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What is the best treatment for osteoporosis?

What is the best treatment for osteoporosis?

 There is no single treatment for osteoporosis, says the National Institute for Clinical Excellence (NICE). Instead, those with osteoporosis must take a two-pronged approach to treat the condition. Alongside prescription drugs, Patients must make lifestyle changes that can strengthen bones and reduce the risk of falls and fractures. 

 In this article, we describe the NHS-approved strategies and treatments available for osteoporosis. We also provide information on the benefits and impact of Low-intensity vibration for those with osteoporosis.

What treatments are available for osteoporosis?

 Osteoporosis is a progressive condition characterised by low bone mineral density (BMD) and a deterioration of bone tissue. Over time, bones lose their strength, leading to an increased risk of fractures and falls.  The condition is most common in postmenopausal women, those aged over 50 and people who have taken corticosteroids for long periods. 

 Once osteoporosis has been diagnosed, medical professionals recommend two ways to treat the condition. “A combination of lifestyle changes and drug treatment aims to prevent fragility fractures in patients with osteoporosis,” says NICE in its guidelines. 

 Current treatments aim to maintain and improve bone density. Together, lifestyle changes and long-term prescription medications can stop bone loss and help the body to produce more bone. However, there are side effects associated with the long-term use of prescription medications.

Lifestyle changes 

While the causes of osteoporosis are complex, the lifestyle you lead and your overall physical health impact your body’s ability to create new bone. Lifestyle changes proposed by the NHS aim to improve your body’s ability to build bone. 

 The NICE guidelines recommend that every patient with a confirmed diagnosis does five things: 

  1.  Increases physical activity
  2. Stops smoking 
  3. Maintains a healthy weight
  4. Reduces drinking
  5. Takes supplements (if necessary)

 Let’s look at these in greater detail.

Increase physical activity

 Regularly exercising is crucial at maintaining your freedom, strength and flexibility, says NICE. While you’re unlikely to be running a marathon, you don’t need to. Instead, simply getting out and about every day can work wonders for your wellbeing.

 On its Exercises for health bones page, the NHS provides some ideas. For those who remain active, they recommend:

  • walking
  • lifting weights or using resistance bands
  • some impact activities like running, jumping or skipping

 If you’re currently not very active, the NHS recommends less intensive activities, including:  

  •  walking
  • stair climbing
  • strength exercises at home

 Any time you’re out and about, whether it’s gardening, walking to the shops, swimming or cycling, you’re helping your body.

 Avoid excessive amounts of exercise. Instead, the NHS says, focus on getting your body moving and blood pumping at least once a day, preferably for 30 minutes. 

Stop smoking 

 Smoking can have a significant impact on your health and wellbeing. A leading cause of several forms of cancer, smoking can also damage your bones, so every patient with a confirmed diagnosis of osteoporosis is encouraged to quit. 

 The NHS offers support packages for anyone of any age that wants to quit. Learn more here. 

Maintain a healthy weight

 NICE recommends that those with osteoporosis maintain a healthy weight, with a BMI between 20-25. You can use the NHS BMI calculator to get your reading. 

 Being overweight and underweight can put a strain on your body, so losing weight (or gaining it) can help your bone health and over physical wellbeing. 

 The NHS has developed its own 12-week weight loss plan that helps you lose weight in a slow and (hopefully) sustainable way. You should avoid putting stress on your body and your bones by crash dieting, instead focus on making long-term changes to your diet that stick.

 As well as losing weight, it’s crucial to eat a balanced diet that’s rich in vitamins and minerals. Make sure you’re getting enough calcium and protein as well. 

 “The safest strategy is eating a diet that’s low in salt and rich in fresh and minimally processed whole grains, fruits and vegetables,” say the experts at WebMD, and we agree.

Reduce your drinking

 Excessive alcohol intake can harm bone health, cautions NICE. While you can continue to enjoy a drink while living with osteoporosis, you should follow the NHS guidelines for men and women to consume no more than 14 units per week. 

 You should spread your drinking over several days, with drink-free days punctuating the week. 

 If you’re having trouble cutting down, speak to your doctor or get help from a charity like Alcohol Change

Take supplements (if necessary)

 “Patients at risk of osteoporosis should also ensure an adequate intake of calcium and vitamin D. Calcium should preferably be obtained through increasing dietary intake,” says NICE. 

The health body recognises how challenging it may be for those with life-limiting conditions such as osteoporosis to get enough vitamin D and recommends that, “A daily dietary supplement of vitamin D may be considered for those at increased risk of deficiency.”

 As well as vitamin D supplements, patients with osteoporosis may benefit from supplements containing calcium, magnesium and Omega-3.

 There is little risk in taking supplements. The costs are low and there are likely to be no side effects, even with long-term use. 

Drug treatments

The treatment you receive depends on the type of osteoporosis you have and your gender says NICE. Most patients are prescribed bisphosphonates, a drug designed to help strengthen bones, reducing the risk of breaks and fractures. 

 In most cases, bisphosphonates are taken orally with a glass of water. After taking them, you’ll need to avoid eating for at least 30 minutes and remain upright to prevent heartburn. 

 Digestive problems are the most likely side effect of bisphosphonates, but others can include:

  • itchy rashes or photosensitivity (rash on exposure to sunlight)
  • a sore mouth
  • flu-like symptoms (more common with intravenous treatment)
  • bone pain (more common with intravenous treatments)
  • muscle pain
  • headaches 

Postmenopausal osteoporosis

“Oral bisphosphonates alendronic acid and risedronate sodium are considered as first-line options for most patients with postmenopausal osteoporosis,” says NICE. 

 In some cases, younger women may be prescribed hormone replacement therapy (HRT). The drugs teriparatide and romosozumab may be prescribed to postmenopausal women with severe osteoporosis at very high risk of fractures, (particularly in the back). 

Glucocorticoid-induced osteoporosis

“Glucocorticoid treatment is strongly associated with bone loss and increased risk of fractures,” says NICE. Long-term use can lead patients to suffer from severe bone loss and require bone protection treatments. 

 Those most likely to receive bone protection treatments are men and women aged over 70 years who have experienced a fragility fracture or have been taking glucocorticoids for long periods of time. 

 Bone protection treatments may be prescribed for others if it’s medically beneficial, say the guidelines.

Osteoporosis in men

 “The oral bisphosphonates alendronic acid or risedronate sodium are recommended as first-line treatments for osteoporosis in men,” recommends NICE.

As with the other groups, if men are resistant to bisphosphonates, Zoledronic acid or denosumab may be prescribed as alternatives. (teriparatide or strontium ranelate are also available as options for doctors).

How long can I take medications for osteoporosis?

 Over time, the benefits of bisphosphonates may lessen, so your doctor may advise that you stop taking them for a period. 

 If you are prescribed bisphosphonates for osteoporosis, this will be reviewed after 5 years. (If you’re prescribed zoledronic acid, your prescription will be reviewed every 3 years).

 During the review, your doctor will assess whether the treatment is working and whether it is still of benefit. While you may be prescribed a course of bisphosphonates again, there is “no evidence for treatment beyond 10 years,” says NICE. Instead, “management of these patients should be on a case-by-case basis with specialist input as appropriate.”

 Health professionals are cautious about long-term use as the bisphosphonates can have a significant impact on health. “Long-term (use of bisphosphonates) can cause osteonecrosis jaw, esophageal cancer, atrial fibrillation and increase the risk of atypical fractures and probably adynamic bone disease,” researchers found. 

 Low-intensity Vibration (LiV)

 People across the world are beginning to understand the positive impact that low-intensity vibration can have in treating osteoporosis. A growing body of evidence and anecdotal testimony from users, has shown the positive impact it can have on improving bone strength.

 Low-intensity vibration devices, such as Marodyne LiV, work by delivering highly-targeted vibrations through your body. The vibrations encourage your bones to grow while halting bone loss.

 Learn more about the positive benefits of LiV, including how Low-intensity Vibration can help you build bone in our detailed insight section. 

Long-term management of osteoporosis

 There is no cure for osteoporosis, but the condition can be managed using a combination of lifestyle changes, medical treatments and beneficial therapies such as LiV.

 A diagnosis of osteoporosis isn’t the end, say scientists. “The average life expectancy of osteoporosis patients is in excess of 15 years in women younger than 75 years and in men younger than 60 years,” scientists have found. 

 A long-term treatment osteoporosis management plan must be developed for every patient. The program includes short-term lifestyle changes (stopping smoking, cutting alcohol and improving your diet) and longer-term aims such as losing weight. 

Alongside lifestyle changes, treatment with bisphosphonates can help maintain bone strength and density, helping you live an independent life for longer.

So, what is the best treatment for osteoporosis?

 Treating osteoporosis isn’t as simple as taking a drug; it involves changes to your lifestyle too. In addition, long-term use of medication can also come with side effects. 

 If you are diagnosed with osteoporosis, your doctor will work with you to develop a treatment plan and suggest lifestyle changes to improve your bone health. If you follow their advice, you can make a positive difference to your bone health. 

 Combining these with LiV can help you fight back against osteoporosis and maintain your freedom and flexibility for longer.

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