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Update on Osteoporosis: Who, What, When, Where. and How?
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Posted on: 08/28/2008
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Given the aging of America and rising numbers of women with fractures from osteoporosis, it's time to review this topic. In this article, current understanding of risk factors, screening, and treatment for postmenopausal osteoporosis are summarized. The goal is to reduce modifiable risk factors and prevent osteoporosis as much as possible.
The loss of estrogen as a result of menopause (cessation of the menstrual cycle) can lead to decreased bone mineral density. The concern is that 30 to 50 per cent of postmenopausal American women have a bone fracture.
One way to prevent this from happening is to identify women who are at high risk for osteoporosis. Risk factors that can be changed include cigarette smoking, alcohol abuse, low body weight, and use of steroids.
As part of the screening process, bone density can be tested. Current guidelines recommend all postmenopausal women 65 years old and older should have bone density tests done. And any woman of any age who is postmenopausal with bone loss for any reason should be tested, too. For example, this would include women who go into menopause as a result of a hysterectomy.
Once a woman has been diagnosed with osteoporosis, treatment can begin. Daily intake of calcium is important. The formation of new bone requires sufficient calcium. The woman must get enough vitamin D to help the body absorb the calcium. Many calcium supplements include both calcium and Vitamin D to help with this.
Studies have not been able to show that the risk of bone fracture is less with vitamin and mineral supplementation. To offset this risk, physical activity and exercise is needed. But not just any kind of exercise is advised. Weight-bearing and resistance exercises are required. The contraction of muscles and pull of tendons on the bone is what stimulates bone growth.
There are also new drug treatments available. Women who should consider the pharmacologic approach include those who have had osteoporotic vertebral fractures or low bone density scores (- 2.5 or less). Testing for bone density is done with dual-energy X-ray absorptiometry (DXA). This screening technology measures bone density throughout the entire body.
Drug treatment is also considered for women with T-scores between -2.0 and -2.5 who have other significant risk factors. This would include thin women with low body mass index (BMI). A personal or family history of hip fracture (or other fragility fracture) are additional risk factors to consider.
Drugs used to prevent or treat osteoporosis include bisphosphonates, calcitonin, raloxifene, and parathyroid hormone (PTH) teriparatide. Each one of these medications has its own actions and indications. The two broad categories are antiresorptive and anabolic agents.
Antiresorptive agents keep bone from being dissolved or absorbed by the body. Bisphosphonates, raloxifene, and calcitonin are examples of antiresorptive agents. Anabolic treatment increases bone formation rather than preventing bone resorption. PTH teriparatide is the only anabolic agent approved by the FDA for this purpose so far.
The decision as to which drug to use can be complex. It must be made by the physician with the patient based on the woman's history, current physical and mental health, cost, and ease of treatment doses. Some drugs are taken in pill (oral) form. Others are given under the tongue, in the nose, or injected into the muscle.
Each pharmacologic agent has its own advantages and disadvantages. Some can be used as a preventive and treatment of osteoporosis. Others have just one function either as a preventive or treatment option. Some have side effects such as stomach upset, irritation of the esophagus, difficulty swallowing, or jaw osteonecrosis (death of bone tissue).
Women should be advised and cautioned how to take the medication. They should also be instructed what to look for and when to report any side effects. All of these guidelines will continue to be reviewed and revised as new research evidence comes available. Updates such as the information in this article will help keep patients and practitioners up-to-date.
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References:
Nicole K. Johnson, PharmD, et al. Understanding Risk Factors, Screening, and Treatment of Postmenopausal Osteoporosis. In Orthopedics. July 2008. Vol. 31. No. 7. Pp. 676-680.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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