Osteoporosis: Diagnosis and Treatment

Once you know you have osteoporosis, you have many options for treating the condition and strengthening your bones to prevent fractures. Talk to your doctor about what’s most likely to help you. You may try a few different approaches at once, including medications, changing your diet and exercise habits, and other lifestyle choices.

How Is Osteoporosis Diagnosed?

If your doctor thinks you might have osteoporosis, they may start by measuring your height to see if you’ve gotten shorter. The bones of the spine are often the first ones affected by the condition, which can change how tall you are.

Your doctor may also recommend a test to measure your bone density. One test called a DEXA scan (dual energy X-ray absorptiometry)is the most common tool used to measure bone density and diagnose bone loss and osteoporosis at an early stage. Quantitative computed tomography is another method, but it uses higher levels of radiation than other bone density tests. Ultrasound, which typically tests the heel of your foot, can also detect early signs of osteoporosis.

In addition to these bone density tests, your doctor might take blood or urine samples and test them to see if you have another disease that’s causing bone loss.

Although osteoporosis is sometimes diagnosed by accident after you’ve had an X-ray for a fracture or an illness, it’s not a very useful tool for early screening.

Medications for Osteoporosis

The goal of most osteoporosis medicines is to help your bones stay as strong as possible. But each of them works in different ways:

Bisphosphonates, like alendronate (Binosto, Fosamax), ibandronate acid (Boniva), and risedronic acid (Actonel, Atelva) treat osteoporosis by keeping the body from breaking down bone. You take Boniva once a month, while the others can be taken weekly. If you take these medicines incorrectly, they can lead to ulcers in your esophagus, so it’s important to follow the instructions exactly.

Zoledronic acid (Reclast, Zometa) is a once-yearly 15-minute infusion you get through a vein. It is a bisphosphonate that can increase bone strength and reduce fractures in the hip, spine, wrist, arm, leg, or rib. The most common side effects include bone pain, nausea, and vomiting. People whose kidneys don’t work very well should avoid it or use it with caution.

Raloxifene (breast-cancer-during-pregnancy' target='_blank' rel='noopener noreferrer' >Evista) is an osteoporosis treatment that acts like the hormone estrogen and can help maintain bone mass. But studies have shown that it doesn't have some of the downsides of estrogen, like increasing the risk of breast or uterine cancers. Evista often causes hot flashes and makes you more likely to have blood clots.

Abaloparatide (Tymlos) or teriparatide (Forteo) treat osteoporosis in postmenopausal women and men who are more likely to get severe fractures. It’s a man-made form of the parathyroid hormone that your body produces, and is the first drug shown to make the body form new bone and increase bone mineral density. You take it as a daily injection for up to 2 years. Side effects include nausea, leg cramps, and dizziness.

Romosozumab-aqqg (Evenity) is a monoclonal antibody used to treat osteoporosis in postmenopausal women at high risk of fracture. It blocks the effects of the protein sclerostin and works mainly by increasing new bone formation. It is taken by injection once a month with a limit of 12 doses.

Denosumab (Prolia, Xgeva)treats osteoporosis by interfering with the body's bone-breakdown process. It's for women with a higher chance of fracture who’ve tried other osteoporosis drugs that have not worked. Side effects can include pain in the back, arms, and legs. You get an injection of this drug twice a year.

Osteoporosis and Hormone Replacement Therapy (HRT)

Hormone replacement therapy (HRT) -- either estrogen alone or a combination of estrogen and progestin -- is approved for the prevention and treatment of osteoporosis in women.

The Women’s Health Initiative study found that while estrogen lowers women’s chances for fractures, it may make them more likely to have other health problems. Conjugated estrogens/medroxyprogesterone acetate (Prempro), one type of combination hormone replacement therapy, was shown to increase some women’s chances of breast cancer, heart disease, and stroke. However, Premarin alone did not increase breast cancer risk.

So while HRT may help preserve bone and prevent fractures in postmenopausal women, your doctor may want you to use other medications first. Talk with your doctor about HRT and its benefits and risks.

Nutrition for Strong Bones

Your diet is an important part of treating and preventing osteoporosis, especially getting enough calcium to build and maintain strong bones. Eat plenty of calcium-rich foods, such as nonfat or low-fat milk, low-fat yogurt, broccoli, cauliflower, salmon, tofu, and leafy green vegetables. One glass of skim milk has the same amount of calcium as whole milk: 300 milligrams.

Women through age 50 should get 1,000 milligrams of calcium each day. Older women need 1200 milligrams a day.

For men, the recommended amount of calcium is 1,000 milligrams per day between ages 25 and 70 and 1,200 milligrams per day from age 71 and up.

Your body also needs vitamin D to absorb calcium and move it into and out of bones. Adults ages 19-70 need 600 international units per day and those 71 and older need 800 international units per day. Fatty fish like salmon and tuna are good sources. But not many other foods are rich in vitamin D, so you may need to take a supplement to get enough.

Because calcium supplements can keep the body from absorbing certain drugs, check with your doctor before you start taking them if you are on any medications. You may need to take the supplements at a different time of day from your other meds.

How to Eat for Bone Health

Along with foods that are naturally rich in calcium, there are other ways to get more of it in your diet:

• Add nonfat dry milk to everyday foods and drinks, including soups, stews, and casseroles. Each cup of dry milk adds about a third of the calcium you need each day.
• Avoid foods with a lot of the mineral phosphorous, which can promote bone loss. They include red meats, soft drinks, and those with phosphate food additives. Drinking a lot of alcohol and caffeine may also reduce the amount of calcium your body absorbs. People with osteoporosis should avoid getting too much.
• Some people say postmenopausal women should get more plant estrogens, especially through items like tofu, soybean milk, and other soy products. The idea is to keep estrogen levels from dropping. However, there is no evidence to prove that these things help prevent or delay osteoporosis.

Exercise Your Bones

Exercise is a key way to keep bones strong. Make sure you get two main types:

• Weight-bearing exercise, which puts stress on bones. Running, walking, tennis, ballet, stair-climbing, and aerobics fall into this category.
• Muscle- strengthening exercises, such as weight lifting

To get the most benefit, you should try to do your workouts at least three times per week for 30-45 minutes, but even doing a little at a time helps.

Swimming and bicycle riding, although good exercises for your heart, don’t seem to be as helpful in preventing osteoporosis because they're not weight bearing -- they don’t make your bones work and get stronger.

Osteoporosis and Mental Health

It’s important to recognize that osteoporosis can take an emotional toll and to get treatment for that too. Depression is common in people with this disease.

Osteoporosis can damage your self-image. You may see yourself as fragile, and be too scared of breaking a bone to do activities you’ve always enjoyed. If spinal compression fractures have caused a serious rounding of your upper back, you might not like the way you look.

Consider therapy or a support group. The National Osteoporosis Foundation sponsors local support groups called Building Strength Together. You can find one, join one, or start one on their website. And the same exercise that keeps your bones strong can also boost your mood.

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