Facts About Osteoporosis
- It is a common condition that affects over 25 million people each year.
- 80 percent of people with osteoporosis are women.
- 80 percent of women over age 65 have osteoporosis.
- Osteoporosis is responsible for one and a half million fractures each year and costs $15 billion for fracture care. Fractures do heal with appropriate measures
- After menopause, women lose about one to two percent of their bone density each year.
- Although the vast majority of people with osteoporosis are women, 1.5 million men also have osteoporosis, and another 3.5 million men are at high risk.
- By the age of 80, nearly half of all women show on an X-ray that they have had a fracture of their spine. Yet many cannot recall any injury or incident that would have caused the fracture.
Prevention Recommendations for All Patients:
Calcium and vitamin D: Individuals 50 years and older should have adequate intake of calcium (³ 1,200 mg daily) and vitamin D (800 to
1,000 international units daily), including supplements if necessary. Calcium intake greater than 1,200 to 1,500 mg daily has limited benefit and may increase the risk of developing kidney stones or cardiovascular disease.
Lifestyle modification: Regular weight-bearing and muscle-strengthening exercise can reduce the risk for falls and fractures. Weight-bearing exercises include walking, jogging, tai chi, stair climbing, dancing, and tennis. Muscle-strengthening exercises include weight training and resistance exercise. Any new vigorous exercise should begin only after a patient has been clinically evaluated. Patients should also decrease their risk for falling by taking preventive measures, such as having their vision and hearing corrected, checking prescription medications for side effects that may affect balance, and improving home safety. The risk for hip injury can be reduced by the use of hip pad protectors. Finally, tobacco use and excessive alcohol intake are detrimental to bone health and overall health and should be avoided.
Recommendations for Drug Therapy:
1. Bisphosphonates: Bisphosphonates, such as, Alendronate (Fosamax)and Risedronate (Actonel) are the first-line drugs of choice for treating postmenopausal women with osteoporosis. Bisphosphonates significantly increase bone mineral density at the spine and hip and are dose dependent in this population. In women with osteoporosis. Bisphosphonates have been shown to reduce the risk for vertebral fractures by 40% to 70%. There is no evidence to support recommendations regarding the optimal duration of bisphosphonate therapy.
Side effects for all oral bisphosphonate medications include:
1. Esophagus problems and difficulty swallowing; worsening heartburn
2. Low calcium levels in your blood (hypocalcemia); symptoms may be muscle cramps twitching or spasms
3. Bone, joint, or muscle pain
4. Severe jaw bone problems (osteonecrosis); . Your doctor should
examine your mouth before you start alendronate sodium tablets. Your doctor may tell you to see your
dentist before you start alendronate sodium tablets. It is important for you to practice good mouth care
during treatment with alendronate sodium tablets.
5. Unusual thigh bone fractures; Symptoms of a fracture may include new or unusual pain in your hip, groin, or thigh.
It is important that you take bisphosphanate tablets exactly as prescribed to help lower your chance of getting esophagus problems. It is recommended that it be taken once you're up for the day, in the morning before breakfast with a glass of water and no other food or drink for 30 minutes. Certain individuals, such as those with digestive problems or severe kidney disease, should not take these drugs.
2. Raloxifene (EVISTA) - EVISTA has been approved by the FDA for the prevention of osteoporosis in postmenopausal women.
- Raloxifene is a member of a new class of drugs known as selective estrogen modulators (SERMs). SERMs are designed to mimic the beneficial effects of estrogen on the bone, without negative effects on the uterus and breast.
- Evista lowers the risk of fractures in the spine and has not been shown to lower the risk of hip fractures.
- It can be given along with Fosamax or Actonel with a greater increase in bone density usually found than with either drug alone.
- Studies have shown raloxifene to be less effective than estrogen in increasing bone mineral density, but it is not associated with increased risk of uterine cancer.
-Evista lowers the risk of breast cancer by 70 percent. Therefore, it is an alternative for the prevention of
Osteoporosis for women who are unwilling or unable to take estrogens. Side effects include hot flashes and leg cramps.
- Raloxifene is administered at a dosage of 60 mg daily and has been shown toprevent bone loss and reduce the risk for vertebral fractures.
- It is important to consider the potential risks and benefits when choosing raloxifene therapy. A rare risk for fatal stroke was reported in one trial in a sample of women who had an increased stroke risk at baseline. Bone loss commonly resumes upon discontinuation of therapy.
3. Calcitonin (miacalcin) - is a hormone that slows the removal of bone. It has been shown to reduce the risk of spine fractures but does not lower the risk of hip fractures. An additional advantage of calcitonin is its analgesic properties, which help relieve the bone pain that can occur with established osteoporosis.
- Calcitonin is approved for the treatment of osteoporosis in women who are 50 yo postmenopause. It is administered daily via an intranasal spray or subcutaneous injection. Rhinitis and, rarely, epistaxis or nose bleeds have been reported with the nasal preparation.
- Calcitonin is not recommended as a first-line drug for the management of postmenopausal osteoporosis. It is not recommended for osteoporosis prevention, and it is less effective than other agents used to treat osteoporosis. It is considered an alternative for women who cannot or do not wish to take another form of therapy. It is not recommended for treating bone pain, with the exception of that caused by acute vertebral compression fractures.
- The efficacy of calcitonin has not been demonstrated in young postmenopausal women and is recommended for use only in women who are over 50 years old postmenopause.
4. Estrogen therapy/hormone therapy: The use of ET/HT is approved for the prevention of osteoporosis and the relief of menopausal symptoms.
- Women who have not undergone a hysterectomy should receive HT with a progestin component to protect the uterine lining.
- The completion of 5 y of HT has been shown to reduce the risk for both vertebral and hip fractures. Because of the associated risks, including myocardial infarction, stroke, invasive breast cancer, pulmonary embolism, and deep vein thromboembolism,
- ET/HT should be used cautiously and only when benefits outweigh the risks.
- Estrogens and estrogen/progestin combinations are approved for the prevention, but not for the treatment, of postmenopausal osteoporosis. These agents may be a prevention option in the early stages following menopause.
- Consistent increases in BMD were found at all sites in women using these products, and standard dosages of both estrogens and estrogen/progestin combinations have
- Combination products have been associated with an increased risk for breast cancer, stroke, and thromboembolism, while estrogens alone in women who have undergone a hysterectomy have been associated with an increased risk for stroke and deep venous thrombosis.
Osteoporosis results in significant use of healthcare resources. It is a common disease and has become a major public health problem, especially in the United States and Europe, as the number of elderly people in the population has increased.
Despite the profound effect of osteoporosis on the quality of life of millions of people, preventive measures and the various treatment options can be strategically used to minimize both the morbidity of the disease and its burden on society. The primary goal should be to ensure that optimum peak bone mass is achieved by early adulthood. Adequate dietary calcium intake, good nutrition, exercise and hormone sufficiency all contribute to this goal. The secondary goal is to maintain bone mass by these measures as well as by avoiding tobacco and excessive alcohol consumption. Effective management of diseases and certain drugs that can cause bone loss should also be considered.
Osteoporosis and its consequent fractures cause significant morbidity and mortality among both men and women. A number of risk factors can help to broadly identify persons at risk for osteoporosis and fractures; however, risk factors need to be further defined to differentiate persons at high risk from those at negligible risk. The assessment of bone mineral density is the single best predictor of risk for osteoporotic fractures and contributes to clinical decision-making. Periodic measurements of bone mass in a given individual, using modern techniques (eg, bone densitometry) may alert the physician to a progressive bone loss before clinical or x-ray evidence of osteoporosis occurs. Measures to prevent progressive loss of bone mass may be more effective than treatment of the clinical disease, which at present is costing $13.8 billion in medical care annually in the United States.