Treating Osteoporosis

with Ashwini Gundelly, M.D., Internal Medicine specialist with Advanced Healthcare

Last Updated: Oct. 1, 2003

Osteoporosis is a stealthy disease. “Often there are no symptoms until a fracture occurs, though there can sometimes be back pain or loss of height,” said Dr. Ashwini Gundelly, an internal medicine specialist with Advanced Healthcare.

“The first thing I tell a patient with osteoporosis is that we have to deal with the non-drug measures first. These include diet, smoking cessation and exercise,” Dr. Gundelly said.

Ashwini Gundelly, M.D., Internal Medicine specialist with Advanced Healthcare "My advice is to begin treating osteoporosis with prevention. Take in enough calories, eat calcium-containing products like low-fat yogurt, and supplement your calcium so you have high bone density before you reach menopause."

Lifestyle changes and osteoporosis
The doctor recommends a diet with an adequate intake of calories as well as calcium and vitamin D. Supplements may also be suggested, particularly for those who have already had fractures. She also suggests that patients limit alcohol or give it up altogether, and, above all, stop smoking. “Smoking accelerates bone loss,” she said.

Any weight-bearing exercise is beneficial, including walking. “Exercise should be done at least three times a week, thirty minutes at a time. And people need to keep up with their exercise program. The benefits are lost if a patient stops exercising,” she said.

A fractured hip may mean weeks of bedrest, and a long road back to normal life even in a young patient. In the elderly, they can result in death or in permanent disability. That’s why the type of exercise a person chooses to do should be realistic for their age and stamina. “Any exercise that increases the risk of falling should be avoided,” Dr. Gundelly said.

In addition, patients need to work to minimize the danger of falls. They should have their eyes examined regularly to be certain their vision is good. To prevent accidents, they should remove throw rugs and other items that can lead to tripping, make certain that the traffic areas of a home are adequately lit, and avoid slippery floors or ice.

Drugs that decrease coordination or balance are also a concern. Patients should discuss the types of drugs they are taking with their physicians to minimize dangerous side effects or interactions.

Drug treatment
Dr. Gundelly believes that estrogen and progesterone therapy should not be the first line of treatment for osteoporosis because of the increased risk of breast cancer, stroke and blood clots. “We use it most often for those who also have persistent menopausal symptoms or who cannot tolerate other drugs,” she said.

Bisphosphonates are the first choice for the treatment of osteoporosis. Fosamax is the best known of these. They stop the breakdown of bone and help the body to rebuild its bone mass. The drugs are highly successful, and there are minimal side effects. The most troublesome of these for most people is an inflammation of the esophagus. To minimize this risk, patients are asked to take the drug on an empty stomach, then sit upright or stand for at least a half hour after taking the drug.

The Food and Drug Administration recently approved a once-a-week bisphosphonate that makes taking the drug much easier. Researchers are also working on a yearly dosage. “When this is approved it will be a good thing for patients. It will be given in the form of an IV, likely as part of the yearly physical,” Dr. Gundelly said.

Raloxifene has some estrogen-like effects and it has been approved for prevention and treatment of osteoporosis but less effective than bisphosphonates. It also reduces the incidence of vertebral fractures and may reduce breast cancer risk. Raloxifene may be considered for women who have a strong family history of breast cancer or are unable or unwilling to take estrogen.

Calcitonin is a hormone that is produced by the thyroid. Its purpose is to help regulate calcium concentrations in the body. When given as a supplement it increases bone formation, usually on a short-term basis. “Often the drug is used for patients who also have substantial pain from an acute osteoporotic fracture since it has a pain-relieving effect,” the doctor said.

Parathyroid hormone is a new treatment for severe osteoporosis. It has been found that when this hormone is given intermittently, it increases bone formation. Other therapies that are being investigated include androgen (male) hormones such as testosterone. Early studies have shown great benefits for elderly osteoporosis sufferers though the side effects – facial hair, acne, and others – can be troublesome for some women.

Diagnosing osteoporosis
A doctor makes a preliminary diagnosis of osteoporosis through a patient’s history and a physical exam. If a doctor suspects osteoporosis, he or she will likely order lab tests to rule out other conditions that might cause bone thinning and also order a bone scan. The results will determine the type of treatment for each patient.

Osteoporosis is one of the most common diseases among the elderly. According to government statistics, osteoporosis accounts for 1.3 million fractures annually in the United States. Of these, 50% are in the vertebrae of the spine, 25% in the forearms and, most dangerous to the elderly, 25% occur in the hips. Among those over age 90, one in three will have a hip fracture.

The disease is more prevalent in women than men. Women are three times more likely to have a vertebral or hip fracture, and six times more likely to have a forearm fracture than men. This is due to the decline in estrogen in women following menopause. Men will also have age-related bone loss but not at the same rate. For this reason, osteoporosis education is directed far more frequently to women than to men.

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