How to Treat Osteoporosis

Osteoporosis is a bone disease that develops because of bone loss. Many factors contribute to the development of the disease, including calcium deficiency, low levels of estrogen, and a lack of physical exercise throughout a person’s life.

When osteoporosis develops, the bones become weak and brittle. This leads to an increased risk for fractures that can cause disability or death. There are usually no symptoms of osteoporosis, and people only find out they have it after experiencing a broken bone.

Roughly 10 million American adults have osteoporosis. Women are affected much more often than men. Most osteoporosis cases occur in people over the age of 50. However, younger people can also develop or be at a higher risk for developing osteoporosis depending on their lifestyle.

Treatment options for osteoporosis include hormone therapy, medications to decrease bone loss, and diet and exercise modifications.

Common Osteoporosis Medications

The main goal of osteoporosis treatment is to lower the risk of bone fractures by slowing the loss of bone and increasing bone density.

There are several options for treating osteoporosis including medications called bisphosphonates and hormone therapies. Other treatment options include vitamin and mineral supplementation, exercise regimens, and in severe cases, surgery.

Bisphosphonates

Bisphosphonates are medications used to help reduce bone loss by inhibiting the action of the cells that are designed to break down bone (osteoclasts). The cells perform this action regularly throughout a person’s life. Other cells called osteoblasts help to rebuild new bone tissue in a process called bone remodeling.

When the rebuilding of new bone tissue does not occur, it can lead to osteoporosis. Since bisphosphonates discourage osteoclasts from breaking down the bone that cannot be replaced, they are often the first-line therapy for osteoporosis.

Some oral versions of bisphosphonates include:

• Actonel, which helps to reduce hip and spinal fractures
• Fosamax, which can reduce bone loss and reduce spinal fractures: It can be taken either daily or weekly.
• Boniva, which can be taken orally or through an injection: Oral administration can be done once per month or daily, while injections are done once every three months.

Two types of bisphosphonates can be given through a needle in your arm (intravenously or IV administration): Reclast and Zometa. These infused medications are given once a year.

The side effects of bisphosphonates depend on the type of medication, how your body responds to it, and how you take it. For example, if you take the medication orally, you may have heartburn, indigestion, headaches, and inflammation of the esophagus.

Getting a medication through an IV can cause flu-like symptoms (e.g., headaches or sore muscles and joints). A more serious side effect of IV administration of bisphosphonates is damage to the kidneys.

Hormone Therapy

Hormone therapy can involve different hormones, but one of the most often used is estrogen. The loss of estrogen during menopause or due to estrogen deficiency that happens before menopause can increase bone loss and lead to osteoporosis.

A loss of estrogen causes bone loss because the hormone helps to protect bones. When there is not enough of it in the body, that protection is lost. When estrogen levels are replenished, it can help preserve bone density.

Hormone therapy with estrogen does come with risks, including:

• Breast cancer
• Strokes
• Heart attacks
• Blood clots

Even though it has risks, estrogen therapy can help preserve bone density and is an effective method often used to help prevent fractures in women under the age of 60. Hormone replacement therapy (HRT) can be administered by mouth (orally) or placed on the skin (transdermal), where it is absorbed into the bloodstream.

Evista is a medication that mimics the action of estrogen. It can be given to help reduce bone loss and build new bone density in people who have low levels of estrogen. It is taken as a pill once per day. The side effects of Evista can include hot flashes, leg cramps, sweating, and headaches.

Men with osteoporosis can be prescribed testosterone if they have low levels of the hormone. When testosterone levels decrease in men, the resulting bone loss is much slower than it is in women as they lose estrogen, but the loss can still lead to osteoporosis.

Another form of hormone-replacement therapy that may help people with osteoporosis is the use of a synthetic form of parathyroid hormone. This hormone naturally occurs in the body and helps to form bones by increasing the number of cells that build bones (osteoblasts) and inhibiting the action of the cells that break down bones (osteoclasts).

Parathyroid hormone therapy is generally used when a person has not responded to other forms of osteoporosis medications. Examples of parathyroid hormone mediations include:

• Forteo
• Tymlos

Several side effects can occur if you take these medications including dizziness, leg cramps, and kidney stones.

Denosumab

A medication known as denosumab is often used in the treatment of osteoporosis because it can help to prevent osteoclasts from forming, which in turn decreases the number of cells in the body that break down bone.

By slowing the action of bone breakdown, these medications slow the progression of the disease. Some examples of this type of medication include:

• Prolia, available as an injection taken every six months
• Xgeva, available as an injection taken every four weeks

The side effects and adverse effects of denosumab medications include an increased risk of infection; slower wound healing; back, joint, and muscle pain; and an increase in cholesterol levels.

Lifestyle Modifications

People can make various lifestyle changes to help treat their osteoporosis.

Vitamins and Minerals

Nutrition plays a vital role in bone loss. Specific nutrients such as vitamin D and calcium are especially important for people with osteoporosis.

Around 99% of the calcium in the body is found in the bones and teeth. The mineral is tasked with maintaining bone structure and bone strength.

Although calcium can be taken as a supplement, it is most beneficial when you can get it from dietary sources. Foods that are high in calcium include fortified cereals, bread, juices, green leafy vegetables, and dairy products.

Vitamin D is necessary for bone health because it helps your body absorb calcium. You usually get vitamin D from sunlight exposure. There are also plenty of food sources of vitamin D such as egg yolks, oily fish, red meat, and some fortified foods.

Sometimes, vitamin D supplementation is necessary—for example, if you do not spend enough time outside or your diet is deficient in vitamin D-rich foods.

Diet

In addition to vitamin D and calcium, your body needs other vitamins to maintain bone density as well as slow the progression of the disease.

Other important vitamins for bone health include:

• Vitamin C: Vitamin C prevents the action of osteoclasts which leads to a decrease in their ability to break down bones. It can also help aid in bone formation. Vitamin C can be consumed in foods such as kiwi, oranges, and cruciferous vegetables or in supplement form.
• Vitamin K2: Osteocalcin, a specific protein hormone that binds to calcium to help build and heal bones, is protected by vitamin K2. Adequate levels of this vitamin are crucial for people with osteoporosis. Vitamin K2 can be found in dark leafy green vegetables and vegetable oils, but the best source of the nutrient is meat products such as chicken or beef.

Exercise Regimens

Weight-bearing and resistance exercises have been shown to help improve bone health and are often prescribed as a lifestyle modification in the treatment of osteoporosis. These exercises drive specific responses in the body that lead to the bones producing more bone cells.

Exercise can also help to build muscle and improve coordination, which can decrease a person’s risk of falling and having a fracture.

Specialist-Driven Procedures

People with osteoporosis who experience fractures may require specialist-driven treatments, such as surgery. Potential surgical treatments for osteoporosis include:

• Vertebroplasty and kyphoplasty are similar procedures; both are minimally invasive and designed to help treat compression fractures that have occurred in the spine. Vertebroplasty is done by injecting bone cement into the fracture to help stabilize it. Kyphoplasty is done by inserting an inflated balloon into the compressed vertebrae to help open the area before filling it with bone cement.
• Spinal fusion is performed by fusing two bones in the spine together to prevent movement of the spine. It is designed to stabilize the spine and help reduce further fractures. It is typically only done if all other treatment options have not worked.

Mental Health Treatments

Mental health disorders such as schizophrenia have been associated with lower bone density and an increased risk for fractures. Treating mental health conditions can be part of the treatment for osteoporosis.

Although it is not clear how the two are connected, treating schizophrenia in people with osteoporosis may help decrease their risk of fractures.

Herbal Remedies

There is very little clinical evidence to support the use of herbal remedies to help slow bone loss, but there has been some research on using melatonin.

Melatonin is a hormone that naturally occurs in the body and plays a vital role in the sleep-wake cycle. While using melatonin supplements has not been officially examined as a potential treatment for osteoporosis, one review found that it may help promote the growth of healthy bone cells.

Summary

There are many ways to treat osteoporosis, including lifestyle changes, medication, and surgery. The treatment that will be best for you will depend on the risk factors that you have, how severe your bone loss is, your overall health, and your preferences. Your doctor can help you find the safest and most effective way to treat the disease and improve your bone health.

Osteoporosis is a progressive disease, which means you should seek treatment as soon as possible to help prevent more bone loss. Getting the right treatment will not just help prevent bone loss, but can sometimes restore it. Treating osteoporosis is also important for reducing your risk of fractures.