Prevention Strategies
The best long-term approach to osteoporosis is prevention. If children and young adults,
particularly women, have a good diet and get plenty of exercise, then they will build up and
maintain bone mass. This will provide a good reserve against bone loss later in life. Exercise
places stress on bones that builds up bone mass, particularly skeletal loading from muscle
contraction with weight training exercises. However, any exercise of any type is better than
none at all, and exercise also provides benefits for prevention of cardiovascular diseases that
are more common in the elderly. Athletes tend to have greater bone mass than non-athletes.
Exercise in later life will help to retard the rate of bone loss. (Sweet et al, 2009)
A healthy diet should include not only enough calcium and vitamin D, but also other nutrients,
including a range of vitamins and minerals found in a diet that contains fruit and vegetables, as
well as dairr products. Appropriate protein intake has an anabolic effect to build osteoid matrix.
(Tucker, 2009)
Treatment
Persons with osteoporosis may benefit from an improved diet, including supplementation with
vitamin D and calcium, and moderate exercise to help slow further bone loss.
Most drug therapies work by decreasing bone resorbtion. At any given time, there is bone that
has been resorbed but not replaced, and this accounts for about 5 to 10% of bone mass. By
decreasing resorbtion of bone, a gain in bone density of 5 to 10% is possible, taking about 2 to
3 years. However, no drug therapy will restore bone mass to normal. Women past menopause
with accelerated bone loss may benefit from hormonal therapy using estrogen with
progesterone. The estrogen retards bone resorption and thus diminishes bone loss. This effect
is most prominent in the first years after menopause, while risks from hormone replacement
therapy increase. (Nelson et al, 2002)
One of the more common non-estrogen therapies is the use of bisphosphonates such as
alendronate or risedronate that act an an inhibitor of osteoclastic activity. Bisphosphonates
may be beneficial, particularly in women who cannot tolerate estrogen therapy.
Bisphosphonaes are effective in inhibiting bone loss after menopause. In one study
risedronate has shown effectiveness in reducing the risk of hip fracture among elderly women
with osteoporosis. Short term adverse effects of bisphosphonate therapy include esophagitis,
musculoskeletal pain, ocular inflammation, and hypocalcemia. Long term adverse effects
include increased risk for esophageal cancer, osteonecrosis of the jaw, femoral fracture, and
atrial fibrillation. (Kennel and Drake, 2009)
Raloxifene is a selective estrogen receptor modulator (SERM) that may also replace estrogen
therapy. Raloxifene can act in concert with estrogen in bone to inhibit resorbtion and decrease
the risk for fractures. Though raloxifene inhibits bone resorbtion, it does not have an anabolic
effect. Additional potential benefits from raloxifene therapy include decreased risk for breast
cancer, because raloxifene acts antagonistically to estrogen on the uterus. Conversely,
raloxifene acts in concert with estrogen to protect against and reduce atherogenesis. (Jordan,
2007)
Teriparatide is a recombinant human parathyroid hormone administered by subcutaneous
injection which binds to specific high-affinity cell-surface receptors in bone and kidney, similar
to the 34 N-terminal amino acids of parathyroid hormone, and has the same physiological
actions on bone and kidney. Daily administration of teriparatide stimulates new bone formation
by promoting osteoblastic activity over osteoclastic activity, improving trabecular bone
architectural remodelling and increasomg bone mass. (Cappuzzo and Delafuente, 2004)
(Sweet et al, 2009)
Denosumab is a human monoclonal antibody that binds to and inhibits the receptor activator of
nuclear factor-kappaB ligand (RANKL) that is elaborated by osteoblasts. The RANKL
interacting with RANK receptor expressed on osteoclasts is affected by this drug, leading to
reduced osteoclast activation and survival, thus inhibiting bone resorbtion that helps increase
bone mineral density. (McClung et al, 2006) (Romas, 2009)
Other drug therapies are less commonly employed. Calcitonin, a hormone that decreases
bone resorbtion, may be taken by injection or by nasal spray. Sodium fluoride can increase the
measured bone density in vertebra, but seems to have no overall effectiveness in reducing
vertebral fracture. Zoledronic acid has shown effectiveness in treating bone loss. (Rahmani
and Morin, 2009)
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