Osteoporosis

Treatment of secondary osteoporosis varies depending on the actual disease process which has produced the osteoporosis, and may include adjustments to thyroid medication, dietary supplementation with calcium or vitamin D (which is involved in the ability of the intestine to absorb calcium in the diet), or other treatment of the primary disease.

Treatment of primary osteoporosis in the elderly involves adequate intake of calcium and vitamin D, as well as regular exercise. Recommendations for calcium supplementation suggest taking 1500 mg per day alone, or 1000 mg per day in conjunction with estrogen replacement therapy. Exercise is helpful both to strengthen muscle and to increase weight-bearing activity (remember that bone formation occurs most effectively along lines of stress and weight-bearing).

A current area of interest in the study of osteoporosis prevention is the role of estrogen replacment therapy. Bone loss can be decreased in elderly women by estrogen replacement therapy, ideally beginning during the first years of menopause. Such estrogen replacement therapy, however, has been called into question for a number of reasons. Estrogen given alone, for example, has been shown to increase the rate of endometrial cancer. For this reason, most hormone replacement regiments couple estrogen with progesterone, which reduces the risk of endometrial cancer. Unfortunately, some studies have also pointed to estrogen (with or without progesterone) as potentially causing an increased risk of breast cancer development. Several important studies are underway to investigate this association.

In the past, the majority of treatment for osteoporosis occurred in the form of treatment of the fractures resulting from the disease. Now, however, some exciting new therapies exist. Calcitonin is normally produced by the thyroid gland, and works to lower blood calcium levels and prevent bone resporption. A calcitonin product is available for treatment of osteoporosis. It is given either as a nose spray, or as an injection. Its effects simulate those of naturally produced calcitonin, resulting in slower progression of bone loss. Alendronate is a biophosphonate which is taken orally, and which slows bone breakdown. Raloxifene is a type of Selective Estrogen Receptor Modulator. This class of drugs have estrogen-like effects on the body, including on the bone and heart. They are believed, however, to have less pronounced effects on uterine lining (endometrial cancer development) and breast tissue (breast cancer development).

Treatment of actual symptoms of osteoporosis include pain medications and heat for vertebral compressions, simple casts for uncomplicated fractures, or hip replacement surgery for more complicated hip fractures.

The importance of osteoporosis in terms of the misery it causes and its economic impact is underscored by these statistics. About one-third of all women over the age of 70 experience hip fracture. Of those elderly people who fracture a hip, about 15% die of complications secondary to that hip fracture. A large percentage of those who survive are unable to return to their previous level of activity, and many times a hip fracture precipitates a move from self-care to a supervised living situation or nursing home. The yearly cost of osteoporotic injury in the United States is greater than $10 billion.