HealthHints

Osteoporosis: Part 2 –
Can it be prevented? Reversed?

October 2010 – Vol. 14, No. 10

Editor: Janet M. Pollard, MPH

“Many people are unaware of the link between broken bone and osteoporosis.”1 Osteoporosis means “porous bone.”2 It is a disease in which bones become fragile and more likely to break.3 Currently in the U.S., about 10 million people (8 million women and 2 million men) suffer from osteoporosis, and about 34 million more people are estimated to have low bone mass, placing them at increased risk for the disease.4

Like muscle, bone is a living, growing tissue that constantly breaks down and reforms. We often think about building and maintaining our muscle strength; we need to remember to build and maintain our bone strength as well.5,6 Osteoporosis is a disease that can be prevented and treated.7 An early diagnosis can make a difference.7 Talk with your doctor about when to begin looking at how dense your bones have become and whether or not an osteoporosis medicine may be needed to help prevent or slow the process of bone loss.” At any age, it is never too late to take steps to protect your bones and prevent fractures.”7

For many people, bone loss can be prevented by continuing to get calcium, vitamin D, and exercise and by avoiding tobacco and excessive alcohol use.5 You can also build some bone and potentially get out of the osteoporosis range with drug therapy, and you can reverse the consequences of osteoporosis by preventing broken bones.8

In the previous issue of HealthHints (PDF), we discussed osteoporosis and how to maintain bone health with dietary and exercise choices.

In this issue, we will discuss:

  • the impact of smoking and alcohol on bone health;
  • bone mineral density (BMD) testing for early diagnosis and to measure response to osteoporosis treatment; and
  • medications that prevent and treat bone loss, with a goal to prevent fracture and its resulting consequences.

The Impact of Smoking & Alcohol: Increased fracture risk

“If you smoke, you double your risk of suffering an osteoporotic fracture. Researchers have found that smoking reduces your ability to absorb calcium. That’s because cigarette smoke is thought to damage bone cells and prevent new bone growth.9 Additionally for women, smoking can prevent estrogen from protecting the bones.10

People who drink too much alcohol on a regular basis are also prone to bone loss and fractures.9 When too much alcohol is consumed, it interferes with the pancreas and its absorption of calcium and vitamin D.11 It also “affects the liver, which is important for activating vitamin D – which is also important for calcium absorption.”11 Excess alcohol also kills osteoblasts, which are the bone-making cells; and it creates an increase in two bone-damaging hormones, cortisol and parathyroid hormone. “High levels of cortisol seen in people with alcoholism can decrease bone formation and increase bone breakdown. Chronic alcohol consumption also increases parathyroid hormone, which leaches calcium from the bone.”11 Drinking too much can also lead to poor nutrition, nerve damage to the hands and feet (peripheral neuropathy), and increased risk of falling.”9

Bone Density Testing: Talk to your doctor

“Since osteoporosis can develop undetected for decades until a fracture occurs, early diagnosis is important.” “A bone mineral density (BMD) test is the best way to determine your bone health. BMD tests can:

  • identify osteoporosis,
  • determine your risk for fractures, and
  • measure your response to osteoporosis treatment.

The most widely recognized BMD test is called a dual-energy x-ray absorptiometry, or DXA test. The BMD test is painless – a bit like having an x-ray, but with much less exposure to radiation. It measures bone density at your hip and spine.

During a BMD test, an extremely low-energy source is passed over part or all of the body. A computer program evaluates the information and allows the doctor to see how much bone mass you have. Because bone mass serves as an approximate measure of bone strength, this information also helps the doctor to accurately detect low-bone mass, make a definitive diagnosis of osteoporosis, and determine your risk of future fractures.

BMD tests provide doctors with a measurement called a T-score, a number value that results from comparing your bone density to optimal bone density. When a T-score appears as a negative number (such as –1, –2 or –2.5), it indicates low bone mass. The greater the negative the number, the greater is the risk of fracture.”12

Talk with your doctor about when to have a BMD test. The following reasons (called risk factors) may help determine if you need to have a BMD test and when. Risk factors increase your likelihood of developing osteoporosis. The more risk factors you have, the more likely you are to get osteoporosis and broken bones. Some examples are being small and thin, older age, being female, a diet low in calcium, lack of enough vitamin D, smoking, and drinking too much alcohol.7 “Your healthcare provider may recommend a BMD test if you are:

  • a postmenopausal woman under age 65 with one or more risk factors for osteoporosis;
  • a man age 50–70 with one or more risk factors for osteoporosis;
  • a woman age 65 or older, even without any risk factors;
  • a man age 70 or older, even without any risk factors;
  • a woman or man after age 50 who has broken a bone;
  • a woman going through menopause with certain risk factors;
  • a postmenopausal woman who has stopped taking estrogen therapy (ET) or hormone therapy (HT).

Some other reasons your healthcare provider may recommend a BMD test are:

  • long-term use of certain medications, including steroids (for example, prednisone and cortisone), some anti-seizure medications, Depo-Provera® and aromatase inhibitors (for example, anastrozole, brand name Arimidex®) [see Medicines that May Cause Bone Loss (PDF)];
  • a man receiving certain treatments for prostate cancer;
  • a woman receiving certain treatments for breast cancer;
  • overactive thyroid gland (hyperthyroidism) or taking high doses of thyroid hormone medication;
  • overactive parathyroid gland (hyperparathyroidism);
  • x-ray of the spine showing a fracture or bone loss;
  • back pain with a possible fracture;
  • significant loss of height;
  • loss of sex hormones at an early age, including early menopause;
  • having a disease or condition that can cause bone loss (such as rheumatoid arthritis or anorexia nervosa).”7

“Although no bone density test is 100-percent accurate, this type of test is the single most important predictor of whether a person will have a fracture in the future.”12 BMD tests are painless, safe, and require no preparation on your part.13 The test itself takes only about 5–10 minutes to perform. Currently, Medicare reimburses for BMD testing every two years.4

Medication: Bone building & protecting

If you have osteoporosis or if your healthcare provider believes you are at high risk for the disease, be sure to ask questions about drug options. There are several options for medications. Some are taken orally, while others are given by injection. Some are taken once a week, while others are taken once a month. Some are new on the market, while others have been around for 10 or more years. In any case, all have potential side effects in addition to their benefits, which should be discussed. Be sure to let your doctor know about all medications, as well as vitamins and other dietary supplements you are taking. Also, discuss any other chronic health conditions that may affect your choice of medication. There are six classes of drugs approved by the FDA to prevent or treat osteoporosis (see the table on below):

  1. Bisphosphonates (PDF)
  2. Calcitonin (PDF)
  3. Estrogen (PDF)
  4. Selective Estrogen Receptor Modulators (SERMS, also called estrogen agonists/antagonists) (PDF)
  5. Parathyriod hormone (PDF)
  6. RANK ligand (RANKL) inhibitor (also called denosumab) (PDF).

Bisphosphonates, calcitonin, estrogen, SERMS, and RANK ligand (RANKL) inhibitors are all medications that slow bone loss. When people start taking these medications, they stop losing bone as quickly as before, but they still make new bone at a normal pace. The goal of treatment with these types of medications is to prevent bone loss and lower the risk of breaking bones.14

A form of parathyroid hormone called teriparatide is currently the only osteoporosis medication in the U.S. that rebuilds bone. It does this by increasing the rate of bone formation in the bone remodeling cycle. The goal of treatment with parathyroid hormone is to build bone and lower the risk of breaking bones.14 If you are considering medications, click here to learn more about different groups of medications (PDF).

For more information about osteoporosis medications – their benefits and side effects – see the following resources:

Osteoporosis: Prevent and protect

Old or young, man or woman, early diagnosis is important in the fight against osteoporosis. If you already show signs of weakening bones, it is important to act now. Most of the time, you will not know your bones are weak until you experience a fracture. That’s why BMD testing is so important. It is the only way to detect osteoporosis and weakening bones. So talk with your doctor about when to begin BMD testing as well as possible medications you might take and their benefits and potential side effects.

Preventing osteoporosis and reducing its consequences is possible. Protect your bones – eat a diet rich in calcium and vitamin D, choose weight-bearing exercises, don’t smoke or consume alcohol, and see your doctor for a BMD test and to discuss medication options.

Medications Approved to Prevent and/or Treat Osteoporosis14**

Class and Drug Brand Name Form Frequency
Bisphosphonates
Alendronate Fosamax® (Generic also available) Oral (tablet) Daily/Weekly
Alendronate Fosamax Plus D™ (with 2,800 IU or 5,600 IU of Vitamin D3) Oral (tablet) Weekly
Alendronate Fosamax® Oral (liquid solution) Weekly
Ibandronate Boniva® Oral (tablet) Monthly
Ibandronate Boniva® Intravenous (IV) Four Times per Year
Risedronate Actonel® Oral (tablet) Daily/Weekly/Twice Monthly/Monthly
Risedronate Actonel® with Calcium Oral (tablet) Weekly
Zoledronic Acid Reclast® Intravenous (IV) One Time per Year/Once Every Two Years
Calcitonin
Calcitonin Fortical® Nasal spray Daily
Calcitonin Miacalcin® (generic also available) Nasal spray Daily
Calcitonin Miacalcin® Injection Varies
Estrogen*
Estrogen Multiple Brands Oral (tablet) Daily
Estrogen Multiple Brands Transdermal (skin) patch Twice Weekly/
Weekly
Estrogen Agonists/Antagonists
Also called Selective Estrogen Receptor Modulators (SERMs)
Raloxifene Evista® Oral (tablet) Daily
Parathyroid Hormone
Teriparatide Forteo® Injection Daily
RANK ligand (RANKL) inhibitor
Denosumab Prolia™ Injection Two Times per year

*Estrogen is also available in various vaginal preparations, in a vaginal ring, as a cream, by injection, and as an oral tablet taken sublingually (under the tongue).

**This table is excerpted from the National Osteoporosis Foundation (2010). Medications to prevent and treat osteoporosis [online]. Retrieved June 24, 2010. From http://www.nof.org/aboutosteoporosis/managingandtreating/medicinesneedtoknow.

This document is meant for educational purposes only and is not intended to replace the advice of your doctor or other health care provider.

References:

  1. National Institute of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases (2009). Osteoporosis and fracture [online]. Retrieved http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/Fracture/default.asp.
  2. National Osteoporosis Foundation (2008). Osteoporosis: Bone basics [online]. Retrieved June 21, 2010. From http://www.nof.org/osteoporosis/bonehealth.htm.
  3. National Osteoporosis Foundation (2008). Osteoporosis: What is it? [online]. Retrieved June 21, 2010. From http://www.nof.org/osteoporosis/index.htm.
  4. National Osteoporosis Foundation (2010). Osteoporosis: Fast facts [online]. Retrieved June 21, 2010. From http://www.nof.org/osteoporosis/diseasefacts.htm.
  5. National Institutes of Health, Osteoporosis and Related Diseases – National Resource Center (2009). What is bone? [online] Retrieved June 21, 2010. From http://www.niams.nih.gov/Health_Info/Bone/Bone_Health/.
  6. American Academy of Orthopaedic Surgeons (2007). Weightbearing exercise for women and girls [online]. Retrieved June 21, 2010. From http://www.orthoinfo.org/topic.cfm?topic=A00263.
  7. National Osteoporosis Foundation (2008). BMD testing: What the numbers mean [online]. Retrieved July 26, 2010. From http://www.nof.org/osteoporosis/bmdtest.htm.
  8. Doheny, K (2010). Can you reverse osteoporosis? [online]. Retrieved July 26, 2010. From http://www.webmd.com/osteoporosis/features/can-you-reverse-osteoporosis.
  9. American Academy of Orthopaedic Surgeons (2007). What is your risk for osteoporosis? [online]. Retrieved June 21, 2010. From http://orthoinfo.aaos.org/topic.cfm?topic=A00126.
  10. National Osteoporosis Foundation (2008). Prevention: Who’s at risk? [online]. Retrieved June 21, 2010. From http://www.nof.org/prevention/risk.htm.
  11. Davis, JL (2007). Drink less for strong bones [online]. Retrieved July 26, 2010. From http://www.webmd.com/osteoporosis/features/alcohol.
  12. National Institute of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases (2009). Osteoporosis: The diagnosis [online]. Retrieved June 25, 2010. From http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/diagnosis.asp.
  13. National Institute of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases (2009). Osteoporosis: Warning signs and diagnosis [online]. Retrieved June 21, 2010. From http://nihseniorhealth.gov/osteoporosis/printerFriendly.html?selectedTopics=
    selectTopic&warningsignsanddiagnosis=Warning+Signs+and+Diagnosis&
    print=Confirm+print+selection.
  14. National Osteoporosis Foundation (2010). Medications to prevent and treat osteoporosis [online]. Retrieved June 24, 2010. From http://www.nof.org/aboutosteoporosis/managingandtreating/medicinesneedtoknow.

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Last updated: 28 September, 2010

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