How is osteoporosis treated and what is the prognosis for the condition?

How is osteoporosis treated?

The treatment options that are recommended for osteoporosis will often depend on a person’s estimated risk of bone fractures occurring in the following ten years, this will be calculated based on the information from a bone density test. If the risk is not very high, then treatment may not include medications but rather focus on modifying the risk factors associated with potential falls and bone loss.

Both men and women who have an increased risk of fracture may be prescribed some of the most widely accepted and used medications for osteoporosis. These are known as bisphosphonates and are a class of drugs that treat the condition by preventing the loss of bone mass.

Some examples of bisphosphonates include:

• Risedronate (Actonel, Atelvia)
• Ibandronate (Boniva)
• Alendronate (Fosamax)
• Zoledronic acid (Reclast)

There are a number of potential side effects when taking bisphosphonates, the most common of which include heartburn, nausea and abdominal pain. These are, however, far less likely to occur when these drugs are taken correctly, as instructed by a healthcare professional.

There are also intravenous (injected into a vein) forms of bisphosphonates which do not result in stomach upset, they do however result in headaches, muscle aches and fever that can last for up to three days. It is sometimes easier to schedule a yearly or quarterly injection with a doctor than trying to remember to take a weekly or monthly tablet, however, the intravenous forms of bisphosphonates are often costlier.

Using bisphosphonates medications for longer than a period of five years has been associated with an extremely rare condition wherein the middle of the thighbone cracks and may even break completely.

Bisphosphonates may also affect the jawbone, this is known as osteonecrosis of the jaw. This is rare condition and is caused by a reduction in blood flow to the bones and joints, causing the bones to break down and die. Osteonecrosis of the jaw may occur after having a tooth extraction wherein a section of the jawbone where a tooth has been pulled is unable to heal. It is therefore important that one has a dental exam before starting bisphosphonates.

Hormone therapy

• Selective oestrogen receptor modulators (SERMs) – These drugs replicate the effects of oestrogen. The administration of oestrogen, particularly after going through menopause, is able to aid in maintaining bone density. Bear in mind, however, that taking oestrogen does come with a few risks, including an increased risk of blood clots, breast cancer, endometrial cancer and possibly even heart disease. As a result, oestrogen will typically be used to improve bone health in younger women or women with menopausal symptoms that require treatment.
  
  A drug known as Raloxifene (Evista) mimics the beneficial effects of oestrogen on bone density in women who are postmenopausal, this drug does not carry the risks associated with oestrogen. By taking this medication, the risks of developing breast cancer may be lowered, however, it can increase the risk of blood clot formation. A commonly seen side effect is hot flushes.

Osteoporosis in men is often linked to the gradual decline of testosterone levels that are associated with age. Testosterone replacement therapy may help in improving symptoms that are associated with low levels of testosterone, therefore, these are recommended to be taken alone, or as an additional medication to testosterone. Men are often treated with raloxifene and alendronate.

Other medications for osteoporosis

There are a number of other medication options to treat osteoporosis. These include:

• Denosumab (Prolia) – Denosumab is a kind of biological therapy in the sense that it is an antibody that targets a specific protein that is involved in the breakdown of bones. When this drug is compared with bisphosphonates, doctors have noticed that denosumab produces better or similar results regarding bone density and also reduces the risk of all kinds of fractures. This drug will be administered through an injection under the skin bi-annually.
• Teriparatide (Forteo) – This is a very powerful drug that is a form of parathyroid hormone and stimulates new bone growth. Teriparatide is administered through a daily injection under the skin. However, the long-term use of this drug is not recommended, because of this, another drug will be prescribed to treat the condition on an ongoing basis.
• Calcitonin (Miacalcin) – This drug is a synthetic version of the hormone that is produced by the thyroid gland. Calcitonin is administered through a nasal spray and blocks the breakdown of bones.

Lifestyle factors

The benefits of exercise

One of the most vital lifestyle factors for the treatment of osteoporosis is exercise. Exercise has a number of beneficial effects. Bear in mind that while exercise is not able to increase bone density in a substantial manner, it can, however, decrease one’s risk of falling as balance improves, muscle strength increases and bone loss is slowed.

Currently no research exists as to what kinds of exercise are best for those with osteoporosis or for how long exercise should be performed to be of benefit. Until research can confirm the correct form of exercise best suited to osteoporosis, doctors recommend weight-bearing exercises such as walking or dancing.

Other exercises include:

• Running
• Gardening
• Climbing stairs
• Jogging
• Hiking
• Playing tennis
• Lifting weights
• Tai chi
• Yoga
• Pilates

However, caution should be taken when exercising with osteoporosis as there is an increased risk of injury to already weakened and fractured bones. Those over the age of 40 who are suffering from a condition such as obesity, hypertension (high blood pressure), diabetes or heart disease, should follow an exercise regimen that is prescribed and monitored by a treating physician. Partaking in extremely strenuous levels of exercise, for example, running a marathon, is not advisable for those with bone health issues. Younger women who actively partake in marathon running may have their bone health affected at an older age.

Stop smoking

Smoking raises one’s chances of developing osteoporosis⁵. Smoking tobacco products harms the bones and lowers the amount of oestrogen found in the body. Healthy levels of oestrogen aid in slowing down bone loss.

Smoking is also able to lead to menopause at an earlier age.

Drink alcohol in moderation

It is generally advised that men do not consume more than four drinks a day and women more than three. Alcohol makes it harder for the body to absorb calcium and affects one’s balance when intoxicated, which may lead to falls and fractures.

Make one’s home safer

The risk of falling can be reduced through improving the safety of one’s home. Some home-safety recommendations are as follows:

• Using a rubber bath mat in the bath tub or shower will prevent slipping.
• Keeping floors free from clutter that may be tripped over.
• Removing any rugs that may result in slipping and falling or rubberising the under sides of slippery rugs.
• Installing grab bars in the bath tub and shower (if these are not already there).

Treating fractures

If one has osteoporosis and fractures a hip, then a doctor or specialist may suggest surgical repair. This will be conducted in order to stabilise and realign the hip.

If a wrist fracture occurs, this may heal on its own when placed in a cast or brace. In some cases, surgery may be required to have the bones realigned.

Other treatment options for fractures include rest and pain medications.

Calcitonin injections have been known to reduce spinal pain associated with new compression fractures.

Prognosis

The outlook for those with osteoporosis is generally a positive one⁴. Particularly if the condition is detected during the initial stages of the disease and treated effectively. Bone density, even if osteoporosis is severe, can generally be improved or stabilised. Through detection and treatment, the risk of bone fractures is significantly reduced.

If one suffers from mild osteoporosis then a significantly positive outlook is expected if effective treatment commences and is adhered to. If a fracture occurs, bones will generally heal effectively and the pain associated with the fracture will typically resolve within a few weeks.

In some people with osteoporosis, the cause of the condition is not always known, this makes their prognosis difficult to determine. The outlook is often better if the cause can be correctly identified and treated.

 

 

^References

^{4. Harvard Health Publications. October 2012. Osteoporosis. Available: https://www.health.harvard.edu/pain/osteoporosis [Accessed 31.08.2017]}

^{5. Office on Women’s Health. Osteoporosis. Available: https://www.womenshealth.gov/a-z-topics/osteoporosis [Accessed 31.08.2017]}