Treatment

Regardless of Your T- score, there are steps that can help prevent osteoporosis and fractures:

Exercise — bones are stronger when stressed. Individuals who are bedridden or do not exercise are at high risk for osteoporosis. You should exercise at least 2 1/2 hours every week. Weight bearing or muscle strengthening exercises are best. (jogging, biking, elliptical, walking and aerobics, lifting weights, Pilates and yoga.)

Calcium and Vitamin D — calcium helps build strong bones and vitamin D is necessary to absorb calcium. The National Osteoporosis Foundation recommends calcium and vitamin D as follows:

Adults under age 50

• 1000 mg of calcium and
• 400-800 IU of vitamin D every day

Adults age 50 and over

• 1200 mg of calcium and
• 800 to 1000 IU of vitamin E every day

OSTEOPOROSIS MEDICINE

People with normal bone density (T-scores of -1 and above) do not need to take an osteoporosis medicine.

People with low bone density or osteopenia (T-scores of -1 to -2.5) with certain risk factors on the FRAX screen for fracture risk should consider an osteoporosis medicine. The NOF recommends that individuals with a FRAX risk of hip fracture >3% or of any major osteoporotic fracture > 20% should consider treatment.

All people with osteoporosis (T scores of -2.5 and below) or broken bones in the spine or hip should consider taking an osteoporosis medicine.

Bisphosphate

Alendronate (Fosamax), Risedronate (Actonel), and Ibandronate (Boniva), may reduce the incidence of spine fracture by about 50%. These medications may be taken by mouth but there are strict dosing requirements. Individuals must take the medicine on an empty stomach and not eat or drink for 30 to 60 minutes while remaining upright. Occasional headache has been reported.

Intravenous Bisphosphates

Administered over 15 to 30 seconds every three months (Ibandronate- Boniva) or over 15 minutes once yearly (Zolendronic acid- Reclast). This does not require the restrictions after doing noted above.

Selective Estrogen Receptor Modulator (SERM)

Raloxifen (Evista)- Once daily pills by mouth. This medication can not be taken by premenopausal women.

Hormone

Teriparatide (Forteo)- Human parathyroid hormone.  Once daily injection for hypogonadal osteoporosis or those with sustained glucocorticoid therapy.

Calcitonin- Salmon (Miacalcin)- for post menopausal osteoporosis.  One spray in alternating nostrils daily.

Osteoclast Inhibitor

Denosumab (Prolia)- for patients with high risk of fracture.  Administered with an injection once every six months.

May require failure of bisphosphates for insurance approval.

Physical Therapy

May assist with fall prevention and maintenance exercise programs.