Osteoporosis

The best treatment for any disease is prevention. To maximize bone density, attention must be paid to ensuring adequate calcium and vitamin D intake, frequent weight-bearing exercise, and minimal alcohol and cigarette use from an early age. Estrogen and other medications such as bisphosphonates can decrease the amount of bone lost at the time of menopause. Persons requiring steroids for prolonged periods of time can be treated with bisphosphonates. Even among persons with established osteoporosis, there is much that can be done to reduce further bone loss, increase bone density, and, most importantly, prevent fractures. As many persons have a diet deficient in calcium and vitamin D, supplements are often needed to ensure a daily intake of 1200–1500 mg of elemental calcium and 400–800 IU of vitamin D. Medications that decrease bone turnover include estrogen, SERMs (selective estrogen receptor modulators, such as raloxifene), bisphosphonates (such as etidronate, alendronate, and risedronate), and calcitonin. These have been proven to increase bone density and to reduce vertebral fractures. Estrogen, risedronate, and alendronate have also been proven to decrease the risk of hip fracture. The selection of the best medication for the individual person depends on their other illnesses and risk factors, consideration of potential side-effects, and cost. Although much attention is focused on increasing bone density, equally, if not more important, are measures to reduce the falls that lead to fractures. Exercise, especially balance and resistance training, has been proven to reduce falls. Many medications such as benzodiazepines, antidepressants, and antipsychotics increase the risk of falls and should be stopped or reduced if possible. Vision should be checked. Attention should also be paid to home safety. Throw rugs should be discarded or taped down, grab bars should be installed in the bathroom and there should be adequate lighting. The person should wear sturdy flat shoes and be encouraged to use a walking aid if required. Hip protectors, which are shorts with pads over the hip bone, can also prevent hip fracture.