This undated article was downloaded from http://orthohelp.com/osteoprx.htm in 2003, and appears to have been written about 1997. Dr. Malka retired in 2000. -DAB
 

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The topic of treating osteoporosis is confusing and frequently controversial. I will try to explain in these pages what modalities are available for physicians to treat and prevent this condition and what the pros and cons for each might be.

Before reading this page I believe it will be helpful to first read the page explaining what osteoporosis is. Just click on the word osteoporosis to go there. You can then press the "back" button on your browser to return here.

EXERCISE

In the page about osteoporosis and bone remodelling I explained how bones in our skeleton respond by increasing bone mass or losing bone mass in response to the stresses or lack of stresses placed on these bones. It is therefore easy to find that if we exercise, and therefore put stress demands on our skeleton, the bones respond by increasing their bone mass. Similarly, if we never exercise the bones weaken in response to the lack of stress.

If the bones lose bone mass they weaken and become more prone to break easily. This is a particularly serious problem in astronauts. Because of the lack of gravity and weightlessness in spaceships, the astronauts' skeletons are not even stressed by body weight and become very osteoporotic. The astronauts therefore exercise with weights to keep this to a minimum but the bone loss remains a problem for some time after returning to earth.

I give these examples to point our graphically the tremendous importance of exercise in fighting osteoporosis. Maintaining a good exercise program not only has cardio-vascular benefits but also helps maintain bone mass and develops muscle tone which itself makes a person less likely to fall and break something.

CALCIUM & VITAMIN D

We know that an important ingredient of bone is calcium. It is therefore not surprising that we need to maintain an adequate diet supply of calcium. Because so many of us reduce our dairy products intake in adulthood our supply of calcium from food alone tends to become less than what the body needs. Also many adults become somewhat lactose intolerant with advancing age further decreasing our calcium intake.

Because of the inadequate intake of calcium in the average american diet it becomes necessary to supplement this intake with calcium pills. The usual recommendation is to take 1 -1.5 grams (1,000-1,500mg) of supplemental calcium (element) a day. Although there some minor differences between one type of calcium vs another, by far the most important is to maintain an adequate intake of calcium of some type.

The body needs an adequate supply of Vitamin D to be able to absorb the calcium and use it in the body. There are many sources of vitamin D, including sunshine, but it is probably a good idea to add Vit D to the calcium pills. The recommended doses of Vit D vary between 400 IU to 800 IU a day but there is some evidence that 400 may not be very effective. Most physicians would think it reasonable to recommend calcium and Vit D supplements to women about 5 years after menopause and I agree that, barring contra-indications such as kidney stones, that is a good thing to do. A simple multivitamin pill a day (containing Vit D) provides adquate Vit D for most women.

ESTROGEN REPLACEMENT

This is such an important and sensitive subject that I discuss it separately on another page. Click here to go there.

PHOSPHONATES

We are talking here primarily of a new drug called Fosomax (alendronate). This new medicine is much more effective than the older version, Didronel, and has been shown to definitely reduce the loss of bone mass and thus actually reverse the effects of osteoporosis. In one study bone mass increased by 5-7% after using Fosomax for 2 years.

Fosomax, however is not "the solution" to osteoporosis. Many women have gastric intolerance to it (diarrhea) and it needs to be taken 1 hour before eating, a somewhat inconvenient feature. Also we do not know yet the possible effects of Fosomax accumulating in bones for years. Today it is recommended primarily for women who cannot take estrogen and calcium and who have objective evidence of osteoporosis.

CONCLUSION

--Everyone should exercise to maintain bone mass, especially after menopause.
--1,000-1,500 mg of calcium supplements a day (with Vit D) in women 5 years after menopause.
--Estrogen-Progestin replacement therapy 5 years after menopause, unless there are risk factors for breast cancer.
--Fosomax is reserved for special cases that cannot take estrogens and have evidence of osteoporosis.

Related Topics.

Osteoporosis
Modern Treatment of Osteoporosis
Calcium content of foods

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