Treatment of Osteoporosis
There are different approaches to treating osteoporosis depending upon each patient's characteristics (age and comorbidities), bone densitometry results, whether they have a prior history of fractures and which medicines they have taken previously.
Osteoporosis treatments are based around 4 pillars:
Calcium. It is essential to follow a calcium-rich diet or, failing this, take appropriate supplements.
Calcium intake or calcium supplements
All patients with osteoporosis, osteopenia and/or risk factors for developing osteoporosis are recommended to follow a calcium-rich diet. You should aim for a calcium intake of approximately 1000–1200 mg/day, preferably sourced from your diet. You may be prescribed calcium supplements if your dietary intake is found to be insufficient. Food's chart (Asociación Española con la Osteoporosis y la Artrosis).
Vitamin D. An appropriate intake of vitamin D helps the body absorb calcium and ensures correct bone mineralisation.
What is vitamin D?
Vitamin D is the hormone responsible for transporting calcium from the intestine to the bones. Vitamin D levels should be maintained at least 20 ng/mL (50 pmol/L), but ideally they should be greater than 30 ng/mL.
Only a few foods are rich in vitamin D. Blue fish (oily fish), cod liver oil and egg yolk are foods known to contain the highest vitamin D levels. Our most important source of vitamin D is derived from exposure to sunlight. Therefore, recommendations are for a daily exposure to sunlight of around 30 minutes in order to stimulate sufficient vitamin D synthesis, but this depends on diverse factors including geographical latitude, age and each person’s risk of developing skin cancer.
The daily recommended intake of vitamin D is 800–1000 IU; individuals with a low vitamin D blood level, particularly those of an advanced age and/or who have osteoporosis, should be treated with supplements.
A healthy lifestyle. All patients with osteoporosis, osteopenia and/or risk factors for developing osteoporosis should follow a healthy lifestyle. In addition to a calcium-rich diet, individuals should also perform regular physical exercise, quit smoking and drink alcohol in moderation.
Medicines designed to reduce the risk of suffering fractures.
The drugs used to treat osteoporosis fall into two categories: those used to reduce bone resorption/reabsorption (antiresorptive agents) and those which stimulate bone formation (bone-forming agents). It is important to point out that not all antiresorptive agents are the same. Bisphosphonates (e.g., alendronic acid, risedronic acid, ibandronic acid and zoledronic acid) are the most well-known and commonly used antiresorptive agents.Treatment with denosumab has recently been introduced as an antiresorptive therapy. Other antiresorptive treatments include selective oestrogen receptor modulators (SERMs) and oestrogen therapies. The only bone-forming agent currently available is teriparatide.
Duration of treatment
Each treatment follows a different regime and its duration should be determined by your doctor. Oral bisphosphonate treatments should generally be reassessed every 5 years and at this point, based on the clinical response, the severity of the osteoporosis and any associated risk factors, your doctor will recommend that you either continue with or take a break from the treatment.
The total duration of treatment (years) and/or the planned treatment break will depend on several factors, including the type of bisphosphonate being taken or the severity of the osteoporosis.
On the other hand, bone-forming treatment with teriparatide is recommended for a course of 2 years.
In the case of treatment with denosumab, it is important not to abandon it without consulting your doctor, because there is a risk that the effect will be lost and that the disease worsens.
The following table lists the different drugs used to treat osteoporosis.
|Alendronic acid||70 mg||weekly||oral|
2 days / month
|Ibandronic acid||150 mg||monthly||oral|
|Zoledronic acid||5 mg||annually||intravenous|
Patients should undergo a clinical check-up 6 or 12 months after starting osteoporosis treatment in order to assess drug tolerance and treatment compliance (i.e., whether you are following treatment guidelines consistently and correctly). The frequency of laboratory tests and bone density scans will depend on each patient's characteristics and the type of drug used.
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