Osteoporosis II – Prevention and Treatment

If you have a medical problem, or something is bothering you or a member of your family, The Jackson County Times now has a local physician, Dr. John Spence, of the Panhandle Family Care Associates available to respond to your questions via e-mail.


Previously, I commented on the diagnosis and potential courses of both osteoporosis and osteopenia. This installment focuses more on actual prevention and treatment options for those patients so affected.
Calcium has long been recommended for prevention of osteoporosis. Doses of at least 1200 mg per day have been suggested, but effectiveness at reducing fractures is unclear. Calcium carbonate is inexpensive but should be taken with meals to enhance absorption. Calcium citrate, though more expensive, can be taken without food. Commonly, dosing may be limited by constipation or stomach issues. Absorption can be impaired when used in conjunction with thyroid medications, blood pressures medications (specifically ACE inhibitors like lisinopril) or iron, and dosing should be separated by several hours at a minimum.
Vitamin D is critical, as I have mentioned in previous articles. Doses of 800-1000 IU per day are needed. The number needed to treat to prevent one hip fracture is 45 over 2-5 years of treatment. Given its benefit at potentially decreasing risk of stroke and certain cancers, there is no reason that patients should not supplement. This is one of the few supplements that I take personally!
For the most part, therapy revolves around a group of medications known as the bisphosphonates. Included in the class are fosamax, boniva and actonel. These medications inhibit bone turnover and therefore increase bone mineral density and strength. Trials demonstrate a reduction in spine and hip fractures with both actonel and fosamax. The number needed to treat over three years to prevent one fracture is 91 for fosamax and 79 for actonel. Despite weekly and monthly dosing schedules that are now available, noncompliance remains an issue with many patients stopping the medication entirely. Problems surround use of bisphosphonates in that they can cause significant problems with heartburn and esophageal symptoms. They must be taken with a full glass of water and patients must remain upright for at least 30-60 minutes after dosing. A newer option is once yearly intravenous infusion with reclast. Many patients like the convenience of once a year administration and the decreased likelihood of side effects. Cost can be problematic, but we have found that any patient with medicare and a supplemental insurance (i.e. AARP) will have near complete 100% coverage.
Concern has arisen over the potential for destruction of bone at the jaw. The complication is rare and has generally only been noted after intravenous use in patients diagnosed with cancer.
Other medications exist as far as treatment goes, but they are less commonly used and not worth discussing given constraints of space and for fear of completely losing any or all readership I may have secondary to boredom. What about hormones like estrogen? The Women’s Health Initiative trial did report that estrogen did reduce the risk of vertebral and hip fractures with a number needed to treat of 385 over five years. The benefits, however, do not outweigh the risks of estrogen therapy which include increased likelihood of breast cancer, stroke and heart disease. Generally, I do not recommend hormone therapy for treatment of osteoporosis unless the patient has compelling reasons to do so, like horrible hot flashes.
Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at scripna@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.