Approaches to Treating Osteoporosis

Osteoporosis is a bone disease frequently found in women due to lower peak bone mass and menopausal changes. Osteoporosis is characterized by porous, low-density bones that cause the bone to become fragile and easily break or fracture.

Osteoporosis

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Bones are living tissues, which can be viewed as a honeycomb. In osteoporosis, the pores become larger and weak hence causing fragility and other complications. Osteoporosis is the cause of around 8.9 million fractures yearly.

What are the risk factors for osteoporosis?

The risk factors for osteoporosis include modifiable as well as non-modifiable risk factors. The modifiable risk factors include lifestyle, medication use, sex hormones, while the non-modifiable risk factors are family history, sex, and age.

While most people with the disease will have these risk factors, some get the disease with no risk factors.

What are the signs and symptoms of osteoporosis?

Osteoporosis is called a silent disease because there are no visible symptoms in the disease's early stages. An individual may not realize a deterioration going on inside the bone until there is a sudden fracture or bone breakage. Once the disease has affected the bones, the following symptoms may be noticed:

  • Back pain
  • Bone breakage
  • Posture change and loss of height

How is osteoporosis diagnosed?

Osteoporosis can be detected by measuring bone mineral density. Bone mineral density reflects the bone mass of an individual. The bone mineral density measurement can show osteoporosis, measure the rate of treatment response, and predict future fractures. It is good to check the bone mass often to be sure that health is maintained.

What are the treatment approaches for osteoporosis?

The treatment of osteoporosis involves using various pharmacological (i.e., treatment with drugs) or non-pharmacological (i.e., treatment with other methods that do not include drugs).

The choice of treatment is dependent on the nature and extent of the disease, sex, age, previous injury history, and risk of breaking a bone. The primary objective is to reduce the risk of fracture, reduce pain, prevent disability and bone loss.

Non-Pharmacological Approaches

The non-pharmacological treatment approach involves treatment that does not need medications. Non-pharmacological strategies include the following:

  • Exercise: Regular exercise is essential in osteoporosis. It is good for preventing fractures, increasing muscle strength, improving bone health, balance, and coordination. However, exercise should not put excessive strain on the bones. This approach should be closely monitored to avoid damage.
  • Nutrition: It is essential to have foods rich in calcium and vitamin D to prevent osteoporosis. Calcium strengthens the bones, and vitamin D increases the uptake of calcium. Foods rich in calcium and vitamin D include dairy products and certain vegetables such as kale and broccoli. Calcium and vitamin supplements can also be taken. Minerals, vitamins, and other nutrients are also essential for healthy bones. Excessive intake of sodium, caffeine, and protein increases the loss of calcium in the urine and hence should be minimized.
  • Other lifestyle modifications: These include changes such as maintaining proper body weight, avoiding alcohol consumption, and smoking cessation.

Foods high in calcium

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Pharmacological Approach

There are various pharmacological treatments available for osteoporosis treatment. They are broadly classified into:

  • Antiresorptive Therapies: These drugs bind with the mineral matrix of the bone and inhibit the osteoclasts resorption of the bone. They stop the bone from deteriorating and improve bone formation. Antiresorptive therapies include bisphosphonates and monoclonal antibodies.
  • Hormonal Therapies: These are mostly used in post-menopausal osteoporosis. Hormonal therapies reduce the risk of bone breakage and keep the bones healthy. These therapies include the estrogen agonists/antagonists, which are also called selective estrogen receptor modulators (SERMs).
  • Parathyroid Hormone Analogues: Parathyroid hormone analogs are drugs that increase bone strength. They are also called remodeling-based bone-forming therapies, which means they function to remodel and form the bone and prevent further damage.
  • Combination therapy: The drugs mentioned above can be combined by the doctor for better effect and action. Combining drugs can have synergistic or additive action.
  • Calcium and vitamin D supplements: Since calcium is an essential component of the bone and vitamin D facilitates its absorption, supplements can be given to replenish the calcium levels in the body. An average adult needs about 700mg of calcium daily, but a person with osteoporosis will usually require more hence the need for the supplements.

Sources

  • Langdahl BL., (2020). Overview of treatment approaches to osteoporosis.  Br J Pharmacol.;10.1111/bph.15024. doi:10.1111/bph.15024
  • Tu, K. N., et al. (2018). Osteoporosis: A Review of Treatment Options. P & T: a peer-reviewed journal for formulary management. 43(2):92–104.

Further Reading

Last Updated: Oct 29, 2020

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