Understanding Osteoporosis and How It's Treated

By Orthopedic Surgeon Dr. James Slauterbeck

Osteoporosis is a disease that makes bones weak and more likely to break. Sometimes, a person may break a bone from a small fall like slipping on the ground. Typically, bones do not break from this type of injury. If this happens, the doctor might think the person has osteoporosis. To find out for sure, the doctor may order a DEXA scan, which is a special test that checks the strength of bones. 

The two main ways to manage osteoporosis are prevention and treatment.

Prevention

Prevention means doing things to keep your bones strong before any problems happen.

• Staying active is very important. Activities like walking, jogging, yoga, and lifting weights help build strong bones.
• Making healthy choices like not smoking and avoiding too much alcohol is also helpful.
• Eating the right foods matters, too. Foods like milk, cheese, yogurt, and leafy green vegetables are full of calcium, which bones need to stay strong. Vitamin D3 is just as important because it helps your body absorb calcium. You can get vitamin D3 from sunlight, from foods like fish, or by taking a vitamin. If you are going to buy a vitamin pill, choose vitamin D3 instead of regular vitamin D, because D3 is already in the active form and doesn’t need sunlight to work in your body.
• For girls and young women, having a regular monthly period is another sign that their body is making the right hormones to protect their bones.

Treatment

If someone already has osteoporosis or low bone density, they may need treatment. There are two main kinds of medicine to treat osteoporosis:

• The first kind is called antiresorptive medicine. These drugs work by slowing down the process of bone loss. They stop certain cells in the body from breaking down bone too quickly, which helps bones stay stronger and lowers the risk of more fractures.
  • Some of these antiresorptive medicines are taken by mouth. For example, alendronate (Fosamax) and risedronate (Actonel) are pills that are usually taken once a week. There is also ibandronate (Boniva), which is taken once a month as a pill or given every three months as an injection. Another medicine, zoledronic acid (Reclast), is given through a vein (IV) once a year. Denosumab (Prolia) is given as a shot (injection) every six months.
• The second kind of medicine is called anabolic medicine. These help the body build new bone. They work by encouraging bone-building cells to make more bone. These medicines are usually used for people who have very weak bones or have had more than one fracture. Two common anabolic medicines are teriparatide (Forteo) and abaloparatide (Tymlos). Both of these are given as daily shots under the skin and are used for up to two years.

Doctors often don’t wait long to start treatment, especially if someone has already broken a bone. In fact, some medicines, like zoledronic acid or denosumab, can be started just two weeks after a fracture, and studies show they won’t slow down the healing process. While there isn’t an exact rule for when to begin treatment, starting early is usually a good idea, especially for people at high risk of future fractures.

Side Effects of Medicines

Like all medicines, osteoporosis drugs can have side effects. One possible side effect is low calcium levels in the blood, which is called hypocalcemia. This is why doctors check blood tests regularly. Some people may have muscle or joint pain. A rare but serious problem is something called osteonecrosis of the jaw, where part of the jawbone dies. This can happen more often in people who have dental surgery or don’t take care of their teeth. Another rare problem is a special kind of thigh bone fracture that can happen after using antiresorptive medicines for a long time. This is called an atypical subtrochanteric femur fracture.

After taking these medicines for several years the doctor should suggest a break from treatment. This is called a “drug holiday.” It helps prevent the body from slowing bone turnover too much and allows bone to remodel effectively. A drug holiday might be recommended after two to five years of using pill-based medicine like alendronate or after three years of yearly IV treatment like zoledronic acid. Researchers are still learning more about whether other medicines should be taken during this time off.

There are also some other medicines that can be considered but are not first-line medications for the management of osteoporosis.  One of them is raloxifene (Evista), which mostly helps with spine fractures and has a role in management of some breast cancer therapy.  Another medicine, calcitonin, is given as a nasal spray or injection and may help with spine fractures and short-term pain, though it is not used for long-term treatment. Estrogen, a hormone, is also approved to help prevent osteoporosis but is usually not used to treat it.

In conclusion, osteoporosis can be prevented and treated. By staying active, eating healthy foods,  making health choices, getting enough vitamin D3, and taking the right medicine when needed, people can keep their bones stronger and reduce the chance of breaking them. Doctors choose the best treatment based on how high a person’s fracture risk is, their other health conditions, and what works best for that person’s lifestyle.

James Slauterbeck, MD, is an orthopedic surgeon whose special interests include sports medicine, adolescent sports medicine, female sports medicine, and high school and college athletic injuries. He is affiliated with UNC Health Orthopedics at Southeastern Health Park and UNC Health Southeastern. To learn more, call (910) 738-1065 or visit https://www.unchealth.org/care-services/doctors/s/james-r-slauterbeck-md.