Treatment plans are tailored to your needs and may include medications to preserve bone health and/or making changes to your lifestyle to prevent bone loss.
Your doctor will discuss some behavioural changes you can make to help preserve or increase your bone strength and slow down the process of bone loss.
These may include changes to your:
Physical activity – Exercise is important to keep bones strong and maintain bone density. Exercise also increases muscle strength and improves balance, which are important to avoid falls and fractures. General recommendations for exercise include some weight-bearing exercise (e.g. walking), resistance training (e.g. weights) and exercises that improve balance (e.g. tai chi, gentle yoga). The type of exercise should be tailored to your individual needs and abilities; and discussing a new exercise program with your doctor, accredited exercise physiologist or physiotherapist is a great idea.
Diet – Including 3 serves of calcium-containing foods every day will help you get enough calcium in your diet. Dairy foods are the best source of calcium and are also an excellent source of protein. Other foods like sardines and bony fish also contain some calcium. Calcium supplementation may be necessary to help you reach the recommended daily intake (1000mg for most adults;1300mg for women over 50 years and men over 70 years). However, once an adequate calcium intake is achieved, there is little additional benefit to bone health.
For more information about the calcium content of foods, see the calcium fact sheet on the Osteoporosis Australia website.
Sun exposure/Vitamin D – For most Australians, the main source of vitamin D is from exposure of the skin to sunlight. However, it is important to balance the need for sunlight for vitamin D against the risk of sun damage to our skin. Vitamin D helps the body absorb calcium. The amount of time in the sun needed to make enough Vitamin D depends on where you live, the season, and your skin type. Your doctor may check your Vitamin D level and may recommend a supplement if levels are too low.
Smoking – People who don’t smoke have higher bone density than those who do. Quitting smoking can help improve your bone density.
Alcohol intake – Reducing your alcohol intake to recommended levels for good health can help bone health.
The purpose of medication is reduce the risk of fractures. This can happen through two possible approaches:
- slowing down bone loss to preserve existing bone mass (most medications currently prescribed for osteoporosis work through this mechanism)
- building more bone (currently in Australia this approach is limited to people with very severe osteoporosis)
A number of medications are available, and your doctor will discuss the options with you so you can choose one that best suits your situation.
In general, most medication prescribed for osteoporosis approximately halves the risk of a minimal trauma fracture compared with not taking any medication.
The different groups of medications include:
Bisphosphonates – These can be taken as an oral tablet (weekly or monthly) or by an intravenous infusion (usually yearly). Bisphosphonates are taken up into the bone where they switch off the cells that break down bone. Their effects on bone can last past the time they are taken – providing ongoing bone protection.
Denosumab – This therapy acts to slow down bone loss by blocking the cells which break down bone. It is administered as an injection once every 6 months but wears off quite quickly after the six month mark. It is important that denosumab is given on time and not stopped without a plan for alternative treatment as both any improvement in bone density and fracture prevention are rapidly lost after stopping the medication
Hormone replacement therapy (HRT) – This therapy contains oestrogen, which increases calcium absorption, reduces bone loss and helps maintain bone density. It is most suitable for women who are recently post-menopausal and for women less than 60 years.
Testosterone therapy – In men with low testosterone levels, testosterone replacement therapy can improve bone density and strength. This therapy can be administered by injection, or a gel that is rubbed into the skin. However, testosterone therapy has not been shown to prevent fracture.
Selective estrogen receptor modulators (SERMs) – This therapy acts like estrogen in the bone but not in the breast, which makes it a suitable treatment option for women at high risk of breast cancer (SERMs also reduce the risk of breast cancer). SERMS have only been proven to reduce the risk of spinal fractures rather than fractures that occur elsewhere.
Teriparatide – This is a medication containing part of a natural hormone called parathyroid hormone. Unlike the other treatments that work by reducing the breakdown of bone, this works by actively building new bone. It is given by a daily self-injection for a period of 18 months (2 years in some countries). In Australia, the Pharmaceutical Benefit Scheme will only fund this medication for people with more than one fracture and who have continued to fracture despite being on one of the other osteoporosis treatments AND have a very low bone density.
Like any medications, side effects can occur in some people. Serious side effects are mostly associated with long term use. The benefits of treatment far outweigh the risks of rare side effects.
Medications and dental treatment – A rare dental complication called osteonecrosis of the jaw (ONJ) can arise in people on some osteoporosis medications, mainly oral or intravenous bisphosphonates and denosumab. Good dental care can make a huge difference to the risk of osteonecrosis, even through simple measures such as good teeth cleaning.
Ideally, people who need dental work, such as extractions (having teeth pulled out), implants or root canal surgery, should have this done before starting these medications. However, the current International Task Force on ONJ does not recommend that everyone must stop taking medications for dental work; rather, if dental work is needed when you are on these medications, this should be discussed beforehand with your dentist and doctor.2