Bones in your body are living tissues that constantly break down and replace themselves with new material. Osteoporosis is a condition in which your bones break down faster than they regrow. This causes them to become less dense, more porous, and more brittle. This weakens your bones and can lead to more fractures and breaks.
No cure is available. The goal of treatment is to protect and strengthen your bones. Treatment usually includes a combination of medications and lifestyle changes to help slow the rate of bone reabsorption by the body.
Causes and risk factors
Most people have their highest bone mass and density when they’re in their early 20s. As you age, you lose old bone at a faster rate than your body can replace it. Because of this, older people are at a higher risk for osteoporosis.
Women also have a higher risk of developing osteoporosis because they typically have thinner bones than men. Estrogen helps protect bones. Women who are going through menopause experience a decrease in estrogen levels, which leads to brittle bones.
Other risks factors include:
- certain medications, such as steroids, proton pump inhibitors, and barbiturates
- certain diseases, such as rheumatoid arthritis, multiple myeloma
The most aggressive way to prevent bone loss is to take prescription medications, such as the following:
These are the most common osteoporosis drug treatments. They include the following
- Alendronate (Fosamax) is an oral medication people typically take once per week.
- Ibandronate (Boniva) is available as a monthly oral tablet or as an intravenous injection that you get four times per year.
- Risedronate (Actonel) is available in daily, weekly, bimonthly, or monthly doses.
- Zoledronic acid (Reclast) is available as an intravenous infusion that you get once every one or two years.
The side effects of these drugs can include acid reflux, nausea, and stomach pain. In some cases, they can cause bone damage in the jaw, or jaw osteonecrosis. This side effect is rare and occurs more often in people who take high doses of bisphosphonates.
Denosumab (Xgeva, Prolia) is an antibody. It links to a protein involved in your body’s process of bone reabsorption. This antibody slows bone reabsorption. It also maintains bone density. It’s available as an injection that you get every six months. The side effects can include:
- skin irritation
- muscle stiffness
- excessive sweating
- bone fractures in rare cases
Postmenopausal women are at a high risk for osteoporosis. Estrogen helps protect bones, and estrogen production drops during menopause. For women in menopause, hormone therapy, or hormone replacement therapy, is a treatment option. Typically, doctors don’t use it as a first line of defense because it increases your risk of:
- a stroke
- a heart attack
- breast cancer
- blood clots
Types of hormone therapy include the following:
Selective estrogen receptor modulators (SERMs)
SERMs recreate the bone-preserving effect of estrogen. Raloxifene (Evista) is available as a daily oral tablet.
This is a hormone the thyroid gland makes. It helps regulate calcium levels in the body. Doctors use synthetic thyrocalcitonin, or calcitonin (Fortical, Miacalcin), to treat spinal osteoporosis in people who can’t take bisphosphonates. It can also ease the pain in some people who have spinal compression fractures. The drug is available by nasal spray or injection. Side effects from nose sprays may include a runny nose or nosebleeds.
Parathyroid hormone (PTH)
This hormone controls calcium and phosphate levels in bone. Treatments with a synthetic PTH like teriparatide (Forteo) can promote new bone growth. This drug is available as a daily injection in combination with calcium and vitamin D supplements. This drug is expensive and generally reserved for people with severe osteoporosis who have poor tolerance for other treatments.
Calcium and vitamin D
Getting plenty of 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 cereals and orange juices are now available with added calcium as well. Vitamin D helps your body absorb the calcium it needs.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) recommends that women aged 19-50 and men aged 19-70 should take 1,000 milligrams (mg) of calcium per day. They recommend that women aged 51-70 and everyone over 70 should take 1,200 mg of calcium per day.
The NIAMS recommends adults under age 70 should take 600 international units (IU) of vitamin D per day and adults over age 70 should take 800 IU of vitamin D per day.
Exercise helps strengthen your bones. Whatever the form, physical activity helps slow age-related bone loss and can slightly improve bone density in some cases. Exercise can also help improve your posture and balance, lowering your risk of falls. Fewer falls can mean fewer fractures.
Strength training benefits the bones in your arms and upper spine. This can mean free weights, weight machines, or resistance bands. Weight-bearing exercise like walking or jogging, and low-impact aerobics such as elliptical training or biking can also be beneficial. Both can help strengthen the bones in your legs, hips, and lower spine.
Osteoporosis affects many people all over the world, and although a cure isn’t currently available, treatments such as medications, hormone therapy, and exercise can strengthen bones and slow bone loss. Discuss each possible treatment and lifestyle change in detail with your doctor. Together, the two of you can weigh the risks and benefits of treatments.