All About Osteoporosis (and Home Remedies therefor) - Part III

When to seek medical advice

Early detection is important in osteoporosis. Consider your risk factors, then discuss your prevention strategy with your doctor. If you're a woman, it's best to do this well before menopause.

Tests and diagnosis

Osteopenia refers to mild bone loss that isn't severe enough to be called osteoporosis, but that increases your risk of osteoporosis. Doctors can detect osteopenia or early signs of osteoporosis using a variety of devices to measure bone density.

Dual energy X-ray absorptiometry

The best screening test is dual energy X-ray absorptiometry (DEXA). This procedure is quick, simple and gives accurate results. It measures the density of bones in your spine, hip and wrist — the areas most likely to be affected by osteoporosis — and it's used to accurately follow changes in these bones over time.

Other tests that can accurately measure bone density include:

    Ultrasound

    Quantitative computerized tomography (CT) scanning

Should you have a test?

If you're a woman, the National Osteoporosis Foundation recommends that you have a bone density test if you aren't taking estrogen and any of the following conditions apply to you:

•        You're older than age 65, regardless of risk factors.

•        You're postmenopausal and have at least one risk factor for osteoporosis, including having fractured a bone.

•        You have a vertebral abnormality.

•        You use medications, such as prednisone, that can cause osteoporosis.

•        You have type 1 diabetes, liver disease, kidney disease, thyroid disease or a family history of osteoporosis.

•        You experienced early menopause.

Doctors don't generally recommend osteoporosis screening for men because the disease is less common in men than it is in women.

Complications

Fractures are the most frequent and serious complication of osteoporosis. They often occur in your spine or hips — bones that directly support your weight. Hip fractures usually result from a fall. Although most people do relatively well with modern surgical treatment, hip fractures can result in disability and even death from postoperative complications, especially in older adults. Wrist fractures from falls also are common.

In some cases, spinal fractures can occur without any fall or injury simply because the bones in your back (vertebrae) become so weakened that they begin to compress. Compression fractures can cause severe pain and require a long recovery. If you have many such fractures, you can lose several inches of height as your posture becomes stooped.

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Treatments and drugs

Hormone therapy

Hormone therapy (HT) was once the mainstay of treatment for osteoporosis. But because of concerns about its safety and because other treatments are available, the role of hormone therapy in managing osteoporosis is changing. Most problems have been linked to certain oral types of HT, either taken in combination with progestin or alone. If you're interested in hormone therapy, other forms are available, including patches, creams and the vaginal ring.

 

Discuss the various options with your doctor to determine which might be best for you.

Prescription medications

If HT isn't for you, and lifestyle changes don't help control your osteoporosis, prescription drugs can help slow bone loss and may even increase bone density over time. They include:

    Bisphosphonates. Much like estrogen, this group of drugs can inhibit bone breakdown, preserve bone mass, and even increase bone density in your spine and hip, reducing the risk of fractures.

    Bisphosphonates may be especially beneficial for men, young adults and people with steroid-induced osteoporosis. They're also used to prevent osteoporosis in people who require long-term steroid treatment for a disease such as asthma or arthritis.

    Side effects, which can be severe, include nausea, abdominal pain, and the risk of an inflamed esophagus or esophageal ulcers, especially if you've had acid reflux or ulcers in the past. Bisphosphonates that can be taken once a week or once a month may cause fewer stomach problems. If you can't tolerate oral bisphosphonates, your doctor may recommend periodic intravenous infusions of bisphosphonate preparations.

    In 2007, the Food and Drug Association (FDA) approved the first once-yearly drug for postmenopausal women with osteoporosis. The medication, zoledronic acid (Reclast), is given intravenously at your doctor's office. It takes about 15 minutes to get your annual dose. One published study found that zoledronic acid reduces the risk of spine fracture by 70 percent and of hip fracture by 41 percent.

    A small number of cases of osteonecrosis of the jaw have been reported in people taking bisphosphonates for osteoporosis. These cases have primarily occurred after trauma to the jaw, such as a tooth extraction, or cancer treatment. Risk appears to be higher in people who have received bisphosphonates intravenously. While there is currently no clear evidence that you should stop taking bisphosphonates before dental surgery, let your dentist know what medications you're taking and discuss your concerns.

   Raloxifene (Evista). This medication belongs to a class of drugs called selective estrogen receptor modulators (SERMs). Raloxifene mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen, such as increased risk of uterine cancer and, possibly, breast cancer. Hot flashes are a common side effect of raloxifene, and you shouldn't use this drug if you have a history of blood clots. This drug is approved only for women with osteoporosis and is not currently approved for use in men.

    Calcitonin. A hormone produced by your thyroid gland, calcitonin reduces bone resorption and may slow bone loss. It may also prevent spine fractures, and may even provide some pain relief from compression fractures. It's usually administered as a nasal spray and causes nasal irritation in some people who use it, but it's also available as an injection. Because calcitonin isn't as potent as bisphosphonates, it's normally reserved for people who can't take other drugs.

    Teriparatide (Forteo). This powerful drug, an analog of parathyroid hormone, treats osteoporosis in postmenopausal women and men who are at high risk of fractures. Unlike other available therapies for osteoporosis, it works by stimulating new bone growth, as opposed to preventing further bone loss. Teriparatide is given once a day by injection under the skin on the thigh or abdomen. Long-term effects are still being studied, so the FDA recommends restricting therapy to two years or less.

    Tamoxifen. This synthetic hormone is used to treat breast cancer and is given to certain high-risk women to help reduce their chances of developing breast cancer. Although tamoxifen blocks estrogen's effect on breast tissue, it has an estrogen-like effect on other cells in your body, including your bone cells. As a result, tamoxifen appears to reduce the risk of fractures, especially in women older than 50. Possible side effects of tamoxifen include hot flashes, stomach upset, and vaginal dryness or discharge.