Since there is no cure for osteoporosis, the goal is to protect the bone still in place. Treatment usually includes a combination of drugs and lifestyle changes to help slow the rate of bone resorption by the body.
Prescriptions drugs are the most aggressive way to stall bone loss. Below are some of the drugs currently in use and overall treatment methods.
Bisphosphonates are the most common drugs used to treat osteoporosis. They include:
- alendronate (Fosamax), an oral medication typically taken once a week
- ibandronate (Boniva), offered as a monthly oral tablet or as an intravenous injection four times a year
- risedronate (Actonel), available in daily, weekly, bimonthly, or monthly doses
- zoledronic acid (Reclast), given intravenously once every one or two years
The side effects of these drugs can include acid reflux, nausea, and stomach pain. In rare cases, they can cause bone damage in the jaw (called jaw osteonecrosis). This is usually associated with high doses of bisphosphonates.
Denosumab (Xgeva and Prolia) is an antibody that links to a protein involved in the body’s bone production. This antibody has proved effective in slowing bone resorption and maintaining bone density. Injections are given every six months. Side effects can include skin irritations, muscle stiffness, pain or spasms, fatigue, and excessive sweating. In very rare cases, the drug may cause bone fractures.
Postmenopausal women are at a high risk for osteoporosis. With menopause comes a drop in protective estrogen production. For these women, hormone therapy (also called hormone-replacement therapy) is a treatment option. However, HT is not typically used as a first line of defense. The treatment poses increased risks of stroke, heart attack, breast cancer, and blood clots.
Selective estrogen receptor modulators (SERMs) re-create the bone-preserving effect of estrogen. Raloxifene (Evista) is a SERM treatment available in a daily oral tablet.
Thyrocalcitonin is a hormone made by the thyroid gland. It helps regulate calcium levels in the body. Synthetic thyrocalcitonin, or calcitonin (Fortical and Miacalcin), is used to treat spinal osteoporosis in patients who can’t take bisphosphonates. It can also ease pain in some patients with spinal compression fractures. The drug is available by nasal spray or injection. Side effects from nose sprays may include runny nose or nosebleeds. Calcitonin is considered a second or third line of treatment for patients unable to tolerate bisphosphonates.
Parathyroid hormone (PTH) controls calcium and phosphates levels in the bone. Treatments with a synthetic PTH, such as teriparatide (Forteo), can actually promote new bone growth. The drug is given by daily injection in combination with calcium and vitamin D supplements. This drug is very expensive. It is generally reserved for patients with severe osteoporosis who have poor tolerance for other treatments.
Calcium and Vitamin D
Getting enough calcium and vitamin D in your diet can help slow bone loss. Calcium-rich foods include:
- dairy products
- dark green vegetables
- enriched grains and breads
- soy products
Most cereal and orange juice are now available with added calcium. Monitor your vitamin D intake as it’s required for your body to absorb the calcium it needs.
The chart below shows the amount of daily calcium and vitamin D intake recommended by the National Institutes of Health in milligrams (mg) and IU (international units).
|0 to 6 months||210 mg||200 IU|
|7 to 12 months||270 mg||200 IU|
|1 to 3 years||500 mg||200 IU|
|4 to 8 years||800 mg||200 IU|
|9 to 18 years||1,300 mg||200 IU|
|19 to 50 years||1,000 mg||200 IU|
|51 to 70 years||1,200 mg||400 IU|
|Over 70 years||1,200 mg||600 IU|
Exercise provides the resistance your bones need to stay strong. Strength training — such as free weights, weight machines, or resistance bands — benefits the bones in your arms and upper spine. Weight-bearing exercise, such as walking or jogging, and low-impact aerobics such as elliptical training or biking, can strengthen the bones in your legs, hips, and lower spine. Whatever the form, physical activity helps slow age-related bone loss. Physical activity can slightly improve bone density in some cases. Exercise can also help improve your posture and balance and lower the risk for falls. Fewer falls for patients with osteoporosis can mean fewer fractures.
Discuss each possible treatment and lifestyle change in detail with your doctor. Together, the two of you can weigh the risks and benefits of any plan to treat your osteoporosis.