This is the third article in Pain.com’s series about osteoporosis. The subject of this article is treating osteoporosis. Treatment for osteoporosis can decrease or stop the loss of bone mineral density, strengthen bones and decrease the risk of developing bone fractures. These goals can be accomplished using a single medication or a combination of medications, dietary changes, exercise plans and lifestyle changes. More information about pain control, physical therapy, exercise and diet will be discussed in more detail in the next article in this series called “Living With Osteoporosis.”
The first line of medications that are used to increase bone mineral density to treat osteoporosis are called bisphosphonates. Bisphosphonates work by inhibiting the process of bone resorption, or breakdown of bone. In people with osteoporosis, the breakdown of bone is greater than the construction of new bone. Bisphosphonates help balance out this process and in some cases can help increase bone mineral density in certain bones. Bisphosphonates are often prescribed to post-menopausal women who have already been diagnosed with osteoporosis or those who are at high risk for developing the condition, but men with osteoporosis can also benefit from treatment with bisphosphonates. Examples of bisphosphonate drugs include Boniva, Fosamax, Reclast and Actonel. Bisphosphonates are sometimes prescribed as an oral medication that is taken once per week or once per month, but an intravenous injection is also available. Always discuss potential side effects of prescription medications with your doctor or pharmacist.
Calcitonin is another drug that can be used to treat osteoporosis. Calcitonin is a hormone that is naturally produced in your body by your thyroid gland. Calcitonin works by decreasing bone resorption, thus slowing the loss of bone density. This medication is not as effective as bisphosphonate medications, but it is useful to treat osteoporosis in individuals who can not take other types of osteoporosis medications. Calcitonin is available as a nasal spray or intravenous injection.
Hormone replacement therapy to replace estrogen in postmenopausal women was often used in the past to prevent osteoporosis. Hormone replacement therapy works by preventing the natural loss of bone density that usually occurs after menopause. Evidence now suggests that this treatment is too risky to be a routine treatment. Use of estrogen after menopause increases a woman’s risk of developing blood clots, cardiovascular disease, breast cancer and cancer of the uterine lining, or endometrium.
Raloxifene, a drug that is sold under the brand name Evista, works by stimulating some estrogen receptors. Therefore, it has a similar effect on preserving bone mineral density as estrogen replacement therapy, but without the dangerous cardiovascular side effects and cancer risks. Raloxifene is sometimes used to treat and prevent osteoporosis in women. It is not known if it is effective in treating osteoporosis in men. One small study of raloxifene use in men had a positive result, but there is not enough data for the FDA to recommend use of the drug in men with osteoporosis. Raloxifene appears to be effective in reducing the risk of vertebral fractures, but may not have a significant effect on the occurrence of other types of bone fractures. The main risk related to raloxifene is developing blood clots in the veins of the legs.
A drug called Forteo mimics the action of parathyroid hormone, a hormone naturally produced by the parathyroid glands. This drug is used in postmenopausal women with severe osteoporosis. It has to be given as a daily subcutaneous injection. The patient can learn to inject themselves with the medication. Forteo is effective in preventing bone fractures in women who are at a high risk for bone fractures.
People with osteoporosis may take more than one medication at a time or switch medications after a certain period of time to prevent the development of long-term side effects. People with osteoporosis do not usually require surgical procedures. Surgery may be used in people with small vertebral fractures or those with an extremely high risk of vertebral fractures. The vertebrae can actually be strengthened in a “vertebroplasty” procedure. In a vertebroplasty, a biologically-inactive type of glue is used to reinforce areas of the spinal column that are weak or cracked.
Lifestyle changes that can help slow down loss of bone mineral density include quitting smoking and decreasing alcohol consumption. People with osteoporosis can also benefit from certain types of regular exercise. Physical therapy can help these individuals develop exercise routines that are safe and that can strengthen bones. People with osteoporosis may also need to take calcium and vitamin D supplements if they can not get enough of these substances in their diet. Eating foods that are high in calcium and vitamin D can also help strengthen bones. These lifestyle and diet changes will be discussed in more detail in the next article in the osteoporosis series.
People who are undergoing treatment for osteoporosis should have regular bone mineral density tests to see if their treatments are working. Bone density tests are usually given every year or every two years.