Aging

What is osteoporosis and how is it treated?

best treatment for osteoporosis

Osteoporosis happens when the body loses too much bone or doesn’t make enough of it. This leaves the bones weak and brittle. Brittle bones are more likely to break from minor injuries. Osteoporosis-related breaks, or fractures, are commonly seen in the hips, wrists, or spine. There are multiple ways to manage or treat osteoporosis, your doctor can help find the best osteoporosis treatment for you.

Who is at risk of osteoporosis?

Osteoporosis currently affects over 200 million people. In fact, it can occur in both men and women. However, those at the highest risk of developing osteoporosis are women who have passed menopause. Other risk factors can include family history and lifestyle choices—alcohol use, smoking, lack of exercise. In addition, not enough vitamin D and calcium in the diet can also put you at greater risk of osteoporosis.

Recent research has also found a link between heart disease and osteoporosis; the conditions exhibit similar abnormal changes in the body. There are no early noticeable symptoms, but once it has formed, patients typically experience back pain, loss of height, a stooping posture, and easily breakable bones.

What kinds of fractures can occur?

One of the most common kinds of osteoporotic bone breaks are vertebral fractures of the spine. Vertebral fractures can cause deformities. These can be mild, moderate, or severe. These fractures can be easy for doctors to overlook. Importantly, risk of future fractures can be increased when fractures are severe.

Other fractures, such as in the hip, often result in hospitalization. Statistically, 20% of these cases are fatal and 50% lead to severe disability. Osteoporotic fractures require costly care. The medical expenses associated with treating osteoporosis and caring for those affected, leave many with substantial debt. Even more importantly, patient quality of life significantly decreases. Osteoporosis is painful, prevents people from working, and decreases the overall ability to enjoy life.

What is the best treatment for osteoporosis?

Although there is increased awareness for osteoporotic conditions, they remain underdiagnosed and undertreated. The best treatments for osteoporosis include a variety of preventative measures and drug therapies.

Osteoporosis usually affects women who are older than fifty. Premenopausal women lose around 0.3% of their skeleton each year. At, or after, menopause they begin to lose over 2% of their bone mass. Hormones are important for maintaining an ideal bone mass. One of the most studied hormones – estrogen – has been used to prevent and treat osteoporosis.

Estrogen for osteoporosis

This hormone reduces the breaking down of the bone. It can reduce fractures everywhere in the body by almost 50%. It is important to note that taking estrogen can increase the risk of breast cancer by 2.5%. Raloxifene, known as Evista, is a medication used to treat postmenopausal women. It is preferred for women who are at high risk for breast cancer because it can reduce the risk of developing breast cancer.

Calcium and vitamin D for osteoporosis

Important nutrients needed for proper bone formation and long-term health are calcium and vitamin D. These vitamins are taken together because vitamin D increases the amount of calcium absorbed into the bones and makes them stronger. Another benefit is that they can improve muscle function, which helps with balance and reduces the chance of falling. This can help to prevent fractures. Doses of calcium and vitamin D can vary with age.

Parathyroid hormone for osteoporosis

Parathyroid hormone (PTH), secreted by the parathyroid gland, regulates calcium levels. This happens by the regulation of  calcium absorption from the diet, how much is removed by the kidneys, and how much calcium is stored in the bones. PTH can be used as a part of a new class of osteoporosis treatment. Teriparatide is a new PTH drug. It works to create new bone via bone-making cells, faster than the bone is able to breakdown. Research has found that it can increase bone density and overall reduce the risk of hip, spine, vertebral, and other fractures. 

Bisphosphonates for osteoporosis

Another class of drug used to prevent the loss of bone density are bisphosphonates. They work by attaching to bone-breaking cells and stopping them. Previous studies have shown that they can increase bone mass in the spine and hips and reduce the risk of fractures by about 50%. This is helpful, because bone strength depends on the bone mass (how much bone mineral is in bone tissue).

Denosumab for osteoporosis

Denosumab is a human monoclonal antibody used to treat bone loss and giant bone tumors. This therapy works by preventing bone-breaking cells from functioning. It can reduce the risk of hip, spine, and other bodily fractures in both osteoporotic men and postmenopausal women.

Denosumab is an injection that is given by health professionals. Common side effects include pain (in muscles, legs, arms, and back), itchiness and dryness of the skin, and skin infections. Osteonecrosis of the jaw is a rare, but sometimes seen, side effect. This occurs when the jaw bone is exposed and lacks proper blood circulation. As a result, the jaw bone begins to weaken and cause pain. Most patients typically experience infections, tissue swelling, and drainage in the mouth.

Osteoporosis can be prevented or managed through lifestyle changes or appropriate treatments. Always talk to your doctor before making any lifestyle changes or taking any medications or supplements. Your doctor can help you know what the best treatment for osteoporosis is for you.

Written by Melody Sayrany

References:

  1. Denosumab: Osteoporosis Canada. (2019, August 06). Retrieved January 10, 2021, from https://osteoporosis.ca/about-the-disease/treatment/denosumab/
  • Hu, X., Ma, S., Yang, C., Wang, W., & Chen, L. (2019). Relationship between senile osteoporosis and cardiovascular and cerebrovascular diseases. Experimental and Therapeutic Medicine. doi:10.3892/etm.2019.7518
  • Musculoskeletal conditions affect millions. (n.d.). Retrieved January 10, 2021, from https://www.who.int/news/item/27-10-2003-musculoskeletal-conditions-affect-millions
  • Miller, P. D. (2015). Management of severe osteoporosis. Expert Opinion on Pharmacotherapy, 17(4), 473-488. doi:10.1517/14656566.2016.1124856
  • Osteonecrosis of the Jaw. (n.d.). Retrieved January 10, 2021, from https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Osteonecrosis-of-the-Jaw-ONJ
  • Sozen, T., Ozisik, L., & Basaran, N. C. (2017). An overview and management of osteoporosis. European Journal of Rheumatology, 4(1), 46-56. doi:10.5152/eurjrheum.2016.048
  • Image by Michal Jarmoluk from Pixabay 

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