In , researchers found that injecting a particular kind of stem cell into mice reversed osteoporosis and bone loss in a way that could also benefit humans. Scientists believe that genetic factors strongly determine bone density. Researchers are investigating which genes are responsible for bone formation and loss in the hope that this might offer new osteoporosis treatment in the future. Doctors have identified several risk factors for osteoporosis. Some are modifiable, but it is not possible to avoid others.
The body continually absorbs old bone tissue and generates new bone to maintain bone density, strength, and structural integrity.
Bone density peaks when a person is in their late 20s, and it starts to weaken at around 35 years of age, As a person grows older, bone breaks down faster than it rebuilds. Osteoporosis may develop if this breakdown occurs excessively. It can affect both males and females, but it is most likely to occur in women after menopause because of the sudden decrease in estrogen.
Estrogen normally protects women against osteoporosis. The IOF advises that once people reach 50 years of age, 1 in 3 women and 1 in 5 men will experience fractures due to osteoporosis. According to the American College of rheumatology, nonmodifiable risk factors include:. Modifiable risk factors include:. Weight bearing exercise helps prevent osteoporosis. It places controlled stress on the bones, which encourages bone growth.
Research published in suggests that transgender women who receive hormone treatment HT may have an increased risk of osteoporosis. However, using anti-androgens for a year before starting HT may reduce this risk. Transgender men do not appear to have a high risk of osteoporosis. However, scientists need to carry out more research to confirm these findings.
Medical conditions that increase the risk include:. Medications that raise the risk include:. Glucocorticoid-induced osteoporosis is the most common type osteoporosis that develops due to medication use. Calcium is essential for bones. Share on: Facebook Twitter. Show references Osteoporosis overview. Accessed June 3, Merck Manual Professional Version.
Kellerman RD, et al. In: Conn's Current Therapy Elsevier; Ferri FF. In: Ferri's Clinical Advisor Goldman L, et al. In: Goldman-Cecil Medicine. Calcium fact sheet for health professionals. Office of Dietary Supplements. Accessed June 8, Vitamin D fact sheet for health professionals. Rosen HN, et al. Overview of the management of osteoporosis in postmenopausal women. Related Compression fractures Conventional treatment for osteoporosis Exercising with osteoporosis How osteoporosis is diagnosed How to keep your bones strong Osteoporosis — What are your risks?
Osteoporosis and nutrition: 5 key steps Osteoporosis treatment: Medications can help Osteoporosis weakens bone Osteoporosis: How long must I take bisphosphonates? Risks of osteoporosis drugs Show more related content. Mayo Clinic Press Check out these best-sellers and special offers on books and newsletters from Mayo Clinic.
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The results of studies examining the effectiveness of calcium on fracture risk are mixed, but one subgroup from a recent meta-analysis showed decreased fracture rates in older women with 80 percent or greater adherence to calcium supplementation. Most postmenopausal women consume inadequate amounts of dietary calcium; therefore, supplementation is needed.
For optimal absorption, a single dose of calcium supplement should contain mg or less of elemental calcium, necessitating multiple daily doses.
Calcium carbonate is the least expensive, requires acid for absorption, and should be taken with meals. Calcium citrate is more expensive and does not need to be taken with meals. All calcium supplements may cause constipation and gastrointestinal upset. These medications should be given several hours before or after calcium supplements.
For patients with documented vitamin D deficiency, oral ergocalciferol vitamin D 2 in a dosage of 50, IU weekly for eight weeks is usually an effective treatment. This should be followed by a maintenance dosage of 50, IU every two to four weeks ororal cholecalciferol vitamin D 3 in a dosage of 1, IU once daily.
The goal of treatment is a sustained serum hydroxyvitamin D level greater than 30 ng per mL 74 nmol per L. Multiple alternative strategies for treating vitamin D deficiency exist.
Oral bisphosphonates inhibit osteoclastic activity and are potent antiresorptive agents. Randomized clinical trials demonstrate a reduction of vertebral and hip fractures with alendronate Fosamax 16 , 33 , 34 and risedronate Actonel. Weekly and monthly dosing make taking bisphosphonates easier. Nevertheless, nonadherence is problematic and is associated with worse outcomes. A to minute wait is required before reclining or consuming other medications, beverages, or food to lower the risk of upper gastrointestinal adverse effects.
The optimal length of oral bisphosphonate therapy is unknown. A recent study found that women who take alendronate for five years followed by five years of placebo have no increase in the incidence of nonvertebral or hip fractures compared with women who take alendronate for 10 years. There is, however, an increase in vertebral fractures.
The intravenous bisphosphonates currently approved by the FDA for the treatment of postmenopausal osteoporosis are zoledronic acid Reclast , given 5 mg yearly shown to decrease vertebral and hip fractures , 18 , 34 and ibandronate, given 3 mg every three months shown only to increase BMD in the intravenous form; the oral form has been shown to decrease vertebral fractures.
Recent concerns have been raised about the association of bisphosphonates with osteonecrosis of the jaw. To date, this rare complication is most often associated with the frequent infusion of intravenous bisphosphonates in patients with cancer. Raloxifene Evista , a selective estrogen receptor modulator, is approved for the treatment of postmenopausal osteoporosis. Raloxifene has estrogen agonist activity on the bones and lipids, and an estrogen antagonist effect on the breast and uterus.
Raloxifene is effective for reducing the incidence of vertebral fractures, but effectiveness at the hip has not been shown. Although raloxifene increases the risk of venous thromboembolism, it is indicated to decrease the risk of invasive breast cancer in postmenopausal women with osteoporosis.
Perhaps it may be best used in postmenopausal women with osteoporosis who are unable to tolerate bisphosphonates, have no vasomotor symptoms or history of venous thromboembolism, and have a high breast cancer risk score. Calcitonin nasal spray Miacalcin is an antiresorptive agent approved for the treatment of postmenopausal osteoporosis at a dosage of IU in alternating nostrils each day.
It is shown to decrease the occurrence of vertebral compression fractures, but not nonvertebral or hip fractures. Teriparatide Forteo is a recombinant human parathyroid hormone with potent bone anabolic activity.
In a dosage of 20 mcg per day given subcutaneously for up to two years, teriparatide decreases vertebral and nonvertebral fractures. Increased risk of osteosarcoma is seen in rats exposed to high doses. Consequently, teriparatide is contraindicated in patients with risk of osteosarcoma, such as those with Paget disease, previous skeletal radiation, or unexplained elevation of alkaline phosphatase level.
Teriparatide is approved for the treatment of postmenopausal women with severe bone loss, men with osteoporosis who have a high risk of fractures, and persons who have not improved on bisphosphonate therapy. One study suggests that it is advisable to follow teriparatide therapy with bisphosphonate therapy to maintain BMD gained.
The FDA recommends hormone therapy for osteoporosis only in women with moderate or severe vasomotor symptoms, using the lowest effective dose for the shortest time. Bisphosphonates do not have additive effects on BMD when used concomitantly with parathyroid hormone, 44 but they do have additive effects on BMD when combined with hormone therapy. Although research continues, there is currently a limited role for combination therapy beyond subspecialty consultation or clinical trials.
There is no clear evidence to guide follow-up recommendations once the diagnosis of osteoporosis is made and treatment is initiated. It is reasonable to assess response to therapy at least once, after no less than 24 months.
More frequent testing might be appropriate in the setting of accelerated bone loss, such as the chronic administration of glucocorticoids. Successful treatment is best determined by lack of fracture, but the surrogate outcome of stability or increase in BMD suggests treatment effectiveness.
A decrease in BMD suggests noncompliance, inadequate calcium and vitamin D supplementation, an unidentified secondary cause of osteoporosis, or treatment failure.
Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. She received her medical degree from the University of Virginia, Charlottesville, and completed a family medicine residency at Miami Valley Hospital in Dayton, Ohio. Medical Education and Research Center.
Reprints are not available from the authors. Department of Health and Human Services. Bone health and osteoporosis: a report of the surgeon general Accessed December 7, National Osteoporosis Foundation. Preventive Services Task Force. Screening for osteoporosis in post-menopausal women: recommendations and rationale. Rockville, Md. Amin S, Felson DT. Osteoporosis in men. Rheum Dis Clin North Am. Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures: a gap in evidence-based practice guideline implementation.
Arch Intern Med. Geneva, Switzerland; Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density. Am J Manag Care. Screening for postmenopausal osteoporosis: a review of the evidence for the U. Ann Intern Med. Meta-analysis: accuracy of quantitative ultrasound for identifying patients with osteoporosis. Osteoporosis in postmenopausal women: diagnosis and monitoring.
Osteoporosis prevention, diagnosis, and therapy. International Society for Clinical Densitometry. Updated official positions of the International Society for Clinical Densitometry.
Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians [published correction appears in Ann Intern Med. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures.
Fracture Intervention Trial Research Group. Effect of risedronate on the risk of hip fracture in elderly women. N Engl J Med. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res. Risedronate reduces the risk of first vertebral fracture in osteoporotic women. Osteoporos Int. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial.
A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. Am J Med. Effect of parathyroid hormone 1—34 on fractures and bone mineral density in postmenopausal women with osteoporosis. Food and Drug Administration.
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