Osteoporosis Treatment

Usual cure

There are medications and hormones (chemicals that are made in your body) that are used to slow down the bone loss and even help build the strength of the bones back up. These treatments help keep your bones from breaking. Talk with your doctor to find out which treatments are best for you.

A comprehensive osteoporosis treatment program includes a focus on proper nutrition, exercise, a change in lifestyle and safety issues to prevent falls that may result in fractures. In addition, your physician may prescribe a medication to slow or stop bone loss, increase bone density, and reduce fracture risk.

· Nutrition. The foods we eat contain a variety of vitamins, minerals, and other important nutrients that help keep our bodies healthy. All of these nutrients are needed in a balanced proportion. In particular, calcium and vitamin D are needed for strong bones as well as for your heart, muscles, and nerves to function properly. (See Prevention section for recommended amounts of calcium.)

· Exercise. Exercise is an important component of an osteoporosis prevention and treatment program. Exercise not only improves your bone health, but it increases muscle strength, coordination, and balance and leads to better overall health. While exercise is good for someone with osteoporosis, it should not put any sudden or excessive strain on your bones. Asextra insurance against fractures, your doctor can recommend specific exercises to strengthen and support your back.

· Therapeutic Medications. Currently, estrogen, calcitonin, alendronate, raloxifene, and risedronate are approved by the U. S. Food and Drug Administration (FDA) for the treatment of postmenopausal osteoporosis. Estrogen, alendronate, risedronate, and raloxifene are approved for the prevention of the disease. Alendronate is approved for the treatment of osteoporosis in men. Alendronate and risedronate are approved for use by men and women with glucocorticoid-induced osteoporosis.

· Estrogen. Estrogen replacement therapy (ERT) has been shown to reduce bone loss, increase bone density in both the spine and hip, and reduce the risk of hip and spinal fractures in postmenopausal women. ERT is administered most commonly in the form of a pill or skin patch and is effective even when started after age 70. When estrogen is taken alone, it can increase a woman's risk of developing cancer of the uterine lining (endometrial cancer). To eliminate this risk, physicians prescribe the hormone progestin in combination with estrogen (hormone replacement therapy or HRT) for those women who have not had a hysterectomy. ERT/HRT relieves menopause symptoms and has been shown to have beneficial effects on both the skeleton and heart.

Experts recommend ERT for women at high risk for osteoporosis. ERT is approved for both the prevention and treatment of osteoporosis. ERT is especially recommended for women whose ovaries were removed before age 50. Estrogen replacement should also be considered by women who have experienced natural menopause and have multiple osteoporosis risk factors, such as early menopause, family history of osteoporosis, or below normal bone mass for their age. As with all drugs, the decision to use estrogen should be made after discussing the benefits and risks and your own situation with your doctor.

· Raloxifene. Raloxifene (brand name "Evista") is a drug that is approved for the prevention and treatment of osteoporosis. It is from a new class of drugs called Selective Estrogen Receptor Modulators (SERMs) that appear to prevent bone loss at the spine, hip, and total body. Raloxifene has been shown to have beneficial effects on bone mass and bone turnover and can reduce the incidence of vertebral fractures by 30-50%. While side-effects are not common with raloxifene, those reported include hot flashes and deep vein thrombosis, the latter of which is also associated with estrogen therapy. Additional research studies on raloxifene will be ongoing for several more years.

· Alendronate. Alendronate (brand name "Fosamax") is a medication from the class of drugs called bisphosphonates. Like estrogen and raloxifene, alendronate is approved for both the prevention and treatment of osteoporosis. Alendronate is also used to treat the bone loss from glucocorticoid medications like prednisone or cortisone and is approved for the treatment of osteoporosis in men. In postmenopausal women with osteoporosis, the bisphosphonate alendronate reduces bone loss, increases bone density in both the spine and hip, and reduces the risk of both spine fractures and hip fractures. Side effects from alendronate are uncommon, but may include abdominal or musculoskeletal pain, nausea, heartburn, or irritation of the esophagus. The medication should be taken on an empty stomach and with a full glass of water first thing in the morning. After taking alendronate, it is important to wait in an upright position for at least one-half hour, or preferably one hour, before the first food, beverage, or medication of the day.

· Calcitonin. Calcitonin is a naturally occurring non-sex hormone involved in calcium regulation and bone metabolism. In women who are at least 5 years beyond menopause, calcitonin slows bone loss, increases spinal bone density, and according to anecdotal reports, relieves the pain associated with bone fractures. Calcitonin reduces the risk of spinal fractures and may reduce hip fracture risk as well. Studies on fracture reduction are ongoing. Calcitonin is currently available as an injection or nasal spray. While it does not affect other organs or systems in the body, injectable calcitonin may cause an allergic reaction and unpleasant side effects including flushing of the face and hands, urinary frequency, nausea, and skin rash. The only side effect reported with nasal calcitonin is a runny nose.

· Risedronate. Risedronate sodium (brand name Actonel®) is approved for the prevention and treatment of osteoporosis in postmenopausal women and for the prevention and treatment of glucocorticoid-induced osteoporosis in both men and women. Risedronate, a bisphosphonate, has been shown to slow or stop bone loss, increase bone mineral density and reduce the risk of spine and non-spine fractures. In clinical trials, side effects of risedronate were minimal to moderate and those that were reported occurred equally among people taking the medication and those taking a placebo. Risedronate should be taken with a glass of water at least 30 minutes before the first food or beverage of the day other than water. After taking risedronate, it is important to remain in an upright position and refrain from eating for at least 30 minutes.

· Fall Prevention. Falling is a special concern for men and women with osteoporosis. Falls can increase the likelihood of fracturing a bone in the hip, wrist, spine or other part of the skeleton. In addition to the environmental factors listed below, falls can also be caused by impaired vision and/or balance, chronic diseases that impair mental or physical functioning, and certain medications, such as sedatives and antidepressants. It is important that individuals with osteoporosis be aware of any physical changes they may be experiencing that affect their balance or gait, and that they discuss these changes with their health care provider.

Some tips to help eliminate the environmental factors that lead to falls include:

Use a cane or walker for added stability; wear rubber-soled shoes for traction; walk on grass when sidewalks are slippery; in winter, carry salt or kitty litter to sprinkle on slippery sidewalks; be careful on highly polished floors that become slick and dangerous when wet. Use plastic or carpet runners when possible.

Make the environment safe by keeping rooms free of clutter, especially on floors. Keep floor surfaces smooth but not slippery. Be sure carpets and area rugs have skid-proof backing or are tacked to the floor; be sure stairwells are well lit and that stairs have handrails on both sides. Install grab bars on bathroom walls near tub, shower, and toilet; use a rubber bath mat in shower or tub; keep a flashlight with fresh batteries beside your bed. If using a step stool for hard to reach areas, use a sturdy one with a handrail and wide steps; add ceiling fixtures to rooms lit by lamps. Consider purchasing a cordless phone so that you don't have to rush to answer the phone when it rings or you can call for help if you do fall.

Wear supportive, low-healed shoes even at home; avoid walking in socks, stockings, or slippers. Be careful on rainy days and slippery roads.

Remember to check with your doctor. Remedial action in each individual case should be determined with professional medical advice directed toward the individual's particular circumstances and condition.

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