Although a diagnosis of osteoporosis is based on the results of your bone mineral density (DXA) scan, the decision about what treatment, if any, you have can be based on a number of factors, including your risk of fracture. If you’ve been diagnosed with osteoporosis because you’ve had a fracture, you should still be treated to try to reduce the risk of any further fractures.
You may not need or want to take drugs to treat your osteoporosis. However, you should maintain good levels of calcium and vitamin D in your body. Your healthcare team may advise a change to your diet or taking supplements to do this.
Drugs for osteoporosis
There are a number of different drug treatments for osteoporosis. Your doctor will discuss the treatments available and will make sure that the medicines are right for you.
Bisphosphonates work by slowing the rate at which the cells that break down bone (osteoclasts) work. This maintains bone density and reduces the risk of fracture. There are a number of different bisphosphonates, including alendronate, etidronate, ibandronate, risedronate and zolendronic acid. They are given as a tablet or as injection.
The main side effects associated with bisphosphonates include irritation to the oesophagus, trouble swallowing and stomach pain, but not everyone will experience side effects. Osteoneocrosis of the jaw is a very rare side effect that has been linked with the use of bisphosphonates (more frequently with high-dose intravenous bisphosphonate treatment for cancer and not for osteoporosis). The cells in the bone of the jaw die, and this can lead to problems with healing. If you have a history of problems with your teeth, you may need a check-up before you start this treatment. If you have any concerns, speak to your doctor.
Strontium ranelate appears to have an effect on both the cells that breakdown bone and the cells that create new bone (osteoblasts). It can be used as an alternative treatment if bisphosphonates are found not to be suitable. Strontium ranelate is taken as a powder dissolved in water.
The main side effects associated with strontium ranelate are nausea and diarrhoea. A few patients have reported a rare, severe allergic reaction to the treatment. If you develop a skin rash while taking strontium ralenate, stop taking it and speak to your doctor immediately.
Selective estrogen receptor modulators (SERMs)
SERMs are drugs that have a similar effect on bone as the hormone oestrogen. They help maintain bone density and reduce the risk of fracture, particularly at the spine. The only form of SERM available for the treatment of osteoporosis is raloxifene. Raloxifene is taken as a tablet every day.
Side effects that have been associated with raloxifene include hot flushes, leg cramps and a potential increased risk of blood clots.
Parathyroid hormone (PTH) (Teriparetide)
Parathyroid hormone is produced naturally in the body. It regulates the amount of calcium in bone. Parathyroid hormone treatments (human recombinant parathyroid hormone or teriparatide) are used to stimulate cells that create new bone (osteoblasts). They are given by injection. While other drugs can only slow down the rate of bone thinning, PTH can increase bone density. However, it is only used in a small number of people whose bone density is very low and where other treatments aren’t working.
Common side effects include nausea and vomiting. Parathyroid hormone treatments should only be prescribed by a specialist.
Calcium and vitamin D supplements
Calcium and vitamin D supplements can benefit older men and women and reduce their risk of hip fracture. Having enough calcium as part of a healthy balanced diet is important to maintain healthy bones. Aim to eat or drink 700mg of calcium each day. This is roughly equivalent to one pint of milk. If you are not getting enough calcium in your diet, ask your GP for advice about taking a calcium supplement. To have the right effect on your bones and help prevent falls or fracture, or in treatment of osteoporosis, you need the right dose of calcium (1.2g a day) and vitamin D (800 iu). These doses only occur in a small number of branded formulations prescribed by doctors, so any pills you buy over-the-counter may not have enough calcium and generally no vitamin D.
Hormone replacement therapy (HRT)
HRT is used for women going through the menopause as it can help to control symptoms. In addition, HRT has been shown to maintain bone density and reduce the risk of fracture during treatment. However, HRT is not specifically recommended as a treatment for osteoporosis and is now almost never used. This is because there is a risk that HRT slightly raises the chance of developing certain conditions, such as breast cancer, endometrial cancer, ovarian cancer and stroke, more than it lowers the risk of osteoporosis. Discuss the benefits and risks of HRT with your GP.
Calcitonin is a hormone made by the thyroid gland. It inhibits the cells that break down bone (osteoclasts), which increases bone density. Calcitonin or salcatonin are taken as a nasal spray or an injection every day. Side effects include nausea, vomiting and diarrhoea.
Testosterone treatment for men is useful when osteoporosis is due to an insufficient production of male sex hormones (hypogonadism).
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