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ACRMed HQ15644 Pomerado Road
Suite 102
Poway, CA 92064
Office Hours:Mon - Thu : 8:00 am - 4:00 (EST)
Fri: 8:00 am - 3:00 (EST)
Sat - Sun : CLOSED

Osteoporosis

Overview

Osteoporosis is a skeletal disease, marked by low bone mass and microarchitectural deterioration that leads to an increased susceptibility to fractures. Fractures are the single most important clinical consequence of osteoporosis and represent a major health problem in the elderly. Low bone mass, skeletal fragility and propensity to fall are the primary determinants of fracture risk in older persons.

Frequently Asked Questions

How is Osteoporosis diagnosed?
Bone density, a measure of bone mass, can be measured non-invasively using widely available densitometric techniques. This test is called Bone densitometric.
In order to accurately diagnose osteoporosis, it is necessary to perform a bone density evaluation with a dual energy x-ray, absorptiometer (DEXA) or other machine to assess bone mass. This test is painless and quick.
The World Health Organization has defined low bone mass (osteopenia) between 1.0 and 2.5 standard deviations below the mean for young adult women and osteoporosis as a bone density equal to or greater than 2.5 standard deviations below the young adult mean. Women who already have experienced one or more fractures are considered to have “established” osteoporosis.
What happens when you have osteoporosis?
Patients with osteoporosis own bone density are at increased of low trauma spine and hip risk of most types of fractures in elderly women is related to low bone density. Approximately 90% of hip and spine fractures, 70% of wrist fractures and 50% of all other fractures in white women aged 65–84 years are attributable to osteoporosis. 1.3 million fractures per year in the United States are caused by osteoporosis.
Who gets osteoporosis?

  • Gender—Women are four times more likely than men to get osteoporosis, with Caucasian and Asian women most at risk.
  • Hormone Status—Women who have experienced menopause are at greatest risk. Men with testosterone deficiency are also at risk.
  • Calcium Deficiency—A low dietary intake of calcium can contribute to lower bone density.
  • Sedentary Lifestyle—Physical activity increases bone mass, while sedentary lifestyles results in lower bone density.
  • Body Size—Petite women are more at risk than heavier women because fat cells are sites for estrogen production.
  • Family History—A familial history of osteoporosis seems to increase risk.
  • Cigarette/Alcohol Use—These agents reduce the body’s ability to absorb calcium, thus reducing bone density.
  • Medications—Long-term use of corticosteroids, anti-seizure drugs, and excess thyroid hormone can result in osteoporosis.

What are the symptoms of Osteoporosis?
Acute symptoms from an osteoporotic fracture could include intense, localized pain and reduced motion.
Chronic Symptoms include bone pain muscle pain and loss of heights, easy fractures of he spine hip and wrist fractures.
How is Osteoporosis Treated?
If you have osteoporosis, your health care provider will advise the following:
▪ Calcium. Make sure you are getting enough calcium in your diet or you might need to consider taking supplements. The National Osteoporosis Foundation recommends 1,000 milligrams (shortened as mg) per day for most adults and 1,200 mg per day for women over age 50 or men over age 70.
▪ Vitamin D. Get adequate amounts of vitamin D, which is important to help your body absorb calcium from foods you eat. The recommended daily dose is 400–800 International Units (called IU) for adults younger than age 50, and 800–1,000 IU for those age 50 and older. (These are the current guidelines from the National Osteoporosis Foundation.) You may need a different dose depending on your blood level of vitamin D, sometimes as high as 50,000 unit a week for 12 weeks.
▪ Physical activity. Get exercise most days, especially weight-bearing exercise, such as walking.

 

Most people with Osteoporosis or High FRAX scores will also need a medication. A number of medications are available for the prevention and/or treatment (“management”) of osteoporosis.

Bisphosphonates. The US Food and Drug Administration (better known as the FDA) has approved certain drugs called bisphosphonates to prevent and treat osteoporosis. This class of drugs (often called “anti-resorptive” drugs) helps slow bone loss, and studies show they can decrease the risk of fractures. The Table shows the drug names and dosing (how often you receive the drug) of bisphosphonates approved in the US for management of osteoporosis.

Bisphosphonate Medications for Osteoporosis (OP)

Generic drug name

Brand name

FDA approved uses for OP

Dosing and form

alendronate

Fosamax

Prevention and treatment of postmenopausal OP in women

Treatment of OP in men

Treatment of OP due to use of glucocorticoid medicines in women and men

Once-daily or once-weekly pills

risedronate

Actonel

Prevention and treatment of postmenopausal OP in women

Treatment of OP in men

Prevention and treatment of OP due to use of glucocorticoid medicines in women and men

Once-daily, once-weekly or once-monthly pills

ibandronate

Boniva

Prevention and treatment of postmenopausal OP in women

Once-monthly pills, or every three months by intravenous infusion (often called IV) given through a vein

zoledronic acid

Reclast

Same as for risedronate

Once a year by IV

With all of these medications, you should make sure you are taking enough calcium and vitamin D, and that the vitamin D levels in your body are not low. (Your doctor can measure your vitamin D level with a blood test.) Alendronate, risedronate and ibandronate are pills that you must take on an empty stomach with water only, or else you will not properly absorb the medicine. These drugs sometimes can irritate the esophagus (the tube that goes from the throat to the stomach). Therefore, you should remain upright for at least an hour after taking these medications.

Other bisphosphonates include clodronate (Bonefos), etidronate (Didronel), pamidronate (Aredia) and tiludronate (Skelid). They are used to treat other bone diseases but are not FDA approved for osteoporosis treatment. In some other countries, clodronate is approved for osteoporosis treatment. The bisphosphonates are also used to treat cancer that has spread to the bones. The dose used is most often higher than for osteoporosis. Zoledronic acid used in cancer treatment is marketed under another name (Zometa).

There have been reports of rare side effects that may be linked to use of bisphosphonates. These include osteonecrosis of the jaw (also called jaw osteonecrosis or ONJ) and atypical femoral fractures:

Osteonecrosis of the jaw. There have been reports of ONJ (permanent damage of the bones of the jaw) resulting after use of bisphosphonates, mostly in people who recently had a dental procedure or had dental disease.  Most cases were in people who received high-dose IV bisphosphonates for cancer treatment. The risk of this problem in people taking these medications at doses recommended for osteoporosis management seems to be very low.  Still, doctors recommend that anyone taking a bisphosphonate have good oral hygiene and regular dental care.

Atypical femoral fractures. Uncommon types of thighbone fractures have occurred in a small percent of people using bisphosphonates long term for their osteoporosis. Again, this risk appears to be very low, especially compared with the number of fractures that bisphosphonates prevent.

Calcitonin (Calcimar, Miacalcin). This medication, a hormone made from the thyroid gland, is given most often as a nasal spray or as an injection (shot) under the skin. It is FDA- approved for the management of postmenopausal osteoporosis and helps prevent vertebral (spine) fractures. It also is helpful in controlling pain after an osteoporotic vertebral fracture.

Estrogen or hormone replacement therapy. Estrogen treatment alone or combined with another hormone, progestin, has been shown to decrease the risk of osteoporosis and osteoporotic fractures in women. However, combination estrogen and progestin can increase the risk of breast cancer, strokes, heart attacks and blood clots. Estrogens alone may raise the risk of strokes. Consult with your doctor about whether hormone replacement therapy is right for you.

Selective estrogen receptor modulators. These medications, often referred to as SERMs, mimic estrogen’s good effects on bones without some of the serious side effects such as breast cancer. However, there is still a risk of blood clots and stroke with use of SERMs. The SERM raloxifene (Evista) decreases the risk of spine fractures in women. It is approved for use only in postmenopausal women.

Teriparatide (Forteo). Teriparatide is a form of parathyroid hormone that helps stimulate bone formation. It is approved for use in postmenopausal women and men at high risk of osteoporotic fracture. It also is approved for treatment of glucocorticoid-induced osteoporosis. It is given as a daily injection under the skin and can be used for up to two years. If you have ever had radiation treatment or your parathyroid hormone levels are already too high, you may not be able to take this drug.

Strontium ranelate. This medicine is approved for managing postmenopausal osteoporosis in several countries around the world, but not the U.S. (Brand names include Protelos, Protos, Osseor, Bivalos, Protaxos and Ossum.)  Studies show it lowers the fracture risk in postmenopausal women. The drug comes as a powder, which women dissolve in water and take daily. Because of an increased risk of blood clots, it should be used with caution in women who have a history of or risk of blood clots such as deep venous thrombosis or pulmonary embolism.

Denosumab (Prolia). This new class of “antiresorptive” drug is a fully human monoclonal antibody, a type of immune therapy. It works against a protein that interferes with the survival of bone-resorbing cells. This treatment is approved for use in postmenopausal women who have osteoporosis and are at high risk of fracture. Another approved use is for women and men at high risk of bone loss and fractures from hormone-depleting medications used to treat breast and prostate cancer. Patients receive this medicine as an injection under the skin every six months.

This medication can make your calcium levels go very low, so your calcium and vitamin D levels should not be low when you start to take this medicine. There may be an increased risk of infections when using this drug. There have also been rare reports of ONJ linked to use of denosumab. This drug is also approved for the treatment of cancer involving the bones, and is marketed under another name (XGEVA).

As doctors who are experts in diagnosing and treating diseases of the joints, muscles and bones, rheumatologists can help find the cause of osteoporosis. They can provide and monitor the best treatments for this condition.

The most serious health consequence of osteoporosis is a fracture. Spine and hip fractures especially may lead to chronic pain, long-term disability and even death. The main goal of treating osteoporosis is to prevent fractures. If you have osteoporosis, it is important to help prevent not just further bone loss but also a fracture. Here are some ways to decrease your chance of falls:

Use a walking aid. If you are unsteady, use a cane or walker.

Remove hazards in the home. Remove throw rugs. Also, remove or secure loose wires or cables that may make you trip. Add nightlights in the hallways leading to the bathroom. Install grab bars in the bathroom and nonskid mats near sinks and the tub.

Get help carrying or lifting heavy items. If you are not careful, you could fall, or even suffer a spine fracture without falling.

Wear sturdy shoes with soles that grip. This is above all true in winter or when it rains.

Make sure you get enough calcium in your diet or through supplements (roughly 1,000–1,200 mg/day, but will depend on your age).

Get enough vitamin D (400–1,000 IU/day, depending on your age and your blood level of vitamin D measured by your doctor).

Stop smoking.

Avoid excess alcohol intake: no more than two or three drinks a day.

Be physically active and do weight-bearing exercises, like walking, most days each week.  Aim for at least 2½ hours a week (30 minutes a day five times a week or 50 minutes a day three times a week), or as much as you can. Exercises that can improve balance, such as Tai Chi or yoga, may help prevent falls.

Change lifestyle choices that raise your risk of osteoporosis.

Implement strategies to help decrease your risk of falling.

You also should get treatment for any underlying medical problem that can cause osteoporosis. If you are on a medication that can cause osteoporosis, ask your doctor if you can lower the dose or take another type of medicine. Never change the dose or stop taking any medicine without speaking to your doctor first.

If you are at severe risk because of medication you have to take, then some of the above mentioned treatments might be appropriate for you.