious diet that includes adequate amounts of calcium and vitamin D. Both are necessary for building healthy, strong bones. Take supplements if you think you are not getting enough of these nutrients in your diet. The recommended daily intake for adults age 19 to 50 is 1,000 mg of calcium plus 400 IU of vitamin D each day. Men and women age 50 and older need 1,500 mg of calcium plus 800 IU of vitamin D each day. Your bones need vitamin D to absorb calcium. One study showed that vitamin D may reduce an older person's risk of falling by 22%.11 The best source of vitamin D is exposure to sunlight. Vitamin D is also added to milk, some calcium supplements, and many multivitamin supplements.
- Get regular exercise. Weight-bearing exercises, such as walking, jogging, stair climbing, dancing, or lifting weights, keep bones healthy by working the muscles and bones against gravity.
Medications called bisphosphonates, such as alendronate (Fosamax) and risedronate (Actonel), may be used to slow the rate of bone loss and increase bone thickness and strength. This will reduce the risk of broken bones. For more information on bisphosphonates, see:
In select cases, hormone replacement therapy (HRT) or estrogen replacement therapy (ERT) is given to women to slow bone loss from osteoporosis. The Women's Health Initiative (WHI) study found that HRT decreased the risk of hip fracture, but it also led to small increases in a woman's risk of breast cancer, heart attack, stroke, blood clots (pulmonary embolism and deep vein thrombosis), and Alzheimer's disease and other dementias.15, 16 Estrogen alone (ERT), used for women who have had a hysterectomy, was found to increase a woman's risk of stroke, but it did not appear to affect rates of breast cancer or heart attack. Many experts recommend that long-term hormone replacement therapy only be considered for women with a significant risk of osteoporosis that outweighs the risks of taking HRT or ERT.17, 18
If your osteoporosis is severe or you continue to have bone loss while taking a bisphosphonate:
- You may need to take both a bisphosphonate medication and hormone therapy. Studies show that taking both medications results in increased bone mass when compared to taking either alone.20, 21
- Your health professional may prescribe teriparatide (Forteo). Forteo has been shown to slow bone loss and increase the rate of new bone growth.22 However, Forteo is expensive and requires daily self-injections.
It's important to take calcium and vitamin D supplements along with any medications you take for osteoporosis.
Compression fractures resulting from osteoporosis can cause significant back pain that lasts for several months. Treatments available to relieve your pain include:
- Non-prescription non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and ASA (Aspirin).
- Non-prescription acetaminophen (such as Tylenol or Panadol).
- A pain reliever such as a narcotic, which may be prescribed on a short-term basis.
- Other medicines such as calcitonin (Calcimar or Miacalcin) to help decrease pain from spinal fractures.
- A back brace or corset to slow curvature of the spine.
One of two surgical treatments, vertebroplasty or kyphoplasty, may relieve pain from spinal compression fractures. In these procedures, a surgeon injects bone cement into the crushed spinal bones (vertebrae) through a needle.
If you experience a fractured bone related to osteoporosis, treatment to slow your bone thinning becomes very important. If you have had a spinal fracture, you are at risk of having another.3
What to think about
Although HRT and ERT have been used to prevent or slow bone loss, currently they are not recommended for women as the first choice for prevention or treatment of osteoporosis. The Women's Health Initiative (WHI) study found that HRT decreased the risk of hip fracture, but it also led to small increases in a woman's risk of breast cancer, heart attack, stroke, blood clots (pulmonary embolism and deep vein thrombosis), and Alzheimer's disease and other dementias.15, 16 Estrogen alone (ERT), used for women who have had a hysterectomy, was found to increase a woman's risk of stroke, but it did not appear to affect rates of breast cancer or heart attack. Many experts recommend that long-term hormone replacement therapy only be considered for women with a significant risk of osteoporosis that outweighs the risks of taking HRT or ERT.17, 18 To learn more about the study, see WHI: Risks and benefits of taking HRT or ERT.
Because taking estrogen alone increases the risk of developing cancer of the lining of the uterus (endometrial cancer), ERT is only used if a woman has had her uterus removed.
Researchers are studying the effects of low-dose estrogen on women 65 and older. An early small study indicates that a low estrogen dose (one-quarter that of conventional ERT) may provide the same benefit—increased bone density and decreased fractures—as the higher dose. In the same study, about one-third of the women were given the low estrogen dose and progesterone (because these women had not had hysterectomies). This group of women also experienced increased bone density. However, the long-term risks of taking low-dose estrogen (and progesterone in one-third of the cases) were not studied and are unclear.23
It's important to take calcium and vitamin D supplements along with any medications you take for osteoporosis. For more information on taking calcium, see:
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| Author: | Douglas Dana Robin Parks, MS | Last Updated: February 21, 2007 |
| Medical Review: | Joy Melnikow, MD, MPH - Family Medicine Carla J. Herman, MD, MPH - Internal Medicine Andrew Swan, MD, CCFP, FCFP - Family Medicine | |
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