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Osteoporosis is a condition characterized by reduced bone strength that leads to an increased risk of fractures. It is estimated that over 200 million people worldwide suffer from osteoporosis. In this article, we will discuss the various treatment options available for osteoporosis.
Lifestyle Changes
Lifestyle changes are the first line of treatment for osteoporosis. Maintaining a healthy lifestyle through diet, exercise and avoiding smoking can help build bones and slow bone loss. It is recommended to get adequate calcium and vitamin D through diet or supplements. Weight-bearing and muscle-strengthening exercises like walking, dancing and yoga also support bone health.
Medications
Several medications are available for treating osteoporosis and reducing fracture risk. The choice of medication depends on factors like age, general health, risk of fractures and results of bone mineral density tests. Some of the commonly prescribed medications include:
Bisphosphonates
Bisphosphonates like alendronate, risedronate and ibandronate are considered first-line drug therapies for postmenopausal osteoporosis. They work by inhibiting bone resorption and help increase bone mineral density. Bisphosphonates are effective in reducing spine, hip and non-spine fractures when taken continuously for several years. Side effects may include gastric issues like heartburn and musculoskeletal pain.
RANKL Inhibitors
Denosumab, a RANKL (receptor activator of nuclear factor kappa-B ligand) inhibitor, is beneficial for postmenopausal women at high risk of fractures. It reduces bone resorption by inhibiting osteoclast formation. RANKL inhibitors lower the risks of spine, non-spine and hip fractures significantly. Injections needs to be taken every six months. Short term side effects include back pain, muscle pain and hypocalcemia.
TERPARONDOTIDE/ABALOPARATIDE
These anabolic agents can be used in postmenopausal women at high risk for fractures or who cannot tolerate other medications. They work by stimulating new bone formation through Wnt signalling pathway. They help reduce vertebral and nonvertebral fractures effectively and also increase bone mineral density rapidly compared to other drugs.
Selective Estrogen Receptor Modulators (SERMs)
Raloxifene, a SERM, is an option for postmenopausal women with osteoporosis and increased risk for invasive breast cancer. It works by activating estrogen receptors in bone and inhibiting them in breast tissue. Raloxifene decreases vertebral fracture risks by 30-50%. It causes less uterine cancer than estrogen therapy alone. Hot flashes and leg cramps are common side effects.
Calcitonin
Calcitonin nasal spray is prescribed less commonly now for treating postmenopausal osteoporosis. It reduces bone resorption and enhances calcium excretion by kidneys. Calcitonin provides mild pain relief from recent vertebral fractures. Common adverse effects include nausea, flushing and rhinitis.
Surgery
Surgeries like vertebroplasty and balloon kyphoplasty are recommended in cases of painful osteoporotic compression fractures that failed to heal with nonsurgical treatment. In vertebroplasty, bone cement is injected into the fractured vertebra to stabilize it. Balloon kyphoplasty involves inflating a balloon inside the vertebra to create space before cement injection. Both procedures provide effective short-term pain relief from vertebral fractures.
Other Therapies
Teriparatide injections can be used for severe osteoporosis in postmenopausal women or glucocorticoid induced osteoporosis in men. It increases new bone formation and reduces both vertebral and nonvertebral fracture risks. Testosterone therapy for men with low testosterone levels and estrogen therapy for women may slow bone loss from osteoporosis. Parathyroid hormone (PTH) is an anabolic agent that can be considered for severe cases.
Preventing Recurrent Fractures
After an initial low-trauma fracture, the risk of subsequent fractures increases substantially due to compromised bone quality and strength. It is important to continue non-drug therapies as well as anti-resorptive or anabolic medications uninterruptedly to maintain gains in bone mineral density achieved from treatment and prevent future fractures. Therapy compliance and adherence plays a major role in preventing recurrent fractures effectively.
Conclusion
Osteoporosis poses a significant health problem among the aging population. While lifestyle modifications are keystone, medications today allow better management of bone health. With early diagnosis, identification of risk factors and appropriate treatment including anti-resorptive or anabolic therapy on a long-term basis, it is possible to not just prevent fragility fractures but also enhance bone mineral density and quality of life.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
