Symptoms
Nonpharmacological management of osteoporosis includes adequate calcium and vitamin D intake, weight-bearing exercise, smoking cessation, limitation of alcohol/caffeine consumption, and fall-prevention techniques. 2 – 6, 9, 18, 34
Causes
While bisphosphonates are recommended as first-line PMO treatment options, the authors note that raloxifene should be considered for younger postmenopausal women with osteoporosis or with low BMD because it prevents bone loss and reduces risk of vertebral fractures. In addition, teriparatide is suggested for those at high risk for fracture.
Prevention
The American College of Physicians (ACP) recently published updated treatment guideline recommendations for men and women with low BMD and osteoporosis. For women, pharmacological treatment with alendronate, risedronate, zoledronic acid, or denosumab for five years is appropriate.
Complications
Which osteoporosis medications are usually tried first? Bisphosphonates are usually the first choice for osteoporosis treatment. These include: Ibandronate (Boniva), a monthly pill or quarterly intravenous (IV) infusion Another common osteoporosis medication is denosumab (Prolia, Xgeva).
What are the nonpharmacological treatment options for osteoporosis?
Should bisphosphonates be the first-line PMO treatment for osteoporosis?
What are the ACP treatment guidelines for osteoporosis and low BMD?
Which osteoporosis medications are usually tried first?
Can I have a tooth extracted while on Prolia?
Prolia has a side effect in patients who have to have tooth extractions performed. The trauma of the extraction on the bone surrounding the tooth may lead to a condition where the bone dies off, and following the extraction fragments of dead bone are lost from the extraction site.
Is an apicoectomy worth it?
Apicoectomy success rate Apicoectomies are considered routine outpatient dental procedures. A 2020 study found that about 97 percent of cases still experienced excellent results following apical surgery up to 5 years later, and good results in more than 75 percent of cases after 10 to 13 years.
How long do you have to be off Fosamax before tooth extraction?
These studies also suggest that stopping a bisphosphonate for 3 months prior to a procedure seems to reduce the incidence of osteonecrosis.
Does osteoporosis medication affect your teeth?
“The use of bisphosphonates, while excellent to strengthen your bones, can actually negatively influence your dental health,” says Ottawa dentist Dr. Pamela Li. “It can actually lead to something called osteonecrosis of the jaw, which causes serious damage to your jaw bone.”
How painful is an apicoectomy?
Most patients experience little-or-no discomfort during an apicoectomy. In fact, this procedure is often less invasive than the preceding root canal procedure, and involves a shorter and less painful recovery.
Does bone grow back after apicoectomy?
Post-Operative Apicoectomy Recovery You should probably be able to return to work the next day, but full healing will take up to two weeks. The bone of the jaw will take several months to grow back around the tooth.
What is the largest complication of teeth extraction in receiving bisphosphonate therapy?
The most common complication in patients on bisphosphonate therapy is osteonecrosis of jaw (ONJ) which can occur after any surgical dental procedure and the risk for the development of osteonecrosis of jaw is higher in patients receiving intravenous bisphosphonate therapy than in patients receiving oral bisphosphonate ...
Are osteoporosis drugs worth the risk?
For Most, Osteoporosis Treatment Benefits Outweigh Risks “When these drugs are used appropriately, they are safe as compared with many other things that we do in medicine. They will provide a lot more benefit than the risks that they pose,” he says.
What are the side effects of alendronate for osteoporosis?
Alendronate may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:nausea.stomach pain.constipation.diarrhea.gas.bloating or fullness in the stomach.change in ability to taste food.headache.More items...•
How do you slow down bone loss in teeth?
How to stop bone loss in teeth naturallyIncreasing your Calcium intake.Increasing your Vitamin D intake.Avoid smoking.Control your sugar intake.Take good care of your dental health.Visit your dentist on a regular basis.
Does osteoporosis make you tired?
Following a fracture, bones tend to heal within six to eight weeks but pain and other physical problems, such as pain and tiredness or fatigue, may continue.
What are the dangers of Prolia?
Serious side effects that have been reported with Prolia include:severe bone, joint, or muscle pain.serious infections, including serious urinary tract infections or skin infections.unusual fractures in the thigh bone*decreased bone production (bones take longer to form new tissue)More items...
Which Medications Are Commonly Used For Osteoporosis Treatment?
Bisphosphonates are the most common medications prescribed for osteoporosis treatment. These include: 1. Alendronate (Fosamax) 2. Risedronate (Acto...
How Do Most Osteoporosis Medications Work?
With the exception of teriparatide, osteoporosis medications slow bone breakdown. Healthy bones continuously break down and rebuild.As you age — es...
How Do You Know If You're Taking The Right bisphosphonate?
Drugs in the bisphosphonate class are more alike than they are different. They all help maintain bone density. And, all bisphosphonates have been s...
When Might Other Osteoporosis Medications Be used?
Drugs such as denosumab, teriparatide and abaloparatide can be used by anyone with osteoporosis, but are more likely to be recommended for people w...
What Are Common Side Effects of Bisphosphonate pills?
Bisphosphonate pills aren't absorbed well in the stomach. The main side effects of bisphosphonate pills are stomach upset and heartburn. Generic fo...
Do Intravenous Bisphosphonates Have Advantages Over The Pill form?
Infused forms of bisphosphonates don't cause stomach upset. And it may be easier for some women to schedule a quarterly or yearly infusion than to...
Can Bisphosphonates Hurt Your Bones?
Long-term bisphosphonate therapy has been linked to a rare problem in which the upper thighbone cracks and may break. This injury, known as atypica...
How Long Should You Take A Bisphosphonate For Osteoporosis Treatment?
There's some uncertainty about how long to take bisphosphonates because of a lack of long-term studies. Bisphosphonates have been shown to be safe...
What Happens If You Break A Bone While Taking An Osteoporosis medication?
Osteoporosis medications lower the chance of fracture, but they don't eliminate all risk of breaking a bone. If you have a fracture while on treatm...
Can Medication Alone Successfully Treat Osteoporosis?
Don't rely entirely on medication as the only treatment for your osteoporosis. These practices also are important: 1. Exercise. Weight-bearing phys...
What is the best treatment for osteoporosis?
If you can't tolerate the more common treatments for osteoporosis — or if they don't work well enough — your doctor might suggest trying: Teriparatide (Forteo). This powerful drug is similar to parathyroid hormone and stimulates new bone growth. It's given by daily injection under the skin.
How to reduce the risk of osteoporosis?
Smoking increases rates of bone loss and the chance of fracture. Avoid excessive alcohol. Consuming more than two alcoholic drinks a day might decrease bone formation.
What is the complication of bisphosphonates and denosumab?
A very rare complication of bisphosphonates and denosumab is a break or crack in the middle of the thighbone. A second rare complication is delayed healing of the jawbone (osteonecrosis of the jaw). This can occur after an invasive dental procedure such as removing a tooth.
How long can you take teriparatide for osteoporosis?
After two years of treatment with teriparatide, another osteoporosis drug is taken to maintain the new bone growth. Abaloparatide (Tymlos) is another drug similar to parathyroid hormone. You can take it for only two years, which will be followed by another osteoporosis medication. Romosozumab (Evenity).
What is the newest bone building medication?
Romosozumab (Evenity). This is the newest bone-building medication to treat osteoporosis. It is given as an injection every month at your doctor's office. It is limited to one year of treatment, followed by other osteoporosis medications.
How often is denosumab shot?
Denosumab is delivered via a shot under the skin every six months. If you take denosumab, you might have to continue to do so indefinitely.
What are the side effects of bisphosphonates?
Examples include: Side effects include nausea, abdominal pain and heartburn-like symptoms. These are less likely to occur if the medicine is taken properly.
What is the best way to treat osteoporosis?
Osteoporosis care program. Remember that exercise is an important part of osteoporosis care, but it is just one component of that care. Additionally you need to be certain you get enough dietary calcium, take a vitamin D supplement and practice fall prevention.
How to keep your body upright during osteoporosis?
Osteoporosis Exercises. These exercises strengthen the muscles needed to keep you upright. and improve balance. Aim for eight to 12 repetitions of each exercise. Hip extension: While holding onto the back of a chair for balance, slowly raise your right leg straight out behind you.
What are some exercises to help with osteoporosis?
An exercise program for osteoporosis should include four components: Weight-bearing exercises force your body to work against gravity, which helps to strengthen bones. Examples include walking, climbing stairs, playing tennis, and dancing.
How to keep your joints mobile?
Flexibility exercises keep your muscles limber and joints mobile. They include yoga and stretching. Try to stretch for at least five to 10 minutes after every workout. Hold each stretch for 10 to 30 seconds.
How to prevent falls?
Do these types of exercises at least twice a week. Balance exercises improve your ability to hold yourself upright and help prevent falls. Examples include tai chi and yoga. Perform balance exercises at least twice a week. Flexibility exercises keep your muscles limber and joints mobile. They include yoga and stretching.
How does exercise reduce the risk of fractures?
Exercise reduces your risk not only of falling, but also of fracturing a bone if you do fall. An analysis published in BMJ found that programs of balance, strength, and resistance training reduced the odds of falls resulting in fractures by more than 60%.
What to do if you have broken bones in your spine?
If you've already broken bones in the spine, avoid activities in which you bend forward, reach down, twist, or lift heavy weights. Ask your doctor if you need to be aware of any other physical limitations based on your bone strength and general health.
Abstract
Approximately 10 million men and women in the U.S. have osteoporosis, 1 a metabolic bone disease characterized by low bone density and deterioration of bone architecture that increase the risk of fractures. 2 Osteoporosis-related fractures can increase pain, disability, nursing home placement, total health care costs, and mortality.
INTRODUCTION
Osteoporosis is a bone disorder that increases a person’s risk of fracture due to low bone mineral density (BMD), impaired bone microarchitecture/mineralization, and/or decreased bone strength.
PATHOPHYSIOLOGY
Bones provide structure for the body, protection for the organs, and storage for minerals, such as calcium and phosphorus, that are essential for bone development and stability. Individuals continue to build bone and will reach peak bone mass at about 30 years of age, after which they begin to lose bone mass steadily.
ETIOLOGY
Primary osteoporosis is often associated with age and sex hormone deficiency. Age-related osteoporosis results from the continuous deterioration of the trabeculae in bone. In addition, the reduction of estrogen production in post menopausal women causes a significant increase in bone loss.
SCREENING AND DIAGNOSIS
Published osteoporosis screening guidelines vary greatly. In general, most organizations recommend that all adults older than 50 years of age with a history of fracture receive BMD screening.
SELECT GUIDELINES AND RECOMMENDATIONS
In a systematic review, Solomon et al. looked at 18 osteoporosis guidelines, among them those of the NOF, the ACR, and the American Association of Clinical Endocrinologists and American College of Endocrinology (AACE/ACE).
NONPHARMACOLOGICAL MANAGEMENT
Nonpharmacological management of osteoporosis includes adequate calcium and vitamin D intake, weight-bearing exercise, smoking cessation, limitation of alcohol/caffeine consumption, and fall-prevention techniques. 2 – 6, 9, 18, 34
How does Reclast work?
Reclast is a brand name for the generic drug zoledronic acid. It belongs to a class of osteoporosis treatments known as bisphosphonates, which help decrease bone turnover.
How does Prolia work?
Prolia is the brand name for the generic drug denosumab. It inhibits a protein called RANKL. The cells responsible for breaking down bone need RANKL in order to work and survive. By keeping RANKL from binding to its receptor, Prolia limits the ability of these cells to break down bone.
Which works better for osteoporosis?
Both Reclast and Prolia are powerful osteoporosis medications. In a small study with 107 participants, people who received Prolia and those who got Reclast saw similar improvements in their bone mineral density (BMD), a measure of bone health.
How are Reclast and Prolia taken?
There are some key differences in terms of how you take these medications. Reclast is infused into your veins for at least 15 minutes. How often you get this infusion will depend on the reason you’re taking Reclast:
What are common side effects of Reclast and Prolia?
While there are some differences between the two medications as far as side effects and warnings go, there are also several similarities.
Who should not take Reclast or Prolia?
If you are pregnant, you shouldn’t take Prolia at all. Similarly, the manufacturer of Reclast recommends stopping Reclast if you become pregnant.
Do Reclast or Prolia cause drug interactions?
Prolia doesn’t carry much risk of drug interactions, but Reclast has a few known drug interactions:
What is the International Task Force on Osteonecrosis of the Jaw?
In response to concern about jaw necrosis, 14 professional organizations of dentists, physicians, and bone scientists formed the International Task Force on Osteonecrosis of the Jaw. The task force reviewed all the research on that condition published from 2003 to 2014.
How long does bisphosphonate treatment last?
Risk of jaw necrosis and atypical thigh fracture is lower when use of bisphosphonates is limited. For most women, bisphosphonate treatment ends after five years of oral therapy or after three annual intra-venous infusions of zolendronate. However, the drugs' effects remain for several years after therapy is discontinued.
What age should I get a dexa scan?
A DEXA scan is recommended for women ages 65 or older and for women ages 50 or older who have broken a bone recently . (At least 50% of women who have a hip fracture have already broken another bone.) Your doctor may also recommend a DEXA scan if you smoke, consume an average of three or more alcoholic drinks a day, have a low body mass index (BMI), ...
How to reduce risk of tooth loss?
You can further reduce your risk through vigilant dental care. Brush twice a day, floss daily, and have regular dental cleanings. To further minimize risk, choose the least invasive dental procedures possible—a root canal instead of an extraction, or a bridge instead of an implant.
Does zoledronate reduce hip fractures?
For example, taking zoledronate or denosumab can decrease the risk of hip fractures by 40% and spine fractures by about 70% . For women with low bone density, alendronate is associated with a reduction of about 50% for hip and spine fractures and 23% for wrist, ankle, and other bone fractures. (See "Effectiveness of common osteoporosis medications.")
Can you take bisphosphonate with low bone density?
If you have low bone density and are debating whether to take a bisphosphonate, you may consider the following: Osteoporotic fractures can be debilitating. If you accumulate several vertebral fractures, you may lose height, develop a hump, and have less room for your abdominal organs.
Is osteoporosis a common disease?
Osteoporosis is a common disease and fragil ity fractures increase dramatically with age. "The occurrence of a fracture can be devastating, and women can benefit from the effective therapies that markedly reduce their risk of osteoporotic fractures.
What is the ultimate goal of osteoporosis?
The ultimate goal is to maintain your independence and stay fracture free. There is more to bone health than a high DEXA score. Your exercise and nutrition program should also address fall prevention strategies, balance, posture and other important areas. Osteoporosis Diet and Exercise.
What does osteoporosis mean?
Osteoporosis is a term given to indicate a loss of bone mineral density. It is easier to prevent the condition than it is to treat it. However, if your DEXA results indicate that your bone mineral density scores are in the osteoporosis range, there are a number of important considerations to keep in mind.
What happens if you sit on the edge of osteoporosis?
If you are sitting on the edge of osteoporosis (-2.5 to -2.9), you could move into osteopenia territory with the right combination of exercise and diet. Technically, if you have increased you bone density to the point where your new score indicates you have osteopenia, you have “reversed osteoporosis”.
How does exercise improve bone quality?
Exercise has been shown to improve bone quality by altering bone geometry and morphology. While bone density is important and can be easily measured and tracked, it is bone quality that we would like to see improve. Unfortunately, bone quality tests are not easily accessible.
How much bone did the control group lose in the hip?
The women in the control group lost an average 4% bone in the hip. The women in the exercise group gained almost 2% bone in the hip. One could argue that had the exercise group not followed the prescribed exercise routine, they would have lost 2% bone in much the same way as the control group did.
How to build bone mass?
Your best chance to build and maintain your peak bone mass is if you start vigorous and regular exercise before or when you achieve your peak bone mass.
Does pharmaceutical intervention increase bone density?
In the meantime, pharmaceutical intervention may be a reasonable option to consider. Having said that, pharmaceutical intervention (s) may increase your bone density but do not improve the quality of your bone. Another important fact is that pharmaceuticals do not reduce your risk of falling or your quality of life.
What are the benefits of each medication?
Prolia is the brand name for the generic medication denosumab. In the body, Prolia blocks RANKL, a protein that’s important for the cells that break down bone. Prolia keeps RANKL from binding to its receptor, which prevents these cells from breaking down bone.
Which works better for osteoporosis treatment?
Each of these three options can be effective for treating osteoporosis, but there are slight differences between who they treat and how you take them.
How do I take these medications?
Prolia dosing is straightforward. It comes as a shot, and you get 1 injection under your skin every 6 months.
Can I take these medications together?
There is no reason to take two bisphosphonates together, so you will never need to take Fosamax and Boniva at the same time. Doing so could increase your risk of side effects and pose a safety risk.
Are there any other osteoporosis treatment options?
As mentioned before, there are many osteoporosis medications. Here are a few alternatives that may be options for you.
What else should I know about these medications?
Many people with osteoporosis also have low levels of vitamin D and calcium. Your healthcare provider may recommend taking vitamin D and calcium supplements to improve your bone health. If you are taking Fosamax, Boniva, or any other bisphosphonates, remember to wait 30 minutes to 1 hour after taking your medication before taking the supplement.
The bottom line
Fosamax, Prolia, and Boniva are all effective osteoporosis treatments since each one can help lower your risk of fractures. Each also comes with its own risk of side effects. You and your healthcare provider should consider your specific situation to weigh the benefits and risks of each option.
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