Treatment and prevention of Osteoporosis

Osteoporosis means porous bone. It is a disease characterized by low bone mass and loss of bone tissue that may lead to weak and fragile bones.

November 16, 2017

Osteoporosis means porous bone. It is a disease characterized by low bone mass and loss of bone tissue that may lead to weak and fragile bones.
The aim of the treatment is to

  • maintain healthy bone mineral density and bone mass
  • prevent fractures
  • slow or prevent the development of osteoporosis
  • reduce pain
  • maximize the person's ability to continue with their daily life

All of these can be achieved by preventive lifestyle measure and the use of supplements and some medicines.

Lifestyle Changes:

Quitting cigarette smoking, limiting excessive alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D will help prevent osteoporosis.
Regular exercise decreases the risk of falls, probably because balance is improved and muscle strength is increased. However it is important to avoid exercises that can injure already weakened bones. In patients over 40 and those with heart disease, obesity, diabetes mellitus, and high blood pressure, exercise should be prescribed and monitored by physicians. Extreme levels of exercise such as marathon running may not be healthy for the bones.
Smoking cigarettes decreases estrogen levels and can lead to bone loss in women before menopause. Smoking cigarettes also can lead to earlier menopause. Limiting the amount of alcohol and caffeine intake is always advisable for a healthy lifestyle.

Calcium Supplements for Osteoporosis:

An adequate dietary intake of calcium beginning in childhood and adolescence can help building strong and healthy bones. However, a high dietary calcium intake or taking calcium supplements alone is not sufficient in treating osteoporosis. After menopause, rapid bone loss may occur even if calcium supplements are taken for first few years. The following calcium intake are recommended  for all people, with or without osteoporosis:

  • 800 mg/day for children 1-10 years of age
  • 1,000 mg/day for men, premenopausal women, and postmenopausal women who are also taking estrogen
  • 1,200 mg/day for teenagers and young adults 11-24 years of age
  • 1,500 mg/day for postmenopausal women not taking estrogen
  • 1,200 mg-1,500 mg/day for pregnant and nursing mothers

The total daily intake of calcium should not exceed 2,000 mg.
By drinking more milk and eating more yogurt or cottage cheese or by taking calcium supplement tablets, and from calcium-fortified foods such as orange juice, additional calcium can be obtained.
The various calcium supplements contain different amounts of elemental calcium which is the actual amount of calcium in the supplement. Each 1,250 mg of calcium carbonate salt tablet contains 500 mg of elemental calcium. Since the intestines may not be able to absorb more than 500 mg of calcium all at once, it is recommended to split the dose. Side effects are indigestion and constipation. Calcium citrate (Citracal) can be used instead of calcium carbonate supplements if these occur.
Certain medications can interfere with the absorption of calcium carbonate. Examples of such medications include proton-pump inhibitors such as omeprazole, lansoprazole, lansoprazole, and rabeprazole which are used in treating gastroesophageal reflux disease (GERD) or peptic ulcers. In this case, calcium citrate is preferred.
Natural calcium carbonate preparations such as oyster shells or bone meal, may contain high levels of lead or other harmful elements and should be avoided.

Vitamin D for Osteoporosis:

An adequate intake of calcium and vitamin D are important for maintaining bone density and strength. However, calcium and vitamin D alone are not sufficient to treat osteoporosis and should be given in conjunction with other treatments. Vitamin D helps the absorption of dietary calcium from the intestines. Along with adequate calcium it can increase bone density and decrease fractures in postmenopausal women. The lack of vitamin D alone can cause calcium deficiency in bone, which further weakens the bones and increases the risk of fractures.
Vitamin D can be obtained from the diet and the skin. On exposure to sunlight, vitamin D is produced by the skin.
The following Vitamin D intake are recommended  for all people without osteoporosis:

  •     800 IU/day for men and women over the age of 71
  •     600 IU/day for women in other age groups, men, and children
  •     400 IU/day for infants under 12 months

400 IU twice per day as the usual daily intake along with prescribed medications are recommended for people with osteoporosis. An average multivitamin tablet contains 400 IU of vitamin D. Vitamin D can also be obtained in combination with calcium in tablet forms, such as Caltrate 600 + D.
Excessive use of vitamin D can lead to toxic levels of vitamin D, elevated calcium levels in blood and urine, and may also cause kidney stones. Therefore it is important to review vitamin D content in dietary supplements before taking additional vitamin D.