Bone Health and Osteoporosis

Page 4

Treatment
The ultimate goal of diagnosis and treatment of osteoporosis is to reduce the number of fractures. Because bone density is the most reliable measure of osteoporosis, treatment is focused on increasing bone density. Bone strength is directly related to density, and ultimately, the stronger the bone, the less likely it will fracture. Bone strength also improves with proper diet and exercise. Hormones and genetics also influence bone strength. Treatment of osteoporosis is most effective using a combination of medications, calcium, vitamin D, weight-bearing exercise, and lifestyle and dietary modifications.

The most effective osteoporosis medications to date are the bisphosphonates, marketed as Fosamax and Actonel. Taken once weekly, these drugs are the most likely to increase bone density, decrease fracture risk, and reduce bone breakdown. Bisphosphonates function by interfering with the natural process of bone resorption and have been shown to reduce spine fracture risk by 30 to 50 percent and hip fracture risk by 24 to 50 percent. Estrogen supplements can prevent the development of osteoporosis and some fractures but are not recommended specifically for treatment, nor are they recommended for more than five years after menopause. Other types of drugs that are also used are described in the following chart. Consult with your doctor if you are taking some of the less-effective medicines, especially if you have a definite diagnosis of osteoporosis.

Medications Used to Treat and Prevent Osteoporosis, in Increasing Order of Effectiveness

Drug Type (Common name)	Function	Side Effects	Effectiveness
Calcitonin (Miacalcin), nasal spray; also can be injected	Helps bones absorb calcium; also helps with pain of vertebral (spine) fractures	Itchy or runny nose, pain from injection	More effective five years after menopause; minimal effect on bone density or strength
Estrogen, oral or patches (Estraderm,Climera, Premarin) cyclic estrogens with progesterone (Premphase), estrogen with progesterone (Prempro, Femhrt, Activella)	Allows bones to absorb and retain calcium better	Blood clots, stroke; some women at greater risk of breast cancer; mood changes, depression, weight gain, breast tenderness	Prevention only: although the number of hip and spine fractures are reduced, these are not recommended for treatment of osteoporosis
Selective estrogen receptor modulator, (SERM) Raloxifene, Evista	Tissue-specific estrogens used in women who have had breast cancer or other risk factors with estrogen; prevents breast cancer in some women	Similar to estrogen side effects	Recent studies do
			not show that these reduce the risk of hip and other fractures; more preventive than treatment
Bisphosphonates, Fosamax (Alendronate Sodium), Actonel (Risedronate Sodium)	Decreases bone breakdown	Irritation of the esophagus; needs to be taken first thing in the morning with a full glass of water; remain upright for 30 minutes	Extremely effective; reduces all fractures vertebral (spine) to fractures by 30 to 50 percent and the the incidence of hip fractures by 24 to 50 percent
Parathyroid hormone, Forteo (teriparatide)	Increases bone formation and decreases resorption	Needs to be injected daily; will often be used in combination with drugs; may cause cancer	Potential to increase bone formation and reduce fractures by 60 percent; not yet widely available or tested

Nutrition is very important, as bone growth and strength cannot occur without calcium, the building block of bone. Vitamin D and magnesium also play an important role. Vitamin D helps the body retain calcium and prevents it from being excreted out of the body via the kidneys. Bone specialists recommend taking 1,300 to 1,500 mg of calcium in two or three divided doses with two of the doses taken in the evening (one with dinner, one before bed). A multivitamin containing 400 IU of vitamin D should also be taken with the evening meal. There are also other trace minerals involved in bone formation, including magnesium; these are covered by taking your multivitamin daily, a recommended habit for everyone.

When totaling your calcium and vitamin D intake, include food and drink sources so you do not overdo the amounts. Adding your total calcium milligram is easy by reading labels-add a zero to the percent daily value of calcium listed on the food label to easily calculate the mineral content. Supplement to total 1,500 mg. For example, if you have eaten three servings of dairy products, each containing 30 percent the "daily value" (%DV) of calcium (such as milk, cheese, and calcium-fortified orange juice), your total calcium intake through foods is 900 mg. So on this day, you only need to take one 600 mg supplement of calcium. Daily vitamin D needs are covered in your multivitamin and the milk products you have consumed. It is not recommended to take more than 2,000 mg of calcium or 800 IU of vitamin D daily. Also, do not take vitamin A supplements if you have osteoporosis; this has been shown to increase fracture risk.

In women who have osteoporosis, excess salt, high-protein diets, alcoholic drinks, and carbonated drinks should be kept to a minimum, as these can interfere with the body's calcium absorption and retention. Caffeine can also increase calcium loss, but this effect is minimal, unless you are also a smoker. Smoking is detrimental to the bones and should be stopped!

Exercise improves bone strength, just as it improves muscle strength. Our bodies work as hard as possible to positively respond to the healthy stress of exercise, resulting in not just stronger muscles and lung and heart function, but also stronger bones. The proven way to strengthen bones is with weight-bearing exercise, brisk walking, mountain biking, stair climbing, soccer, basketball, racket sports, and hiking. The greater the weight-bearing impact, the greater the effect. (Gymnasts and runners tend to have very strong bones, despite their thin frames.) Resistive weight training has also been shown to positively stress bones and make them stronger.

It is recommended to use a combination of these weight-bearing exercises for the most effective increase in bone strength, ideally doing weight-bearing exercise for at least 20 to 30 minutes each day, along with upper body strength training three times a week for 20 minutes. Lower body strength training should be done if your exercise program is not weight bearing such as swimming, cycling, or kayaking. Be aware that exercise can also be overdone, causing bones to negatively respond to the excess stress with stress fractures; therefore, impact or intense weight training is not recommended for more than one hour each day, unless you are a highly trained athlete.