Treatment

Treatment overview

Although a diagnosis of osteoporosis is based on the results of your bone mineral density scan (DEXA or DXA scan) , the decision about what treatment you need if any is also based on a number of other factors. These include your:

• age
• sex
• risk of fracture
• previous injury history

If you've been diagnosed with osteoporosis because you've had a fracture, you should still receive treatment to try to reduce your risk of further fractures.

You may not need or want to take medication to treat osteoporosis. However, you should ensure you're maintaining sufficientlevels of calcium and vitamin D . To achieve this, your healthcare team will ask you about your diet and may recommend making changes or taking supplements.

NICE recommendations

The National Institute for Health and Care Excellence (NICE)has made some recommendations about who should be treated with medication for osteoporosis.

Anumber of factors are taken into consideration before deciding which medication to use. These include your:

• age
• bone mineral density (measured by your T score)
• risk factors for fracture

NICE has summarised its guidance for two groups of people:

• postmenopausal women with osteoporosis who haven't had a fracture (primary prevention)
• postmenopausal women with osteoporosis who have had a fracture (secondary prevention)

You can read the NICE guidance by clicking on the links below.

• NICE guidance : Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragilityfractures in postmenopausal women
• NICE guidance : Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women

Medication for osteoporosis

Anumber of different medications are used to treat osteoporosis. Your doctor will discuss the treatments available andmake sure the medicines are right for you.

Bisphosphonates

Bisphosphonates slow down the rate at which bone is broken down in your body. This maintains bone density and reduces the risk of fracture.

There are a number of different bisphosphonates, including

• alendronate
• etidronate
• ibandronate
• risedronate
• zolendronic acid

They're given as a tablet orinjection.

You should always take bisphosphonateson an empty stomach with a full glass of water. Stand or sit upright for 30 minutes after taking them. You'll also need to wait between 30 minutes and two hours before eating food or drinking any other fluids.

Bisphosphonates usually take 6 to 12 months to work and you may need to take themfor five years orlonger. You may also be prescribed calcium and vitamin D supplements to take at a different time to the bisphosphonate.

The main side effects associated with bisphosphonates include:

• irritation to the oesophagus (the tube that food passes through from the mouth to the stomach)
• swallowing problems (dysphagia)
• stomach pain

Not everyone will experience these side effects.

Osteonecrosis of the jaw is arare side effect that's linked with the use of bisphosphonates, althoughmost frequently with high-dose intravenous bisphosphonate treatment for cancer and not for osteoporosis.

Inosteonecrosis, the cells in the jaw bone die, which can lead to problems with healing. If you have a history of dental problems, you may need a check-up before you start treatment with bisphosphonates. Speak to your doctor if you have any concerns.

Strontium ranelate

Strontium ranelate appears to have an effect on both the cellsthat break down bone and the cellsthat create new bone (osteoblasts).

It can be used as an alternative treatment if bisphosphonates are unsuitable. Strontium ranelate is taken as a powder dissolved in water.

The main side effects of strontium ranelate are nausea and diarrhoea . A few people have reported a rare severe allergic reaction to the treatment. If you develop a skin rash while taking strontium ralenate, stop taking it and speak to your doctor immediately.

Selective oestrogen receptor modulators (SERMs)

SERMs are medications that have a similar effect on bone as the hormone oestrogen. They help to maintain bone density and reduce the risk of fracture, particularly of the spine.

Raloxifene is the only typeof SERM that's available for treating osteoporosis. It's taken as a tablet every day.

Side effects associated with raloxifene include:

• hot flushes
• leg cramps
• a potential increased risk of blood clots

Parathyroid hormone (teriparatide)

Parathyroid hormone is produced naturally in the body.It regulates the amount of calcium in bone.

Parathyroid hormone treatments (human recombinant parathyroid hormone or teriparatide) are used to stimulate cells that create new bone (osteoblasts). They're given by injection.

Whileother medicationcan only slow down the rate of bone thinning, parathyroid hormone can increase bone density. However, it's only used in a small number of people whose bone density is very low and when other treatments aren't working.

Nausea and vomiting are common side effects of the treatment. Parathyroid hormone treatments should only be prescribed by a specialist.

Calcium and vitamin D supplements

Calcium is the major mineral found in bone, and having enough calcium as part of a healthy, balanced diet is important for maintaining healthy bones .

For most healthy adults, the recommended amount of calcium is 700 milligrams (mg) of calcium a day, which most people should be able to get from a varied diet that contains good sources of calcium .

However, if you have osteoporosis you may need more calcium, which will usually be in the form of supplements. Ask your GP for advice about taking calcium supplements.

Vitamin D is needed to help the body absorb calcium.All adultsshould consume 10 micrograms (mcg) of vitamin D a day.

Because vitamin D is found only in a small number of foods, it might be difficult to get enough from foods that naturally contain vitamin D and/or fortified foods alone. Soall adultsshould consider taking a daily supplement containing 10mcg of vitamin D.

For more information, read about who should take vitamin D supplements .

Hormone replacement therapy (HRT)

HRT is sometimes recommended for women who are experiencing the breast cancer , endometrial cancer , ovarian cancer , stroke and venous thromboembolism more than it lowers the risk of osteoporosis.

Discuss the benefits and risks of HRT with your GP.

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Testosterone treatment

In men, testosterone treatment can be useful when osteoporosis is caused by insufficient production of male sex hormones (hypogonadism).