A comprehensive osteoporosis treatment program focuses on nutrition, exercise, safety-precautions to prevent falls that may result in fractures and, if necessary, medication to slow or stop bone loss, increase bone density and reduce fracture risk. If you are at risk for or have osteoporosis, there are several treatment and preventive measures that your health care professional may recommend:
- a diet rich in calcium and vitamin D
- regular weight-bearing exercise
- avoid smoking and excessive drinking of alcohol ("moderate drinking" for women and older people is defined by the National Institute on Alcohol Abuse and Alcoholism as one drink per day — one drink equals: 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits)
- medications to stop bone loss, improve bone density and prevent fractures
- surgery or external fixation for fractured bones
- a new technology, where cement is injected into the affected vertebra called vertebraplasty or kyphoplasty, can be considered for particularly painful vertebral fractures
- Hip protectors or pads for women at high risk of hip fracture, especially if they're thin.
There are several medications approved by the U.S. Food and Drug Administration (FDA) for the prevention and/or treatment of osteoporosis. These medications may postpone bone loss indefinitely, but only when they are taken regularly. As with any medication therapy, there are certain risks and side effects. Ask your health care professional about the risks and benefits of the recommended treatment for your specific health needs.
Postmenopausal Estrogen Therapy
Postmenopausal estrogen therapy has been shown to be highly effective in reducing bone loss and increasing bone density in the spine and hip, even when started after age 70. Postmenopausal estrogen therapy and combination estrogen-progestin therapy (commonly called HRT) are available in a variety of applications: pills, creams, skin patches, vaginal ring and injections.
Once thought safe for the long-term prevention of osteoporosis and heart disease as well as for the short-term relief of menopausal symptoms such as hot flashes, the safety of postmenopausal hormone therapy for either use is now under intense scrutiny by the Federal government — scrutiny triggered by major studies of postmenopausal hormone therapy published in 2002.
In January 2003, the U.S. Food and Drug Administration (FDA) announced that it would require a new, highlighted and boxed warning on all estrogen products for use by postmenopausal women. Five products currently on the market in the U.S. contain estrogen and progestin, while 15 contain estrogen alone. The so-called "black box" is the strongest step the FDA can take to warn consumers of potential risks from a medication. The warning highlights the increased risk for heart disease, heart attacks, stroke and breast cancer from supplemental estrogen — risks identified by one part of the Women's Health Initiative, one of the largest studies of women's health ever undertaken. While other sections of the WHI are still underway, the study that identified the health risks associated with postmenopausal estrogen-progestin therapy was abruptly halted.
Also emphasized by the "black-box" warning is that estrogen products are not approved for heart disease prevention. It advises health care professionals to prescribe estrogen products at the lowest dose and for the shortest possible length of time. Women taking estrogen products are cautioned to have yearly breast exams, perform monthly breast self-exams and receive periodic mammograms.
Because every woman's risk profile is different, women who are considering postmenopausal hormone therapy as a treatment option or who now take it to prevent osteoporosis should discuss their personal risks for heart disease and breast cancer with their physician. They may wish to review their options and treatment plans with their health care professional in light of the FDA's recent warning. Alternative treatments and preventive medications are available.