| Prevention is always the best treatment, and this is especially important for individuals with multiple risk factors for osteoporosis. Preventive measures may include nutritional counseling on diet and the intake of vitamins, particularly calcium and vitamin D; cessation of tobacco and alcohol use; maintenance of fitness and adequate daily weight-bearing exercise (e.g. walking, jogging); and judicious use of medications that affect bone metabolism.
Once the diagnosis of osteoporosis has been made, treatment may include calcium and vitamin D supplementation, use of bisphosphonates or calcitonin, increase in weight-bearing activity, and treatment of any underlying metabolic disease. Nonsteroidal anti-inflammatory medications can be used to treat pain. Hormone (progesterone and estrogen) replacement therapy (HRT) was once considered a first-line treatment for osteoporosis in postmenopausal women. More recent studies have found an association with an increased risk of breast cancer, heart attack (myocardial infarction), stroke (cerebral infarction), and blood clots (embolism). HRT is no longer recommended as a treatment for osteoporosis in postmenopausal women (Jacobs-Kosmin).
Pharmacologic treatments for osteoporosis include bisphosphonates, parathyroid hormone, selective estrogen receptor modulators (SERMs), and calcitonin. Bisphosphonates reduce bone resorption and increase bone mass density, thereby reducing the risk of fracture. In the US, bisphosphonates are approved for the prevention and treatment of osteoporosis in post-menopausal women, osteoporosis in men, and osteoporosis caused by treatment with steroids.
Intermittent injections of parathyroid hormone increase bone formation and therefore bone mass. Possible side effects include increased risk of certain types of bone cancer. This treatment is contraindicated in individuals at high risk for this complication (Jacobs-Kosmin). In the US, parathyroid hormone injection is approved for use in women with postmenopausal osteoporosis and men with primary osteoporosis.
Selective estrogen-receptor modulators (SERMs) may provide the benefits of estrogen without the increased risk of breast and uterine cancer. SERMs are approved in the US for prevention and treatment of postmenopausal osteoporosis but should not be used in women with a history of phlebitis.
Calcitonin therapy can increase bone mineral density and offer some pain-relieving (analgesic) effects in individuals with fractures. It is used in the prevention and treatment of osteoporosis in individuals who cannot take or do not tolerate bisphosphonates or estrogen.
Calcium and vitamin D supplementation are used in prevention and treatment of osteoporosis because many individuals consume inadequate amounts of these in their diets. Both calcium and vitamin D are essential for normal bone formation.
Treatment of fractures that result from osteoporosis may be challenging because the changes in bone metabolism that cause osteoporosis also make healing more difficult. Secondary complications may occur, especially with hip and vertebral fractures. Often with wrist fractures, the bones are not lined up properly by manipulation (reduction) because of the risk of further damage. Compression fractures of the spine may be treated with a corset or supporting brace and limited bed rest. Vertebroplasty involves injection of bone cement into the fractured vertebral body to stabilize it and reduce pain. Sometimes the injection is preceded by inflation of a balloon within the compressed vertebra in an attempt to elevate it back to its normal height. Since falls are the most common cause of osteoporotic fractures, assessment of risk factors, individual and caretaker education, and creation of a safe environment to reduce the chance of falls are imperative. |
Source: Medical Disability Advisor