Osteoporosis, Fragility & Bone Health Edition | “Stiffen Up” Management of Osteoporosis
Oct 26, 2023
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In this podcast, Kurt A. Kennel, M.D., discusses the treatment options for osteoporosis, emphasizing the importance of preventing fractures. They explore the role of calcium and vitamin D, potential side effects of medications, and the importance of good oral hygiene. The podcast also highlights the key points in managing osteoporosis, including fall prevention, nutrition, exercise, and continuously assessing treatment choices.
Bisphosphonates are considered first-line therapy for osteoporosis and work by suppressing bone breakdown, with options for oral or infusion treatment and recommended drug holidays to maintain bone resorption balance.
Anabolic agents are a newer class of drugs that stimulate bone-building cells to work faster, and can be considered for severe osteoporosis or multiple fractures. After anabolic therapy, individuals usually transition to anti-resorptive medications to maintain bone density.
Deep dives
Goal of Osteoporosis Treatment: Preventing Fractures
The goal of treating osteoporosis is to prevent fractures and the resulting complications, such as chronic pain and disability. Treatment options like bone density tests aid in identifying those at risk, but the focus remains on avoiding fractures. Calcium and vitamin D supplements are recommended, with targets of around 1,000 milligrams of calcium per day and 20 to 25 micrograms of vitamin D. Bisphosphonates are considered first-line therapy and work by suppressing bone breakdown. They can be taken orally for five years or via infusion for three years. Drug holidays may be recommended to maintain a healthy balance in bone resorption. It is important to prioritize oral health to minimize the risk of complications such as osteonecrosis of the jaw.
Anabolic Agents: Building Bone Strength
Anabolic agents are a newer class of drugs that stimulate bone-building cells to work faster. They can be considered for individuals with severe osteoporosis or multiple fractures. Teriparatide and abaloparatide are administered daily via subcutaneous injection for two years, while romosozumab, known as Evenity, is a monthly subcutaneous injection for one year. These agents offer more potent bone-building capabilities. However, they can require more effort, potentially leading to lower adherence rates. After completing anabolic therapy, individuals usually transition to anti-resorptive medications, such as bisphosphonates, to maintain bone density.
Looking ahead: Future Possibilities in Osteoporosis Treatment
Exciting developments in osteoporosis treatment include exploring non-drug strategies to maintain skeletal health, such as mechanical vibration, magnetic or electrical stimulation. Researchers are investigating ways to deliver targeted treatments directly to affected bones. Clinical trials are underway to examine the efficacy of injecting mineral components and chemicals into specific areas of the skeleton to enhance bone strength. Encouraging better long-term outcomes, scientists are seeking to leverage the body's natural biology and healthy aging processes. These approaches aim to reduce potential side effects and better address individual health conditions.
According to the Bone Health and Osteoporosis Foundation, over 50 million Americans have osteoporosis. Up to one in two women and one in four men will experience a bone fracture due to the disease. Osteoporosis is a common cause of hip, wrist and vertebral fractures and can result in significant complications including chronic pain, disability and even death. When detected early, these complications need not occur and we now have a variety of very effective treatments for osteoporosis, some relatively new. In this podcast, we’ll discuss the treatment options for osteoporosis with Kurt A. Kennel, M.D., an endocrinologist at the Mayo Clinic.