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Prevention and treatment of osteoporosis

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Prevention and treatment of osteoporosis

Written by Dr Dan Rutherford, GP

Ideally, osteoporosis is a condition that should be prevented from occurring, but this is unrealistic given our present state of knowledge and ability to influence it.

What steps can I take to prevent osteoporosis?

These general measures can be used by everyone, whether or not you ultimately go on to develop osteoporosis.

Exercise and lifestyle

Advice for runners Excessive running may cause increased bone loss.

Because some runners are very thin, they should take advice on the best way to avoid bone problems later in life.

The majority of us who are not in the elite athlete category need not be so concerned.

Diet

Non-dairy food sources of calcium

Nuts and pulses: almonds, Brazil nuts, hazelnuts, sesame seeds.

Green leafy vegetables: broccoli, spinach, watercress, curly kale.

Dried fruits: apricots, dates, figs.

Fish: mackerel, pilchards, salmon, sardines.

Tofu and various calcium-fortified foods.

What about taking supplements?

Calcium supplements can be bought. There are several types available on prescription if someone's dietary intake is low or marginal.

Frail elderly people with poor mobility may be helped by taking a calcium supplement along with vitamin D.

This type of supplement is safe, but is best discussed with a doctor first.

Treatment

More detailed intervention depends on individual circumstances, and so only an overview can be presented here. There are several types of treatment available, and often a combination will be more appropriate than just one.

Hormone replacement therapy (HRT) Oestrogen seems to protect bone strength. The drop in oestrogen that occurs following menopause is mirrored by an increased loss of bone for a few years thereafter. The loss continues, but less steeply, in older women.

Hormone replacement therapy replaces oestrogen and so reduces the rate of bone loss.

The pros and cons of HRT are many, and are the subject of much debate. HRT is thought to be of most benefit for preventing osteoporosis if it is started early in menopause and is taken for at least five years. However long-term use increases the risk of side effects. Any woman considering HRT should therefore discuss the risks and benefits for her individual circumstances with her doctor before making a decision about treatment.

Briefly, HRT is known to be associated with an increased risk of breast cancer, cancer of the lining of the womb (endometrial cancer), blood clots in the veins (thrombosis), stroke and heart disease. However, as well as preventing osteoporosis, HRT reduces the symptoms of the menopause, which can be very distressing for some women, and is also associated with a reduced risk of bowel cancer.

The length of time that treatment should be continued is also an issue of contention. Whether or not to use HRT to prevent osteoporosis and how long for will depend on a woman's individual risk of developing the condition, her personal and family medical history and her individual views on the potential risks and benefits, all of which should be discussed with her doctor.

HRT is not now recommended as a first choice of therapy for long-term prevention of osteoporosis in women who are over 50 years of age, as there are other medicines available that do not carry the risks associated with HRT. There is more information about these medicines below.

HRT remains an option for women over 50 at risk of fractures for whom these other medicines are not suitable. HRT is also still a suitable option for women who have had an early menopause. However in this case HRT should only be used for treating menopausal symptoms and preventing osteoporosis until the age of 50, after which time other medicines may be more suitable.

Bisphosphonates

This is a group of medicines that slows the rate at which bone is dissolved, thus favouring a build-up in bone strength over time. Two types are in common use: alendronic acid and disodium etidronate .

Alendronic acid and disodium etidronate can be used in men and women who have, or are at risk of developing, osteoporosis, including where this is secondary to the use of steroid drugs.

Risedronate sodium and ibandronic acid are other bisphosphonates used only in women after the menopause, but are otherwise similar to the others.

There are slight differences between the bisphosphonates in the available preparations and how frequently they are taken, but they act in the same way.

Alendronic acid and risendronate sodium reduce the occurrence of fractures of the hip and spine, whereas etidronate and ibandronic acid have only been shown to reduce fractures of the spine.

The most common side effects associated with bisphosphonates are digestive in nature, for example indigestion, diarrhoea, constipation and abdominal pain. Alendronic acid and ibandronic acid have strict instructions for how they should be taken because they can cause irritation and ulceration of the foodpipe (oesophagus).

Strontium ranelate

Strontium ranelate is used for the treatment of osteoporosis in postmenopausal women. It is usually reserved for women who cannot take bisphosphonates.

It has a dual action of increasing bone formation as well as decreasing bone breakdown and has been shown to reduce the risk of spinal and hip fractures.

Strontium seems to be asociated with an increased risk of blood clots in the veins, but not to the same extent as HRT or raloxifene (see below).

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