There are several options available to prevent or treat osteoporosis. The treatment choice for one individual may be very different from person to person. There is not necessarily a right or wrong treatment choice, but a treatment that best suits the individual's needs.
The following groups of medications may be used to help treat or prevent osteoporosis:
- selective estrogen receptor modulators (SERMs)
- hormone replacement therapy
Bisphosphonates are very effective in preventing and treating osteoporosis. Some examples of bisphosphonates that are used to treat and prevent osteoporosis are alendronate, risedronate and etidronate. Bisphosphonates have been used very successfully for almost 30 years to treat a bone disorder known as Paget's disease. Over the last ten years, bisphosphonates have increasingly been used to treat women and men with osteoporosis. Large multinational studies of various bisphosphonates have been completed that demonstrate their effectiveness. Bisphosphonates are usually given in a tablet and are either taken daily or in a cycle. Occasionally, bisphosphonates can also be given intravenously to treat osteoporosis. Your physician can discuss the potential benefits of this therapy.
Since bisphosphonates are very poorly absorbed into the bloodstream from the stomach, it is very important that these medications be taken on an empty stomach with a full glass of water. They should not be taken with food, milk, antacids or calcium supplements. It is usually recommended they be taken 30 to 60 minutes before the morning meal. If taken before bedtime, the medication may wash back up into the esophagus (the tube connecting the mouth and stomach) during sleep. Some bisphosphonates have been known to cause severe heartburn or esophagitis (inflammation of the esophagus) and this can be worse if the medication is taken prior to lying down to go to bed. Risedronate and alendronate may be taken once daily or once weekly. Etidronate is taken in cycles with 14 days of active medication and 76 days of calcium supplements.
Selective estrogen receptor modulators (SERMs)
SERMs are also very effective for the prevention and treatment of osteoporosis. Currently, raloxifene is the only SERM available in Canada for osteoporosis. Raloxifene also decreases the risk of some types of breast cancer. Common side effects include leg cramps and hot flushes. It causes a slight increase in the risk of deep vein thrombosis (DVT or blood clots in the legs) and pulmonary embolism (blood clots that break off and lodge in the lungs). If 1000 women took raloxifene for one year, 1 to 3 of them would have a blood clot that broke off into the bloodstream. Raloxifene is taken as a single dose at any time of day.
Calcitonin is a natural human hormone that until recently has not had a lot of clinical uses. With the discovery that marine calcitonins (salmon and eel) were much more potent than human calcitonin, there have been large clinical studies to study marine calcitonin in the prevention and treatment of osteoporosis.
Until 1996, calcitonin was given as a daily injection. Now a nasal spray is available that contains salmon calcitonin. The spray has been shown in clinical studies to be effective in reducing bone loss and decreasing spinal fractures (broken bones in the back). Calcitonin nasal spray is an option for people who cannot use bisphosphonates or SERMs, or who have trouble taking bisphosphonates on schedule. Nasal spray calcitonin may also be considered in younger individuals when there is concern about long-term use of some of the other treatments. It is also used to relieve the pain of spinal fractures. The main side effect is nasal irritation.
Hormone replacement therapy
In women, hormone replacement therapy (HRT) is effective for the prevention and treatment of osteoporosis. It can slow bone loss, increase bone density, and reduce the risk of broken bones. However, the Women's Health Initiative study showed that HRT increases the risk of heart disease, stroke, breast cancer, and blood clots in the lungs. For this reason, HRT is no longer a treatment of first choice for osteoporosis. However, it may be an option for women in the early stages of menopause who are already planning to take HRT to relieve menopause symptoms.
Hormone replacement therapy consists of the use of estrogen, either alone or in combination with the hormone progesterone. In women who have had a hysterectomy, progesterone is not needed. A number of estrogen preparations are available, including pills, skin patches, gels, and vaginal rings.
The Women's Health Initiative study was for a specific type of HRT called PremPlus® (a combination of conjugated estrogens and medroxyprogesterone acetate). It also examined the effects of conjugated estrogens alone in women who had had a hysterectomy. It is not known whether the findings apply to all forms and types of HRT, or just to the treatments that were studied. Anyone considering hormone replacement therapy should have a discussion with her doctor about her individual risks and benefits.
Other ways to fight osteoporosis
Want to decrease your risk of osteoporosis? Here are some simple steps:
- Get active! Specifically, do more weight-bearing exercise, such as running, walking, or aerobics. This can help build up bone thickness and strength. Check with your doctor before starting a new exercise program.
- Quit smoking.
- Reduce your intake of caffeine-containing drinks such as coffee and tea (to less than 4 cups per day), salt (less than 2.1 g per day of sodium), and alcohol.
- Make sure that you get enough calcium and vitamin D in your diet. This can help prevent osteoporosis. Calcium and vitamin D can also be used in combination with other treatments in people who already have osteoporosis.
How much calcium and vitamin D is enough?
The Osteoporosis Society of Canada recommends a daily intake of 1000 mg of Calcium and 400 IU of Vitamin D for men and women aged 19 to 50 years and for pregnant or breastfeeding women of any age.
A daily intake of 1500 mg of Calcium and 800 IU of Vitamin D is recommended for both men and women over the age of 50.
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