Click for larger font-size

Treatment Options

treatment page photo

Welcome to our treatment section. Deciding when and how to treat a patient for low bone mass is surprisingly complex. Many patients feel quite well and don�t have any symptoms at all, yet are still at high risk for future fractures. On the other end of the spectrum, other patients have suffered from multiple fractures and may have associated bone pain or loss of physical function.

With this in mind, our recommendations for patients are highly individualized. In deciding who needs treatment and in deciding what treatment to provide, our providers focus on one very important goal: preventing a bone fracture. As indicated in other parts of our website, there are often a number of factors that lead to a fracture. Finally, since osteoporosis is often a silent disease, a very important part of our therapy relies upon prevention.

I. Calcium and Vitamin D

Calcium

  • - Calcium is critically important for optimal bone health. Calcium is important in the formation of the bone 'mineral,' which serves to strengthen other components of the bone. Furthermore, if calcium intake is too low, the body compensates by 'robbing' the bones for calcium. An adequate calcium intake has been shown to reduce the risk of osteoporotic fractures and increase bone density.
  • - Our center ascribes to the recommendations set forth by the National Academy of Sciences: the optimal calcium intake for adults older than age 50 is 1200mg of elemental calcium/day. This intake includes both food sources and any supplements. All of our patients get instructions on the importance of calcium and are given recommendations as to which supplements will be most beneficial.

Vitamin D

  • - Adequate stores of Vitamin D are required to absorb calcium. Supplemental Vitamin D has been shown to lower the risk of fractures, especially in Vitamin D deficient individuals. In addition to its impact on bone health, Vitamin D plays an important role in balance and muscle strength. In fact, Vitamin D supplementation has been shown to reduce the incidence of falls. Our center recommends 800-1000 IU/day of supplemental Vitamin D, especially in postmenopausal women.
  • - Our center�s providers intimately understand the physiology of Vitamin D and its critical role in bone health and fracture prevention. All of our patients have their Vitamin D level checked, which involves a simple blood test. We routinely provide sound advice on the type of Vitamin D supplements that will most benefit our patients.

II. Fall Risk and Fall Prevention

  • - More than 1/3 of persons over the age of 65 fall each year in the United States. Most fractures in older individuals are caused by falls.
  • - Our center views fall prevention as a critical component to the prevention of fractures. As such, we focus on risk factors that can predispose to falls. Some of these risk factors include prior falls, concomitant arthritis, vitamin D status, vision impairment, and cognitive impairment.
  • - Our fall prevention program focuses on identification and modification of these risk factors. We often engage the assistance of both occupational and physical therapy services to help reduce the risk of falls.

III. Exercise and the prevention of Osteoporosis

  • - Weight bearing and muscle strengthening exercise can improve muscle strength and balance, reducing the risk of falls. In addition the mechanical forces that occur with exercise stimulate bone cells, thereby increasing bone density. Our center views exercise as an important component to maintaining bone health and we help our patients get the proper guidance on specific exercise recommendations.

IV. Pharmacologic (Drug) Treatment

  • - A variety of medications are available to treat osteoporosis. The following is a list of the current FDA-approved therapies. We have a collaborative approach to treatment. The risks and benefits for any treatment are thoroughly discussed with our patients; ultimately, our patients can choose to initiate treatment based upon our recommendations.

FDA-approved Drug therapy (United States)

- Bisphosphonates
  1. Alendronate (Fosamax®)
  2. Risedronate (Actonel®)
  3. Ibandronate (Boniva®)
  4. Zoledronate (Reclast®)
- Estrogen / Hormone Replacement
- Calcitonin (Miacalcin®)
- Teriparatide (PTH 1-34) (Forteo®)
- Selective Estrogen Receptor Modulator (SERM)
- Raloxifene (Evista)

References:

  1. National Academy of Sciences www.nationalacadamies.org
  2. Centers for Disease Control and Prevention; 'Falls Among Older Adults: An Overview'; www.cdc.gov
  3. Clinician�s Guide to the prevention and treatment of Osteoporosis, National Osteoporosis Foundation 2008.
  4. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 7th edition, 2008. American Society for Bone and Mineral Research