How to treat osteoporosis in women?
The National Osteoporsis Foundation says that one in two women and one in eight men over 50 will have an osteoporosis related fracture in their lifetime.Thirty-three percent of women over 65 will experience a fracture of the spine and as many as 20% of hip fracture patients die within 6 months from conditions caused by lack of activity such as blood clots and
As women age estrogen levels decrease and the risk of osteoporosis increases. Women who take birth control pills during their reproductive years may reduce their risk of osteoporosis developing later in life, probably because of the estrogen that many oral contraceptives contain. Estrogen replacement therapy helps to protect women against bone loss.
White women and Asian women face the greatest risk of osteoporosis. An inactive lifestyle puts women at a higher risk for developing osteoporosis. Women with a slender build experience more bone loss than other women. A history of eating disorders increases the risk of osteoporosis. Women whose family history includes osteoporosis have a higher risk of developing this condition. Some medications such as diuretics, steroids, and anticonvulsants increase the risk. Women who smoke or drink alcohol experience a higher incidence of osteoporosis.
Women should be advised to consume >= 1000 mg of elemental Ca in their daily diet, but if a strong family history of osteoporosis is present or if osteoporosis has already been diagnosed, total Ca intake should be 1500 mg/24 h. Typically, a small daily supplement of vitamin D (400 IU) is recommended, unless the patient is hypercalciuric or has abnormal levels of vitamin D. Calcium carbonate tablets 600 mg four to six times/day (equivalent to 1 to 1.5 g/day of Ca) may be given, but calcium citrate is better absorbed in achlorhydric patients and may have fewer GI side effects.
There are several drugs that have been approved by the U.S. Food and Drug Administration for preventing and treating osteoporosis.
The non-hormonal bisphosphonate drugs, alendronate and risedronate, prevent and treat postmenopausal osteoporosis. They have been shown in clinical trials to reduce the risk of spine, non-spine and hip fractures. Both have also been approved for the treatment of glucocorticoid-induced (corticosteroid-induced) osteoporosis in men and women, who require long-term use of these medications (e.g., prednisone and cortisone). Alendronate has been approved to treat osteoporosis in men as well.
If you are taking a bisphosphonate, you should take the drug upon arising in the morning after an overnight fast, with one full glass of water. Stay in an upright position (sitting or standing) after taking the dose and do not drink or eat anything else for the following 30 minutes, in order to permit your body to absorb the medication. Alendronate and risedronate are available in a once-a-week form or a daily form. Side effects for bisphosphonates are uncommon, but may include abdominal or musculoskeletal pain, nausea, heartburn, or irritation of the esophagus.
Calcitonin is a naturally-occurring hormone involved in calcium regulation. Calcitonin reduces the risk of spinal fractures but has not been shown to decrease the risk of non-spine fractures. Because calcitonin is a protein, it cannot be taken by mouth - it would be digested. Calcitonin is most commonly used as nasal spray. While it does not affect other organs or systems in the body, injectable calcitonin may cause an allergic reaction and side effects including red face and hands (flushing), urinary frequency, nausea and a skin rash. Side effects for nasal calcitonin are uncommon, but may include nasal irritation, backache, bloody nose, and headaches.
Raloxifene is approved for preventing and treating osteoporosis in women who have gone through menopause. It is from a class of drugs called SERMs that have been developed to give estrogen-like benefits without estrogen's potential risks. Raloxifene increases bone density and reduces the risk of spine fractures, but it has not been shown to decrease the risk of non-spine fractures. Preliminary information suggests that raloxifene may also decrease the risk of breast cancer, but the issue is still under active investigation. Raloxifene is taken in pill form, once a day with or without meals. While side effects are uncommon, they may include hot flashes and deep vein thrombosis.
Teriparatide is a part (a fragment or portion) of parathyroid hormone, which is involved in calcium regulation. It is approved for those with severe osteoporosis, for both men and women who have a high risk of a fracture. This is the first osteoporosis treatment to stimulate new bone formation and significantly increase bone density. Teriparatide is taken in a daily injection for up to two years. Side effects are uncommon but can include leg cramps and dizziness. Each of these medications has certain benefits and side effects. You should work with your doctor to find the treatment that is right for you. To find an endocrinologist, please visit our physician referral directory.
Women should consider hormone replacement therapy with estrogen, with or without progestin, in addition to Ca; eg, conjugated estrogen 0.625 to 1.25 mg/day, omitting the dosage for 5 consecutive days each month to help prevent uterine endometrial hyperplasia. Estrogen can be taken as estrogen therapy (ET) or as part of hormone therapy (HT; estrogen plus a progestin). Estrogen reduces the rate of bone loss and fracture risk in the spine and hip. It can also relieve other symptoms of menopause, such as hot flashes and dry vaginal tissue. Estrogen is usually given in pill form, combined with a progestin (HT) to reduce the risk of cancer of the uterus. If your uterus has been removed, you do not need to take a progestin with the estrogen. However, if you are at risk for breast cancer or have had cancer of the uterus, estrogen may not be right for you. Based on recent studies, estrogen should be used in as low a dose for as short a time as necessary to relieve symptoms.
When estrogen is prescribed solely for the prevention or treatment of postmenopausal osteoporosis, a woman and her doctor should carefully consider approved non-estrogen treatments. According to the FDA, estrogens and combined estrogen-progestin products should only be considered for women with a significant risk of osteoporosis that outweighs the risks of the drug. Estrogen use increases the risk of deep vein thrombosis (blood clots). Other side effects of estrogen may include vaginal bleeding, breast tenderness, mood disturbances, and gallbladder disease.
More information on osteoporosis
What is osteoporosis? - Osteoporosis is a thinning and weakening of the bones, usually associated with the aging process. Osteoporosis is a disease, often with no detectable symptoms.
Building and maintaining skeletal health - Factors involved in building and maintaining skeletal health are adequate nutrition and body weight, exposure to sex hormones at puberty, and physical activity.
What types of osteoporosis are there? - Osteoporosis can be classified in various ways based on diagnostic categories, etiology. Osteoporosis can be classified as either primary osteoporosis or secondary osteoporosis.
What causes osteoporosis? - Osteoporosis is related to the loss of bone mass that occurs as part of the natural process of aging. Osteoporosis results when there is excess bone loss without adequate replacement.
What are the risk factors for osteoporosis? - Many disorders are associated with increased risk of osteoporosis. Osteoporosis is far more prevalent in women after menopause due to the loss of the hormone estrogen.
What're the risk factors for primary osteoporosis? - Risk factors for primary osteoporosis include age, gender, race, figure type, lifestyle, diet, and lack of sunlight.
What're the risk factors for secondary osteoporosis? - Risk factors for secondary osteoporosis include genetic disorders, hypogonadal states, endocrine disorders,hematologic disorders, nutritional deficiencies, drugs.
What are the consequences of osteoporosis? - Consequences due to osteoporosis are increased risk of fracture with minor trauma, frequency of traumatic events from lifting and bending impact.
What are the symptoms of osteoporosis? - Patients with uncomplicated osteoporosis may be asymptomatic or may have pain in the bones or muscles, particularly of the back. Osteoporosis becomes apparent in dramatic fashion.
How is osteoporosis diagnosed? - The diagnosis of osteoporosis is usually made by your doctor using a combination of a complete medical history and physical examination.
What're the treatments for osteoporosis? - Treatment for osteoporosis includes eating a diet rich in calcium and vitamin D, getting regular exercise, and taking medication to reduce bone loss and increase bone thickness.
What osteoporosis medications (drugs) are available? - Medications (drugs) to cure osteoporosis include bisphosphanates (Fosamax), calcitonin (Miacalcin), raloxifene, estrogen, and selective estrogen receptor modulators (SERMs).
How to treat osteoporosis in men? - Alendronate and teriparatide have been approved to treat osteoporosis in men. Calcitonin may work in men, treatment with testosterone appears to increase bone density.
How to treat osteoporosis in women? - The non-hormonal bisphosphonate drugs, alendronate and risedronate prevent and treat postmenopausal osteoporosis. Raloxifene is approved for preventing and treating osteoporosis.
What lifestyle changes can help osteoporosis? - Alcohol consumption should also be kept within safe limits. Supplements of calcium plus vitamin D may help maintain bone density. Limiting sodium and avoiding junk food.
What osteoporosis exercises are suggested? - Exercise is very important for slowing the progression of osteoporosis. Taking regular exercise is the single most important action improve the strength of their bones.
What osteoporosis diet is suggested? - A good calcium intake is essential throughout life for healthy bones. Vitamin D helps the absorption of calcium from the intestines. Reducing salt may be useful for osteoporosis patients.
What can be done to prevent osteoporosis? - For prevention and treatment of osteoporosis, patients should be encouraged to stop smoking, limit alcohol consumption and perform weight-bearing exercise.
Osteoporosis and calcium - Calcium could alter the physical-chemical properties of the bone mineral. The daily recommended dietary calcium intake varies by age, sex, and menopausal status.
Osteoporosis and magnesium - Magnesium supplementation is as important as calcium supplementation in the treatment and prevention of osteoporosis.
Osteoporosis and vitamin D - Vitamin D is necessary for the absorption of calcium in the stomach and gastrointestinal tract and is the essential companion to calcium in maintaining strong bones to prevent osteoporosis.