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December 2012: Treatment Options for Osteoporosis

01 Dec 2012

Dr. Hema Azad is a board-certified internist at Weiss Memorial Hospital. Her areas of expertise include preventive medicine, women’s health and geriatric care. She has special interest in osteoporosis, diabetes, obesity and hypertension.

Hema Azad, M.D.
Internist
Weiss Memorial Hospital
(630) 910-6200

According to the National Osteoporosis Foundation, osteoporosis affects 44 million Americans. Osteoporosis is a disease where bones become weak and brittle. This disease occurs when the body experiences excessive bone loss or makes too little bone, or both. In this second article of a two-part series, Dr. Azad discusses treatment options and steps for prevention. The first article published in November 2012, presented facts, symptoms, risk factors and diagnosis of osteoporosis.

What is the treatment for osteoporosis, and can osteoporosis be prevented?
For those who are at risk for osteoporosis or already have the disease, current treatments are designed to boost bone mass and prevent further bone loss. The goal of treatment of osteoporosis is the prevention of bone fractures by reducing bone loss or, preferably, by increasing bone density and strength. Following are steps you can take to help treat and even prevent osteoporosis:

1. Adopt healthy lifestyle changes, including quitting cigarette smoking, curtailing excessive alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D.

2. Take medications that stop bone loss and increase bone strength, such as alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), ibandronate (Boniva), calcitonin (Calcimar), zoledronate (Reclast), and denosumab (Prolia).

Other medications that may help reduce the risks of bone density loss include:

  • Bisphosphonates (Fosamax®, Actonel®, Boniva®, Reclast®): To build stronger bones.
  • Calcitonin (Miacalcin®): To slow down bone resorption or bone loss.
  • Hormone Replacement Therapy (Prempro): To build new bones.
  • Recombinant Human Parathyroid Hormone (Forteo™): To build stronger bones.  
3. Get enough calcium each day. While calcium by itself doesn't cure or prevent osteoporosis, getting enough calcium is an essential part of any prevention or treatment program. Following a diet rich in fruits and vegetables and doing weight bearing exercises can also enhance bone strength.  Here’s how much calcium you need:
  • Ages 9-18:  1,300 milligrams (mg) per day
  • Ages 19-50:  1,000 mg per day
  • Ages 51 and older: 1,200 mg per day
Foods rich in calcium include plain fat free yogurt, milk, tofu, fortified orange juice, fortified cereal, cheese, broccoli, spinach and white beans.

A Note About Lactose Intolerance
For those who suffer from lactose intolerance – an inability or difficulty to digest lactose, the sugar found in dairy products – it can be hard to get enough calcium.  Symptoms of lactose intolerance include gas, bloating, stomach cramps, diarrhea, and nausea. Lactose intolerance can start at any age but often starts when you get older.

Fortunately, there’s a great variety of lactose-reduced and lactose-free products available in most grocery stores, including milk, cheese, and ice cream. There are also pills and liquids lactose intolerance suffers can take before eating dairy foods to help with digestion. Please note: If you have symptoms of lactose intolerance, see your doctor or nurse. These symptoms could also be caused from a different, more serious illness.People who are lactose intolerant or who are vegans (eat only plant-based foods) can choose from other non-dairy calcium sources including canned salmon with bones, sardines, Chinese cabbage, bok choy, kale, collard greens, turnip greens, mustard greens, broccoli, and calcium-fortified orange juice. Some cereals also have calcium added. Talk to your doctor or nurse first to see which calcium sources are best for you.

4. Get enough vitamin D each day.
Vitamin D helps your body absorb calcium from the food you eat. Vitamin D is produced in your skin when it is exposed to sunlight. You need 10 to 15 minutes of sunlight to the hands, arms, and face, two to three times a week to make enough vitamin D. Here’s how much vitamin D you need:
  • Ages 19 – 70:  600 International Units (IUs) per day.
  • Ages 71+:  800 IUs per day.
Foods rich in Vitamin D include cooked salmon and other fatty fish, fortified cereals milk, and eggs (specifically, the yolk).

5. Other important nutrients  to help prevent osteoporosis:
Nutrients like vitamin K, vitamin C, magnesium, zinc, and protein, help build strong bones.  Many of these nutrients may be found in milk, lean meat, fish, green leafy vegetables, and oranges. Studies suggest that diets rich in the following foods and nutrients may help prevent bone loss in both men and women:
  • Magnesium: Avocado, banana, cantaloupe, honeydew, lima beans, low fat milk, nectarine, orange juice, potato, spinach
  • Potassium: Whole grains, nuts, spinach, oatmeal, potato, peanut butter
  • Vitamin K: Leafy greens, cauliflower
6. Get moving.
Being active helps your bones by:
  • Slowing bone loss
  • Improving muscle strength
  • Helping your balance
Weight-bearing physical activity
Weight bearing exercises involve any activity in which your body works against gravity. There are many things you can do:
  • Walk
  • Dance
  • Run
  • Climb stairs
  • Garden
  • Jog
  • Hike
  • Play tennis
  • Lift weights
  • Yoga
  • Tai chi
Cardiovascular conditioning
Cardiovascular workouts should also involve bearing weight. It’s important, too, to dial up your exercise intensity.
  • To see improvements in bone density, heighten the intensity of your normal walking pace.
  • Alternating higher-intensity exercises two to three days a week with lower-intensity activities four to five days a week.
Strengthening exercises
Work with free weights, use weight machines at the gym or do floor exercises to gain strength. Most of us don’t lift as much weight as we could. To determine how much weight you should be lifting, search for a “1-Rep Max” calculator available on many websites. Then aim for 70 to 80 percent of your 1 Rep Max.
  • Remember that exercise is site-specific. So target the areas most prone to fracture: spine, hips and wrists.
  • Weight training is recommended two to three times a week.
  • Strengthen your spinal extensor muscles, which lie over the spine, to improve posture and reduce fracture risk by doing the following exercise daily:
 spine exercise
  • Stomp your feet to increase bone density in your hips. Do four stomps on each foot twice a day using enough pressure to crush a can.
Stretching
Lengthening tight muscles will reduce back pain, and promote good spinal mechanics and posture. Muscles that are commonly tight include those you use to arch your back (spinal extensors); raise and rotate your shoulders (shoulder elevators and external rotators); lift your knees (hip flexors); and pull your feet toward your body (ankle dorsiflexors).
  • Perform stretches slowly and smoothly without inducing pain.
  • For maximum benefit, do stretches once or twice a day.
Yoga, Pilates: Helpful or not?
Yoga and Pilates are helpful for stretching and lengthening but include many flexion-based (forward-bending) moves.

Exercises that keep the spine in a straight or slightly arched position are generally safer than exercises that involve bending forward. That’s because most spine fractures occur in a position of forward bending. If you have already had an osteoporotic fracture, avoid exercises that involve forward bending or rotating the trunk.

7. Don’t smoke.
Smoking raises your chances of getting osteoporosis. It harms your bones and lowers estrogen levels, a hormone made by your body that can help slow bone loss.

8. Drink alcohol moderately.
Don’t drink more than one alcoholic drink per day. Alcohol can make it harder for your body to use your calcium intake. And, too much at one time can affect your balance and lead to falls.

9. Make your home safe.
Reduce your chances of falling by making your home safer. Use a rubber bath mat in the shower or tub. Keep your floors free from clutter. Remove throw rugs that may cause you to trip. Make sure you have grab bars in the bath or shower.

New Male Osteoporosis Guidelines
The U.S. Endocrine Society Subcommittee published the first guidelines specific to men and osteoporosis in June 2012. The report states: “Screen men at increased risk for osteoporosis by measurement of bone mineral density (BMD) via dual-energy x-ray absorptiometry (DEXA) at age 70; men ages 50-69 should be tested if additional risk factors are present (e.g. low body weight, prior fracture as an adult, smoking).”

Reference: Watts NB, Adler RA, Bilezikian JP, et al. Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2012;97:1802-1822.

For more information
If you would like more information about osteoporosis or would like to schedule an appointment, please call Dr. Azad’s office at (630) 910-6200. Her office is located at Weiss, Suite #4050, elevator A.