April 20, 2024

Osteoporosis Treatment: Geriatric Approaches to Fracture Prevention

Osteoporosis Treatment

Osteoporosis is a condition characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures of the hip, spine, and wrist. According to the National Osteoporosis Foundation, over 200 million people suffer from osteoporosis globally. As there is no cure for osteoporosis, treatment focuses on preventing fractures and reducing further bone loss. Here are some of the key treatment options for managing this condition.

Lifestyle Changes

Weight-Bearing Exercise
Exercise is crucial for maintaining and building bone density. Weight-bearing activities like walking, hiking, dancing, or yoga help stimulate bone formation and slow bone loss. Aim for at least 30 minutes of moderate exercise on most days of the week.

Calcium and Vitamin D Intake
Calcium and vitamin D work together to help the body absorb calcium. Not getting enough can increase osteoporosis risk. Most adults need around 1000-1200 mg of calcium and 600-800 IU of vitamin D daily. Good food sources of calcium include dairy products, sardines, broccoli, and fortified foods.

Fall Prevention
Fall prevention strategies are also important as falls can cause fractures. Simple measures like removing tripping hazards, installing grab bars in bathrooms, and using nonslip mats in shower can go a long way in preventing falls.

Medication Treatments

Bisphosphonates
Bisphosphonates are the most commonly prescribed drug for osteoporosis. They work by slowing down bone loss and increasing bone density. Some bisphosphonates used are alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva). Side effects may include joint pain, heartburn and esophageal irritation. They need to be taken while sitting or standing.

RANKL Inhibitors
RANKL inhibitors like denosumab (Prolia, Xgeva) work by inhibiting bone breakdown. A single injection every six months makes it convenient compared to oral bisphosphonates. However, they are more expensive. Risks may include joint pain and infections.

Selective Estrogen Receptor Modulators (SERMs)
SERMs work by acting like estrogen in some tissues but blocking its effects in others. Raloxifene (Evista) and bazedoxifene (Duavee) are approved for postmenopausal osteoporosis treatment and prevention. They carry a lower risk of uterine cancer than estrogen but a slightly higher risk of dangerous blood clots.

Parathyroid Hormone Drugs
Teriparatide (Forteo) helps new bone formation by mimicking the parathyroid hormone. It comes in daily injections but only approved for up to two years of use due to a theoretical cancer risk with long-term treatment.

Other Options: Bone Building Injections
When oral or injectable medications are not suitable, options like calcitonin nasal spray may be considered. It helps relieve bone pain from osteoporosis but does not reduce fracture risk like bisphosphonates or teriparatide. Also, teriparatide DTP (Tymlos) has hit the market as a once-weekly injection to treat postmenopausal osteoporosis.

Treatment Plans and Monitoring
An osteoporosis treatment plan will depend on factors like bone density levels (T-scores), other health issues, and risks for fractures. While taking medication, repeat bone density tests and labs are done periodically to check progress and safety. Lifestyle changes need to continue alongside medication treatment. With proper management, osteoporosis can be controlled and risk of fractures reduced significantly.

Preventing Future Bone Loss

For those who have experienced a fracture due to osteoporosis, preventing future fractures is crucial. Proper follow up treatment aims to restore bone mineral density back to normal levels. Bisphosphonates are usually continued for 3-5 years after a fracture to maximize gains in bone strength. Transitioning to another treatment such as denosumab may be done after gains level off, especially for very high risk individuals.

Lifestyle changes like weight-bearing exercise, calcium and vitamin D intake, and fall prevention strategies must continue indefinitely as part of long-term management. Quitting smoking, limiting alcohol, and managing other risks can further support bone health. With a multifaceted treatment and monitoring plan, people with osteoporosis can maximize their quality of life with reduced risks of future fractures. Managing the condition early on and compliance to treatment protocols leads to better outcomes for osteoporosis patients.

*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it