How is osteoporosis treated?

Once the diagnosis has been made several steps may be taken.

Established osteoporosis

after fracture -
Bed rest with analgesia in conjunction with early mobilisation and physiotherapy is the best way of rehabilitating those affected. Calcitonin may also be given as this relieves bone pain, and acts to stimulate the formation of bone.

to restore bone mass -
Research suggests that it is difficult to restore bone mass when it has been lost, however some agents are used:

• Calcium - used to restore the inorganic part of the bone mass. This has been shown to be of limited use in treatment.
• Hormone Replacement Therapy (HRT) - for women, oestrogen has been shown to increase bone mass by up to 4% in post-menopausal women with established osteoarthritis. This must be taken with progesterone if the uterus is intact, as oestrogen alone can increase the risk of endometrial cancer. In men with hypogonadism, replacement of the lost testosterone can also improve osteoporosis.
• Bisphosphonates - these are drugs that stimulate bone formation and inhibit resorption. Alendronate is the best example of this class of drugs and has been shown to increase bone mass by about 8% over three years. It can cause irritation to the gastrointestinal tract and is not well absorbed.
• Calcitonin - the drug actually used is salcatonin, the salmon variety of this hormone! This is used as it is more potent than the human form. It can improve bone mass by up to 4%. As mentioned previously, it also has analgesic properties, relieving pain especially for vertebral fractures.

For secondary osteoporosis
If the osteoporosis is secondary to a disease process then reviewing the management of that condition to lessen the chances of further damage to the bones may be done. Control of the underlying disorder will control the osteoporosis and the medications outlined above may be used to try and restore bone mass.

Similarly if the osteoporosis is due to medication then the doses used may be altered in an attempt to slow down the osteoporotic change. Indeed, those on long term glucocorticoids should be given calcium and vitamin D supplements to counteract the bone resorption stimulated by these medications.