Osteoporosis
Last updated Tuesday, May 15, 2007
Management and treatmentTreatment The first step in treating osteoporosis is to start all
the lifestyle factors discussed previously.
If a patient has already had a fracture, then prescription
medication will be beneficial. If there
has not been a fracture, but just low bone density, then sometimes prescription
medications will help to reduce the risk of getting a fracture. Many of the medicines used to treat
osteoporosis are new (available within the last 5 to 10 years) and so the
long-term effects are still unknown.
That means doctors are not as sure about long-term prevention as they
are about treating a person who already has had a fracture.
In addition to medications, some patients need physical
therapy or nutritional therapy.
Surveys
of hospital discharge records show that osteoporosis treatment is still ignored
in many cases. More education of
doctors, nurses and patients is still necessary!Health care team Osteoporosis is treated by a team of health care
providers including physicians, nurses, and physical therapists.Pain and fatigue The pain from osteoporosis is treated with the same
medications as other kinds of pain.
These medications may include acetaminophen, nonsteroidal
anti-inflammatory drugs such as ibuprofen, and narcotic pain relievers.
Some studies have shown that calcitonin can help to
relieve the pain from an osteoporotic fracture.
Usually
the pain is gone once the fracture has healed.
There may be some aching the persists, that is treated with physical
therapy and mild pain medicines.Diet The diet has been discussed in the prevention section.Exercise and therapy Physical therapy can help to increase the muscle and bone
strength. For patients with spinal
osteoporosis, back extension exercises are recommended. These can be taught by the therapist, who can
help a patient establish a home program for back care.
Sit-ups and other back flexion exercises can increase the
risk of osteoporotic fractures and they should be avoided. Lifting heavy objects also should be
avoided. Lifting and twisting can be particularly
stressful to the bones in the back.
Golfing is an activity that puts a twisting force on the
spine and can cause fractures. Contact
sports and fast downhill skiing cause fractures even in young healthy people
with strong bones, so common sense dictates that it is unwise to engage in
these kinds of activities when people have osteoporosis.
On
the other hand, many patients with a fracture or diagnosis of osteoporosis
become fearful and limit their activity.
This is a bad idea because the bones respond to exercise by becoming
stronger. For the elderly patient with
osteoporosis, a moderate approach to exercise is the best, with back extension
exercises and walking, stair climbing, and arm curls with light weights.Medications The medications used to treat osteoporosis depend on the
cause of the osteoporosis. If there is
no specific cause, then the following treatments have been approved by the US
FDA:
- estrogen
- bisphosphonates (alendronate, risedronate, ibandronate)
- calcitonin
- raloxifene
- teriparatide
Some
patients do not want to take any medications and would prefer to just follow
dietary and exercise recommendations.
But for those who already have fractures, the benefits of preventing
future fractures outweigh the risks and costs of taking the medications.Surgery The role of surgery after a spine fracture is
uncertain. It is possible to insert a
needle into the vertebral body of the spine, and squirt some liquid material
that will harden into the spine. A
small balloon can be inserted first, and expanded to make a space for the
filling material. This procedure can
restore the shape of the vertebra which had been crushed. Many patients fell pain relief after the
surgery, perhaps because the nerve fibers have been numbed by the filling
material.
The long-term effects of this surgery are not known. Some studies show that there is not much
difference a year later between those who had surgery and those treated with
medicine. There are some risks of the
material spilling out into the space around the spinal cord; this can cause
paralysis or nerve damage. There is also
a risk of getting more fractures in the bones above and below the surgical
site.
At
present, research is being done to answer the questions about risk and
long-term effects.Splints or braces In serious cases of kyphosis (forward curvature of the
spine caused by vertbral fractures from osteoporosis) braces can stabilize the
spine and provide protection. Physicians
in rehabilitation can prescribe these special braces.Alternative remedies Hip pads can prevent fractures in frail persons with
osteoporosis. Of course, these pads will
not work if patients do not wear them.
Some studies suggest that nearly half of the hip fractures could be
prevented if all the patients wore these protectors. They must be the kind designed for
osteoporosis.
Various kinds of exercise that improve muscle strength and
balance also can help prevent fractures and even make the bones stronger. Tai Chi, for example, has been shown to be
benficial in preventing hip fractures.
Herbal medications have not been shown to help with osteoporosis. There is interest in phytoestrogens and soy
products. In high enough doses, these
plant products can act like estrogen on the bone. But studies are needed to show if they also
have the side effects of estrogen on other parts of the body.
Many
claims are made for "food" supplements, but they have not been tested
with scientific trials. These include
boron, coral calcium, progesterone cream and strontium citrate.Long-term management Osteoporosis is a chronic condition and frequently
treatment involves prescription medications.
Physicians follow patients regularly, and may repeat bone density tests
or blood tests. It is important to
realize the limitations of bone density repeat testing, because the error of
the machine measurement for an individual person is about 5%. Sometimes patients become worried if the bone
density does not increase or goes down slightly, but this might just be an
error of the measurement.Unproven remedies Some patients think that if some calcium is good for
the bones, then more calcium must be better.
They drink milk, eat chese or yogurt, and take supplements so their
total intake is more than 2,000 mg/day.
This does not help the bones, but it increases the risk of getting
kidney stones.Surgery for Osteoporosis at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 (outside the Seattle area: 800-440-3280) to make an appointment.
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