Treatment Of Osteoporosis

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[edit] Treatment Of Osteoporosis

There are a number of steps that can be taken to minimize further bone loss, to prevent fractures and to ease pain that may be present. As the table below shows, there are a number of factors that need to work in concert. A patient affected with osteoporosis needs to work closely together with the treating physician and ask for the various elements of treatment.

Everybody can walk or engage in an exercise program. Smokers need to quit smoking and heavy drinkers need to quit drinking and likely would do well to join Alcoholics Anonymous. Otherwise all the other elements of therapy are wasted, as it does not make sense to built up bone and then destroy it again.

Calcium carbonate (for instance Rolaids), and a sensible diet, which is sugar free and free of refined carbohydrates (without starches, rice, potatoes and pasta), will all help (see Ref. 3 and 4). In other words a low carb diet that allows the low glycemic index foods (green leaf vegetables, lettuce, red and green peppers, broccoli, cauliflower and other cooked vegetables etc, glycemic index of up to 50). Further the diet recommended is low fat, but contains adequate amounts of protein. Such diets are also called Mediterranean diet, Zone diet, South Beach diet and all of them will help. Vitamin D is useful to improve absorption of calcium.

Treatment of osteoporosis
Therapeutic steps:	Comments:
prevention of falls	carpeting, hip protectors, avoid benzodiazepines; cataract surgery to ensure good vision
calcium supplements	1000 to 1500 mg per day
vitamin D	400 IU to 800 IU to improve absorption and utilization of calcium
calcitonin by injection or by nasal spray	this hormone reduces bone pains and is also useful for up to 3 months for healing fractures
biphosphonates	alendronate (Fosamax) inhibits osteoclast related bone absorption, increases bone densitiy and prevents fractures in postmenopausal women
sodium fluoride	used to be popular, but now most physicians have misgivings about it, because the new bone formation is low quality, more fragile bone leading to fractures (not a good idea, if this is what we want to prevent! )
physical activity	walking, swimming, expander and stretching exercises builds up bone mass
change of diet	a zone type diet will build up bone by avoiding hyperinsulinism (Ref. 3 and 4)
physiotherapy treatments	strengthen and balance muscles to improve gait and prevent falls

Your physician will help you to decide whether estrogen/progesterone (in women) or testosterone therapy (in men) is necessary. In some patients it might be better to use calcitonin instead.

The physician is in the best position to advise the patient. Discussion of the pros and cons between patient and physician is important. There is often more than one right way to treat osteoporosis successfully. Physiotherapy treatments are important to strengthen certain muscle groups and to develop strength thus avoiding falls. Other measures to prevent falls as indicated in the table above are also important. Sometimes it is overlooked that an aging person may have cataracts, which lead to poor vision. Once this is corrected with cataract surgery, the patient often has a much more steady gait. Unfortunately the life of an elderly person is often changed permanently following a hip fracture from a fall. For those patients who end up in nursing home care their independence is lost as well.

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References:

1. ABC of rheumatology, second edition, edited by Michael L. Snaith M.D., BMJ Books, 1999.

2. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 57.

3. B. Sears: "The age-free zone".Regan Books, Harper Collins, 2000.

4. B. Sears: "Zone perfect meals in minutes". Regan Books, Harper Collins, 1997.

5. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders

6. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

7. Rakel: Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier