Osteoporosis

Treatment

Who Treats Osteoporosis?

Although there is no cure for osteoporosis, it can be treated. If your doctor does not specialize in osteoporosis, he or she can refer you to a specialist. There is not one type of doctor who cares for people with osteoporosis.

Many family doctors have been learning about osteoporosis and can treat people who have it. Endocrinologists, rheumatologists, geriatricians, and internists are just a few of the specialists who can provide care to people with osteoporosis.

The Goal of Treatment

The goal of treatment is to prevent fractures. A balanced diet rich in calcium, adequate vitamin D, a regular exercise program, and fall prevention are all important for maintaining bone health.

Several medications are approved by the Food and Drug Administration for the treatment of osteoporosis. Since all medications have side effects, it is important to talk to your doctor about which medication is right for you.

Bisphosphonates

Alendronate, risedronate, ibandronate, and zoledronic acid are from a class of drugs called bisphosphonates that slow bone loss, reduce fracture risk, and in some cases increase bone density. These drugs decrease the activity of bone-dissolving cells.

Side Effects

Side effects of taking oral bisphosphonates may include nausea, heartburn, and stomach pain, including serious digestive problems if they are not taken properly.

A few people have muscle, bone, or joint pain while using these medicines. Side effects of intravenous bisphosphonates may include flu-like symptoms such as fever, pain in muscles or joints, and headaches. These symptoms usually stop after a few days. In rare cases, deterioration of the jawbone or an unusual type of broken bone in the femur (thigh bone) has occurred in people taking bisphosphonates.

The Food and Drug Administration recommends that health care professionals consider periodic reevaluation of the need for continued bisphosphonate therapy, particularly for patients who have been on bisphosphonates for longer than 5 years.

Estrogen

Estrogen is approved for the treatment of menopausal symptoms and osteoporosis in women after menopause. Because of recent evidence that breast cancer, strokes, blood clots, and heart attacks may be increased in some women who take estrogen, the Food and Drug Administration recommends that women take the lowest effective dose for the shortest period possible. Estrogen should only be considered for women at significant risk for osteoporosis, and nonestrogen medications should be carefully considered first.

Raloxifene

Raloxifene, available as a daily pill, is approved for use in postmenopausal women. From a class of drugs called estrogen agonists/antagonists, also referred to as selective estrogen receptor modulators (SERMs), raloxifene is a nonhormonal drug that has estrogen-like effects on the skeleton, but blocks estrogen effects in the breast and uterus. Raloxifene slows bone loss and reduces the risk of fractures in the spine, but no effect on hip fracture has been seen. Side effects may include hot flashes and an increased risk of blood clots in some women.

Other Medications

Calcitonin, available as a daily nasal spray or injection, is approved for the treatment of osteoporosis in women who are at least 5 years past menopause. It is a hormone produced by the thyroid gland that slows bone loss and reduces the risk of spine fractures. It has no serious side effects.

Teriparatide, a form of human parathyroid hormone, stimulates new bone formation. Given as a daily injection for up to 24 months, it increases bone tissue and bone strength, and has been shown to reduce the risk of spine and other fractures.Teriparatide is approved for use in postmenopausal women and men who are at high risk of fracture. Some patients experience leg cramps and dizziness from teriparatide.

Denosumab, a rank ligand (RANKL) inhibitor, is available as an injection every six months for men and postmenopausal women. Side effects include low calcium blood levels; infections; skin and jawbone problems; and pain in the muscles, back, arms, and legs.