Osteoporosis
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Osteoporosis
NIH - Medical Encyclopedia Osteoporosis
"Osteoporosis occurs when the body fails to form enough new bone, or when too much old bone is reabsorbed by the body, or both. Calcium and phosphate are two minerals that are essential for normal bone formation. Throughout youth, the body uses these minerals to produce bones. If calcium intake is not sufficient, or if the body does not absorb enough calcium from the diet, bone production and bone tissues may suffer. As people age, calcium and phosphate may be reabsorbed back into the body from the bones, which makes the bone tissue weaker. Both situations can result in brittle, fragile bones that are subject to fractures, even without trauma. Usually, the loss occurs gradually over years. Many times, a person will sustain a fracture before becoming aware that the disease is present. By the time this occurs, the disease is in its advanced stages and the damage is severe. The leading causes are a drop in estrogen in women at the time of menopause, and a drop in testosterone in men. Women, especially those over the age of 50, get osteoporosis more often than men. Other causes include excess corticosteroid from Cushing's syndrome, hyperthyroidism (too much thyroid hormone), hyperparathyroidism, being confined to a bed, and bone cancers.
Symptoms occurring late in the disease include:
Fractures of the vertebrae, wrists, or hips (usually the first indication) Low back pain Neck pain Bone pain or tenderness Loss of height over time Stooped posture
EXERCISE
Regular exercise can reduce the likelihood of bone fractures associated with osteoporosis. Studies show that exercises requiring muscles to pull on bones cause the bones to retain and perhaps even gain density. Researchers found that women who walk a mile a day have 4-7 more years of bone in reserve than women who dont. Some of the recommended exercises include: Weight-bearing exercises -- walking, jogging, playing tennis, dancing Resistance exercises -- free weights, weight machines, stretch bands Balancing exercises -- tai chi, yoga Riding stationary bicycles Using rowing machines Walking Jogging
DIET
A diet that includes an adequate amount of calcium, vitamin D, and protein should be maintained. While this will not completely stop bone loss, it will guarantee that a supply of the materials the body uses for bone formation and maintenance is available. Supplemental calcium should be taken as needed to achieve recommended daily calcium dietary intake. Current recommendations are for nonpregnant, menstruating women to consume 1000 mg/day, pregnant women need 1200 mg/day, and postmenopausal or nursing mothers should consume 1500 mg/day. High-calcium foods include low-fat milk, yogurt, ice cream and cheese, tofu, salmon and sardines (with the bones), and leafy green vegetables, such as spinach and collard greens. Vitamin D aids in calcium absorption and 400-800 IU per day should be taken by all individuals with increased risk of calcium deficiency and osteoporosis. "
Highlighted Article
Osteoporosis: strategies for prevention and management. (Best Pract Res Clin Rheumatol. 2007)
"The goal of treatment is to reduce the risk of future fracture. Patients at high risk for fracture should be assessed and screened to exclude secondary causes for osteoporosis. Bisphosphonates (alendronate, etidronate, ibandronate, risedronate) are the first-line therapy for the majority of patients and these treatments can be given either orally or intravenously. Alternative treatment options include strontium ranelate and raloxifene. Anabolic therapy with parathyroid hormone can be considered for patients with severe disease. These patients will often require referral for specialist assessment and monitoring. All patients at risk of developing osteoporosis should be given lifestyle advice regarding dietary intake of calcium and vitamin D and regular weight-bearing exercise."
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Notes
The 2007 Treatment Guidelines section will contain the 2007 published guidelines. To view Guidelines from previous years, view year 2006 Treatment Guidelines and 2005 InfoMedlinks (Articles section) or our Monthly Online Newsletter (under the Guidelines section).
Osteoporosis
Daily Treatment Report
Cognitive Therapy-CBT-Psychotherapy
Device Therapy
Drug Side-Effects and Interactions
Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. (J Oral Maxillofac Surg. 2007)
Safety considerations with bisphosphonates for the treatment of osteoporosis. (Drug Saf. 2007)
Common musculoskeletal adverse effects of oral treatment with once weekly alendronate and risedronate in patients with osteoporosis and ways for their prevention. (J Musculoskelet Neuronal Interact. 2007)
Studies Tie Drugs, Unusual Heart Rhythms "The two separate reports published Thursday in The New England Journal of Medicine point to elevated rates of serious episodes of that heart condition in women who took Reclast and Fosamax. Researchers cautioned about overestimating the importance of the heart rhythm problem. The Reclast study showed little apparent difference in overall cardiac deaths and the overall risk of the rhythm condition remained small. For now, it's unknown if the possible risk applies to other drugs in the class known as biphosphonates. Future studies are expected to help clarify the risk."
Osteonecrosis of the jaws associated with use of risedronate: Report of 2 new cases. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007)
The impact of vitamin D status on changes in bone mineral density during treatment with bisphosphonates and after discontinuation following long-term use in post-menopausal osteoporosis. (MC Musculoskelet Disord. 2007) "CONCLUSIONS: optimal 25 (OH) vitamin D concentration prevents bone loss at the hip in patients on bisphosphonates. A prospective controlled trial is needed to further evaluate whether the response to bisphosphonates is influenced by vitamin D status. BMD is preserved at the lumbar spine and total hip following discontinuation of bisphosphonate for a short period following long-term treatment, although a gradual loss occurs at the femoral neck."
Osteonecrosis of the jaw associated with bisphosphonate use: Presentation of seven cases and literature review. (Laryngoscope. 2007) " CONCLUSIONS: Increasing reports of bisphosphonate associated osteomyelitis and the difficulty in treating these patients requires further investigation to identify the subset of patients who are at increased risk for this process. The optimal and safe duration of treatment with bisphosphonates needs to be determined."
Fracture risk and antiresorptive medication use in older women in the USA. (Osteoporos Int. 2007)
Drugs
Systematic Review: Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis. (Ann Intern Med. 2007)
Best Treatment for Osteoporosis Still Unclear Dr. MacLean and colleagues found "good evidence that alendronate, etidronate, ibandronate, risedronate, zoledronic acid, estrogen, parathyroid hormone and raloxifene prevent vertebral fractures more than placebo; the evidence for calcitonin was fair." Alendronate, risedronate and estrogen appear to be superior to placebo in prevention of hip fractures. The effects of vitamin D on fracture risk varied by dose and analogue. Risk of thrombolic events appeared to be increased with raloxifene, estrogen and estrogen-progestin. Esophageal and gastrointestinal ulcerations, bleeding and perforations appeared be a risk with etidronate.
Osteoporosis: non-hormonal treatment. (Climacteric. 2007)
Cost-effectiveness of bisphosphonate therapies for women with postmenopausal osteoporosis: implications of improved persistence with less frequently administered oral bisphosphonates. (Curr Med Res Opin. 2007)
Tibolone and osteoporosis. (Arch Gynecol Obstet. 2007)
Drug insight: the use of bisphosphonates for the prevention and treatment of osteoporosis in men. (Nat Clin Pract Urol. 2007)
Update on the Use of Bisphosphonates in the Management of Postmenopausal Osteoporosis by Obstetricians-Gynecologists. (Obstet Gynecol Surv. 2007) "The current therapy of choice is an oral bisphosphonate, which has proven efficacy in increasing bone mineral density, reducing bone-turnover markers, and reducing fracture rates. Their main drawback is inconvenient dosing requirements, which necessitates taking the drug in the morning at least 30 minutes before the first meal or drink of the day; this may contribute to poor adherence with therapy and suboptimal outcomes. The availability of daily or weekly (alendronate and risedronate) or monthly (ibandronate) bisphosphonates means that patients can have therapy at their preferred frequency, and along with education regarding lifestyle issues such as nutrition, exercise, smoking, and alcohol use, and measures to reduce tripping in the home, should reduce the prevalence of osteoporotic fractures."
Once-Yearly Zoledronic Acid for Treatment of Postmenopausal Osteoporosis (NEJM 2007) "However, serious atrial fibrillation occurred more frequently in the zoledronic acid group (in 50 vs. 20 patients, P<0.001). Conclusions A once-yearly infusion of zoledronic acid during a 3-year period significantly reduced the risk of vertebral, "
Do estrogen or selective estrogen receptor modulators improve quality of life for women with postmenopausal osteoporosis? (Curr Osteoporos Rep. 2007)
Clinical effect of bisphosphonate and vitamin D on osteoporosis: reappraisal of a multicenter double-blind clinical trial comparing etidronate and alfacalcidol. (J Bone Miner Metab. 2007)
Changes in bone resorption markers among Japanese patients with postmenopausal osteoporosis treated with alendronate and risedronate. (J Bone Miner Metab. 2007) "In conclusion, alendronate decreases bone resorption markers more obviously and rapidly than risedronate, especially in high risk for fracture, but not significantly according to the guidelines of the Japan Osteoporosis Society."
Exercise
Tai chi for osteoporosis: a systematic review. (Osteoporos Int. 2007)
Exercise: Can It Help Battle Bone Loss? " says that the benefit of exercise in a middle-aged adult lies not in bone density but in bone quality its "micro architecture" and strength which won't show up on a DXA scan."
Effect of low-intensity back exercise on quality of life and back extensor strength in patients with osteoporosis: a randomized controlled trial. (Osteoporos Int. 2007) "CONCLUSIONS: Low-intensity back-strengthening exercise was effective in improving the quality of life and back extensor strength in patients with osteoporosis."
Recent Developments in Bisphosphonate Therapy. (Semin Arthritis Rheum. 2007)
Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. (J Adv Nurs. 2007) "Conclusions. Beneficial short-term effects of aquatic exercise were found in adults with osteoarthritis of the hip or knee. Although the programme may not offer pain relief or self-reported improvements in physical functioning, results suggest that aquatic exercise does not worsen the joint condition or result in injury. Nurses engaging in disease management and health promotion for these patients should consider recommending or implementing aquatic classes for patients."
General Information
Prevalence of vitamin D depletion among subjects seeking advice on osteoporosis: a five-year cross-sectional study with public health implications. (Osteoporos Int. 2007) "CONCLUSIONS: The prevalence of vitamin D depletion in patients seeking advice for osteoporosis is high and did not change over the 5 years of the study."
Osteoporosis treatment puts brakes on bone loss
Osteoporosis Patients Likely to Pause Medication
[Secondary osteoporosis. Evidence of treatment efficacy in patients with glucocorticoid-induced osteoporosis.] (Clin Calcium. 2007)
[What's new in postmenopausal osteoporosis] (Harefuah. 2007)
Discontinuation of Antiresorptive Therapies: A Comparison between 1998-2001 and 2002-2004 among Osteoporotic Women. (J Clin Endocrinol Metab. 2007) "Conclusions: Even if new dosing regimens were introduced, discontinuation of ART among osteoporotic women remains high."
Guidelines
Immunotherapy
Internet Sites
Treatment Information
Drug-Food-Supplement Information
DrugDigest (drug interactions)
FDA - Drug Interactions: What You Should Know
NIH - Botanical Dietary Supplements: Background Information
NIH - Drug, Supplements, and Herbal Information
NIH - Herbal Supplements: Consider Safety, Too
NIH - Vitamin and Mineral Supplement Fact Sheets
Nutrition
Not just calcium and vitamin d: other nutritional considerations in osteoporosis. (Curr Rheumatol Rep. 2007)
Other
Other Treatments
Experimental
Radiotherapy
Supplements-Vitamins-CAM
Evaluation of calcium and vitamin D supplementation in bisphosphonate therapy. (J Am Pharm Assoc (2003). 2007)
Optimal vitamin d status for the prevention and treatment of osteoporosis. (Drugs Aging. 2007) "Vitamin D(3) (cholecalciferol) sufficiency is essential for maximising bone health. Vitamin D enhances intestinal absorption of calcium and phosphorus. The major source of vitamin D for both children and adults is exposure of the skin to sunlight. Season, latitude, skin pigmentation, sunscreen use, clothing and aging can dramatically influence the synthesis of vitamin D in the skin. Very few foods naturally contain vitamin D or are fortified with vitamin D. Vitamin D sufficiency can be sustained by sensible sun exposure or ingesting at least 800-1000IU of vitamin D(3) daily. Patients being treated for osteoporosis should be adequately supplemented with calcium and vitamin D to maximise the benefit of treatment."
Complementary and alternative medicine use by osteoporosis clinic patients. (Osteoporos Int. 2007)
Bone mineral density and bone markers in patients with a recent low-energy fracture: effect of 1 y of treatment with calcium and vitamin D. (Am J Clin Nutr. 2007) "CONCLUSIONS: A 1-y intervention with calcium and vitamin D reduced bone turnover, significantly increased BMD in patients younger than 70 y, and decreased bone loss in older patients. The effect of treatment was related to physical performance."
Calcium and vitamin D - for whom and when. (J Br Menopause Soc. 2007)
Surgery
Transplantation
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