Table of ContentsView AllTable of ContentsHome Remedies and LifestylePrescriptionsOTC TherapiesSurgeries/ProceduresFrequently Asked QuestionsNext in Osteoporosis GuideHow Osteoporosis Self-Care Slows Bone Loss
Table of ContentsView All
View All
Table of Contents
Home Remedies and Lifestyle
Prescriptions
OTC Therapies
Surgeries/Procedures
Frequently Asked Questions
Next in Osteoporosis Guide
Osteoporosis treatment involves the use of effectiveosteoporosismedications to slow bone loss, increase bone density, and lower the risk of fractures. Fortunately, there are several categories of medications to choose from, some of which may be more effective for certain people than others. Good nutrition and regular weight-bearing exercise are also critical to supporting good bone health and managing the disease—so much so that healthcare providers prescribe them as part of an osteoporosis treatment plan.
Each case is different, but one thing holds when it comes to any osteoporosis treatment regimen—the sooner it is started, the better.
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Osteoporosis is a chronic disease. Managing it appropriately involves lifestyle changes to build and maintain bone density.
Proper Nutrition
You must give your body what it needs to build healthy bones. The two essentials:
On the other hand, there are other elements of a diet that caninterferewith calcium levels and, thus, your bone-building efforts. Key ones to know about:
Caffeine intake has been associated with bone loss in some studies, but the impact is not as notable.
Natural Treatment Options for Osteoporosis
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Weight-Bearing Exercise
Weight-bearing exercisehelps strengthen the bones and protects against further bone loss.Not all exercise is created equal in this regard, though. Weight-bearing or high-impact exercise is what stimulates bone regeneration.
1:10The Best Exercises to Prevent Osteoporosis
1:10
The Best Exercises to Prevent Osteoporosis
Another benefit of regular exercise is that it builds muscle and increases coordination and balance. These all help minimize your risk of falling, which is a common way for people with osteoporosis to fracture bones.
Lifting weights, aerobics, and jogging are good “bone builders.“Low-impactexercises, like swimming, biking, or tai chi, may be good for cardiovascular health, but aren’t as effective for this goal.
Weight-Bearing Exercises and Their Health Benefits
Osteoclastsare cells that break down and remove bone, whileosteoblastsare cells that build bone. Most of the time there is a balance between them, thanks to parathyroid hormone (PTH), so that, after childhood, bones stay roughly the same size and density over time.
There are several different types of medications that may be used for osteoporosis, depending on the cause of your bone loss and other factors. Common types of medications include bisphosphonates, selective estrogen receptor modulators, calcitonin, parathyroid hormone (PTH) therapies, and monoclonal antibody therapies. A new class of medication called sclerostin inhibitors is also available to treat osteoporosis, following the FDA approval of Evenity (romosozumab) in 2019.
These drugs work in different ways to affect these factors to build bone and/or prevent loss. While taking more than one may seem like a good idea, there is little evidence that combining more than one class of these drugs is of benefit, though there are a few exceptions.
Osteopeniais not as severe as osteoporosis, but is on the spectrum of bone loss. Those who have it are at an increased risk of developing osteoporosis or fracture and may wish to consider treatment options as well.When used to treat osteopenia, the doses of some of these medications (but not all) are lower than those used for osteoporosis. However, due to the risks and side effects of the medications, healthcare providers often encourage starting with weight-bearing exercises and calcium for these individuals.
Bisphosphonates
Bisphosphonates are a category of osteoporosis medications that first became available in the 1990s. These drugs reduce the activity of osteoclasts (stop the destruction of bone) to reduce bone loss. This results in a net increase in bone density.
Specific drugs, however, differ in their likelihood of preventing certain fracture types, how they are used, and some of the common side effects.
Oral medications in the bisphosphonate class include the following.
People are instructed to take these drugs with water (orange juice and coffee can interfere with absorption) and remain upright afterward for at least 30 to 60 minutes.
Biophosphonate infusions include:
These are given only one time per year (for osteoporosis) as an infusion. The medication is administered through a needle inserted into a vein in your arm. The process lasts about 15 minutes.
Side effects of bisphosphonatesdepend on the particular drug, as well as how it is given. With oral medications, indigestion, heartburn, headaches, muscle pain, and esophageal inflammation may occur.
Side effects after infusions can include flu-like symptoms, headache, or sore muscles or joints.These side effects generally last just a few days after treatment. An uncommon side effect, especially with Reclast or Zometa, isosteonecrosisof the jaw. Other uncommon but serious side effects may include femur fractures and atrial fibrillation.
Selective Estrogen Receptor Modulators
Selective estrogen receptor modulators (SERMS) are interesting drugs in that they have estrogen-like effects on some tissues (such as bone) and anti-estrogen effects in others (such as breast tissue). Because of this, they may strengthen bones, similar to hormone replacement therapy.
Since estrogen replacement therapy has been linked to breast cancer, Evista provides the benefit of estrogen to the bones without the risk of breast cancer or uterine bleeding found with hormone replacement therapy.
In addition to building bone, Evista may reduce the risk of developing hormone-receptor-positive breast cancer in postmenopausal women.
The drug can perform double-duty for women who have both osteoporosis or osteopeniaandan increased chance of developing breast cancer.
Hormone Replacement Therapy
Once touted for its ability to reduce the risk of osteoporosis,hormone replacement therapy (HRT)with estrogen has fallen out of favor due to it being associated with the risk of cardiovascular disease, dementia, genito-urinary problems, endometrial and ovarian cancer, and venous thromboembolism.
That said, some women continue to use HRT to control menopausal symptoms, and it has clearly been shown to improve quality of life for some people. For those who use HRT for this reason, an added benefit is a reduction in bone loss.
Calcitonin
Calcitonin is a hormone naturally present in your body that works to regulate calcium and bone metabolism. Calcitonin inhibits osteoclast activity and increases renal excretion of calcium, which decreases the resorption of bone matrix and serum calcium levels.
Calcitonin is approved for the treatment of osteoporosis in women who are at least five years beyond menopause. It increases bone density, particularly in the spine, and appears to reduce the risk of spine fractures. It may also reduce pain for people who have fractures.
The effect is greatest in the first year of treatment and falls off rapidly after that time. Healthcare providers often recommend using a vitamin D and calcium supplement along with these medications—check with your practitioner about whether you should take one.
Calcitonin medications are available as a nasal spray or an injection, including the brand name Miacalcin. Miacalcin is available only as an injection. It is approved forPaget’s disease(a disease of the bone), hypercalcemia (elevated calcium level in the blood), and postmenopausal osteoporosis in women.
Side effects of the nasal spray may include nasal irritation, and calcitonin can cause skin flushing, a rash, nausea, and urinary frequency.
Parathyroid Hormone (PTH) Therapies
Unlike bisphosphonates, which reduce bone destruction, parathyroid hormone may actually work tobuildbetter and stronger bones.
Parathyroid hormone is most commonly prescribed for people who have been diagnosed with osteoporosis and who have a high risk of fractures, have failed to respond to other medications, or have experienced side effects with other osteoporosis drugs.
Studies show that the parathyroid hormone was found to reduce the risk of vertebral and nonvertebral fractures in postmenopausal women.
Parathyroid hormone medications include the following.
The most common side effects of Forteo are dizziness and leg cramps. Tymlos has been associated with kidney stones due to increased calcium in the urine.
It’s recommended that use of parathyroid hormone be limited to two years. Parathyroid hormone should not be used for those who have Paget’s disease, bone cancer (osteosarcoma), hypercalcemia, or who have had radiation treatment to their bones. In clinical trials, there appeared to be an increase in bone cancer in rats, which is why these drugs carry a boxed warning.
Both Forteo and Tymlos are very expensive relative to other options: treatment may cost up to $20,000 per year.
Monoclonal Antibody Therapy
The category of monoclonal antibody therapy includes two medications with the same structure but different indications.
Monoclonal antibody therapies include the following.
The most common side effects of these drugs include back, joint, and muscle pain, along with increased cholesterol levels and urinary tract infections.
Adverse effects may include osteonecrosis of the jaw, an increased risk of infections (especially of the heart muscle), the potential for atypical fractures, and slow wound healing.
Here, too, additional use of a bisphosphonate may be recommended for a duration of a few months to a year.
During Cancer TreatmentProlia, Xgeva, and Zometa appear to have anti-cancer properties in addition to reducing fracture risk. These drugs are often referred to as bone-modifying medications. They have been used to reduce the risk of fractures in people who have cancer that has spread to their bones.
During Cancer Treatment
Prolia, Xgeva, and Zometa appear to have anti-cancer properties in addition to reducing fracture risk. These drugs are often referred to as bone-modifying medications. They have been used to reduce the risk of fractures in people who have cancer that has spread to their bones.
Over-the-Counter (OTC) Therapies
With many osteoporosis medications, it’s recommended that people get adequate amounts of calcium and vitamin D.
While adequate amounts of calcium and vitamin D are required for proper bone formation, they are not a substitute for the use of osteoporosis medications.
Surgeries and Specialist-Driven Procedures
When osteoporosis causes fractures, more aggressive treatment may be needed to address the injury and improve the integrity of the bone.
Vertebroplasty and Kyphoplasty
Vertebroplasty is a minimally invasive procedure that is used to treatcompression fracturesof the spine. During this procedure, bone cement is injected into the fractured vertebrae to stabilize the bone.
Kyphoplastyis a similar procedure, except that a small balloon is first inserted into the compressed vertebrae and inflated. This space is then filled with bone cement, bringing back height and stability to the vertebrae.
Both procedures can help reduce pain and restore mobility and stability. Like all medical procedures, there arerisks involved with kyphoplasty and vertebroplastyYour physician will go over these with you.
Spinal Fusion
Spinal fusion is a surgical procedure in which two or more bones in the spine are fused together to prevent movement of the vertebrae and bring stability to the spine. A bone graft is used to fuse the vertebrae.
In most cases, spinal fusion is done when other options have been exhausted and when the benefits outweigh the inherent risks that come with spinal surgery.
Other Fracture Treatments
There are multiple procedures your healthcare provider may recommend fortreating fractures, depending on where your fracture occurs. The goal of surgical treatment of fractures is to obtain a stable fixation, reduce pain, and permit early mobilization. Procedures may include:
Yes. Walking, stair climbing, jogging, and tai chi are examples of weight-bearing aerobicexercisesthat force you to work against gravity. These help you to build bone mineral density, which improves the overall health of your bones.
It’s not recommended. Studies have concluded that drinking even just one or two drinks per day can increase your osteoporosis risk.
Coping With Osteoporosis
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