This document discusses treatment and prevention of osteoporosis. It identifies prescription drugs used to treat osteoporosis including bisphosphonates, denosumab, hormone therapy, and parathyroid hormone. Lifestyle changes like calcium and vitamin D supplementation, exercise, and not smoking are also important for treatment and prevention. The goal of treatment is to slow bone loss and strengthen bones through drugs and lifestyle modifications.

1. Treatment & Prevention

2. Learning outcomes
 Identify the prescription drugs used for osteoporosis
treatment.
 Discuss the side effects of the drugs.
 Identify and discuss the treatment methods using
hormone therapy.
 Discuss and relate the lifestyle changes and physical
activates to osteoporosis treatment.
 Understand and describe ways to prevent osteoporosis.

3. Introduction
Although osteoporosis cannot be reversed, it can be
prevented and treated in a variety of ways.
There's calcium and vitamin D, both key to bone health.
Exercise is another critical part of strengthening bone
mass. There are drugs on the market that slow bone loss
and even hold promise of building new bone.

4. Treatment of Osteoporosis

5. Treatment of Osteoporosis
 Osteoporosis Drugs and Treatments
There is no cure for osteoporosis. The goal of treatment
is to protect and strengthen the bones. Treatment
usually includes a combination of drugs and lifestyle
changes to help slow the rate of bone resorption by the
body.

6. Osteoporosis Drugs
Prescriptions drugs are the most aggressive way to forestall bone loss.
Below are some of the drugs currently in use.
 Bisphosphonates are the most common osteoporosis
drug treatments. Types include:
 alendronate (Fosamax), an oral medication typically
taken once a week
 ibandronate (Boniva), offered as a monthly oral tablet or
as an intravenous injection four times a year
 risedronate (Actonel), available in daily, weekly,
bimonthly, or monthly doses
 zoledronic acid (Reclast), given intravenously once
every one or two years
Treatment of Osteoporosis(cont.)

7. Osteoporosis Drugs(Cont.)
The side effects of those drugs can include:
 Acid reflux.
 Nausea.
 Stomach pain.
In rare cases, they can cause bone damage in the jaw (jaw
osteonecrosis). This rare side effect is usually associated with high doses
of bisphosphonates.
 Denosumab (Xgeva and Prolia) is an antibody that links to a protein
involved in the body’s process of bone resorption. This antibody has
proved effective in slowing bone resorption and maintaining bone
density. Injections are given every six months. Side effects can
include skin irritations, muscle stiffness, pain or spasms, fatigue, and
excessive sweating. In very rare cases the drug may cause bone
fractures.
Treatment of Osteoporosis(cont.)

8. Hormone Therapy
Postmenopausal women are at a high risk for osteoporosis. With
menopause comes a drop in protective estrogen production. For these
women, hormone therapy (hormone replacement therapy) is a
treatment option. However, it’s not typically used as a first line of
defense. The hormone treatment poses increased risks of stroke, heart
attack, breast cancer, and blood clots.
 Selective Estrogen Receptor Modulators (SERMs) re-create the
bone-preserving effect of estrogen. Raloxifene (Evista) is a SERM
treatment available in a daily oral tablet.
Treatment of Osteoporosis(cont.)

9. Hormone Therapy
 Thyrocalcitonin is a hormone made by the thyroid gland. It helps regulate
calcium levels in the body. Synthetic thyrocalcitonin, or calcitonin (Fortical,
Miacalcin), is used to treat spinal osteoporosis in patients who can’t take
bisphosphonates. It can also ease pain in some patients with spinal
compression fractures. The drug is available by nasal spray or injection. Side
effects from nose sprays may include runny nose or nosebleeds. Calcitonin is
considered a second or third line of treatment for patients unable to tolerate
bisphosphonates.
 Parathyroid Hormone (PTH) controls calcium and phosphates
levels in the bone. Treatments with a synthetic PTH like teriparatide
(Forteo) can actually promote new bone growth. The drug is given by
daily injection in combination with calcium and vitamin D
supplements. This drug is very expensive. It’s generally reserved for
patients with severe osteoporosis who have poor tolerance for other
treatments.
Treatment of Osteoporosis(cont.)

10. Lifestyle Changes
Calcium and Vitamin D
 Getting enough calcium and vitamin D in your diet can
help slow bone loss. Calcium-rich foods include dairy
products, dark green vegetables, enriched grains and
breads, and soy products. Most cereal and orange juice
are now available with added calcium. Monitor your
vitamin D intake. Your body needs it to absorb the
calcium it needs.
Treatment of Osteoporosis(cont.)

11. Lifestyle Changes
Age Calcium Vitamin D
0 to 6 months 210 mg 200 IU
7 to 12 months 270 mg 200 IU
1 to 3 years 500 mg 200 IU
4 to 8 years 800 mg 200 IU
9 to 18 years 1,300 mg 200 IU
19 to 50 years 1,000 mg 200 IU
51 to 70 years 1,200 mg 400 IU
Over 70 years 1,200 mg 600 IU
Treatment of Osteoporosis(cont.)
The chart below shows the amount of daily calcium and vitamin D intake
recommended by the National Institutes of Health in milligrams (mg) and
international units (IU).

12. Physical Activity
Treatment of Osteoporosis(cont.)
Exercise provides the resistance your bones need to stay strong. Strength
training benefits the bones in your arms and upper spine. This can mean free
weights, weight machines, or resistance bands. Weight-bearing exercise like
walking or jogging and low-impact aerobics like elliptical training or biking can
be beneficial. Both may help strengthen the bones in your legs, hips, and lower
spine. Whatever the form, physical activity helps slow age-related bone loss.
Physical activity can slightly improve bone density in some cases. Exercise can
also help improve your posture and balance, lowering the risk for falls. Fewer
falls for patients with osteoporosis can mean fewer fractures.

13. Preventing Osteoporosis

14. Preventing Osteoporosis(cont.)
Some of the most important treatments for preventing osteoporosis
include diet, exercise, and not smoking. These recommendations apply
to men and women.
 Diet — An optimal diet for preventing or treating
osteoporosis includes consuming an adequate number of
protein and calories as well as optimal amounts of
calcium and vitamin D, which are essential in helping to
maintain proper bone formation and density.
 Calcium intake
 Vitamin D intake
 Protein supplements
 Alcohol, caffeine, and salt intake

15. Preventing Osteoporosis(cont.)
 Exercise — Exercise may decrease fracture risk by
improving bone mass in premenopausal women and
helping to maintain bone density for women after
menopause. Furthermore, exercise may decrease the
tendency to fall due to weakness. Physical activity
reduces the risk of hip fracture in older women as a result
of increased muscle strength. Most experts recommend
exercising for at least 30 minutes three times per week.
 The benefits of exercise are quickly lost when a person stops
exercising. A regular, weight-bearing exercise regimen that a
person enjoys improves the chances that the person will
continue it over the long term.

16. Preventing Osteoporosis(cont.)
 Smoking — Stopping smoking is strongly recommended
for bone health because smoking cigarettes is known to
speed bone loss. One study suggested that women who
smoke one pack per day throughout adulthood have a 5 to
10 percent reduction in bone density by menopause,
resulting in an increased risk of fracture.

17. Preventing Osteoporosis(cont.)
 Medications — Prolonged therapy with and/or high
doses of certain medications can increase bone loss. The
use of these medications should be monitored by a
healthcare provider and decreased or discontinued when
possible. Such medications include the following:
 Glucocorticoid medications.
 Heparin, a medication used to prevent and treat abnormal
blood clotting.
 Certain antiepileptic drugs (eg, phenytoin, carbamazepine,
primidone, and phenobarbital)

18. End