The most fundamental suggestion is to increase your calcium intake,
either through dietary changes or supplemental pills. It is best for
people to begin adequate calcium intake at an early age, as bone mass
begins to decrease around the age of 30. After age 30, calcium helps
decrease bone loss, strengthen bones, and decrease the risk of
fractures.
The recommended daily intake for women age 25 to 50-and women over
50 who take hormone replacements-is 1,000 mg (milligrams) per day.
Women over 50 who do not take hormone replacements should have 1,500 mg
per day. Men ages 25 to 65 years old should have 1,500 mg per day. And
men and women over 65 should have 1,500 mg per day.
If you take calcium supplements, make sure they contain Vitamin D,
as this helps with absorption. Calcium citrate is absorbed better than
calcium carbonate. If you take the carbonate form, make sure to take it
with food.
A vitamin D deficiency may contribute to bone loss and fracture. At
least 800 mg per day is recommended for all adults. Many calcium
supplements contain vitamin D. You can also get vitamin D through foods
such as egg yolks, fish, and fortified milk and cereals. Fish sources
include halibut, mackerel, sardines, shrimp, pink salmon, and cod liver
oil.
Currently, four medications have approval from the Food and Drug Administration (FDA).
Hormone Replacement Therapy (HRT)
Hormone (estrogen) replacement therapy (HRT) is used for both
prevention and treatment of osteoporosis. HRT can reduce bone loss,
increase bone density in the spine and hips, and reduce the risk of hip
and spinal fractures in postmenopausal women.
HRT is usually given as a pill or skin patch. It is effective even
when started after age 70. Estrogen taken alone can increase the risk
of developing endometrial cancer (cancer of the uterine lining). For
this reason another hormone called progestin is usually prescribed in
combination with estrogen for women whose uterus is intact.
Side effects of HRT can include nausea, bloating, breast tenderness,
and high blood pressure. Some studies indicate a relationship between
estrogen use and breast cancer, while other studies do not. Make sure
to discuss the pros and cons of estrogen replacement therapy with your
doctor.
Bisphosphonates
These compounds inhibit breakdown of bone and slow down bone
resorption. They've been shown to increase bone density and decrease
the risk of hip and spine fractures. Alendronate is the bisphosphonate
that has been approved by the FDA for preventing and treating
osteoporosis in postmenopausal women. The strongest side effect of
alendronate is gastrointestinal problems. To avoid these problems it
should be taken on an empty stomach. Also take it with a full glass of
water and remain in an upright position for at least thirty minutes
afterward.
Calcitonin
Calcitonin is used for women who cannot or choose not to take
estrogen. For women who are at least five years past menopause,
calcitonin can increase spinal bone density and slow bone loss.
Calcitonin is a protein, so it cannot be taken orally because it would
digest before it goes to work. It is available as an injection or nasal
spray.
Selective Estrogen Receptor Modulators (SERMs)
SERMs are compounds that have effects similar to estrogen in some
parts of the body, such as the spine and hip. SERMs seem to prevent
bone loss of the spine, hip, and total body. Raloxifene is the SERM
drug currently approved by the FDA for prevention of osteoporosis. Its
impact on the spine does not appear to be as powerful as either
estrogen replacement therapy or alendronate. There are no common side
effects with raloxifene. Some women have experienced hot flashes and deep vein thrombosis (DVT).
