Prevention (2)
- Exercising with osteoporosis: Stay active the safe way
- Fall prevention: 6 ways to reduce your falling risk
Risk factors (1)
- Hyperparathyroidism
Symptoms (1)
- Symptom Checker
Tests and diagnosis (1)
- Bone density test
Treatments and drugs (1)
- Osteoporosis treatment puts brakes on bone loss
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continued:
Osteoporosis treatment puts brakes on bone loss
What are the side effects of bisphosphonates?
The main side effects with any of the bisphosphonates are:
- Stomach upset
- Heartburn
To ease these potential side effects, take the medication on an empty stomach with a tall glass of water. And don't lie down or bend over for 30 to 60 minutes to avoid the medicine washing back up into the esophagus. The majority of women who follow these tips don't experience these side effects. But it's possible for an unlucky few who take the medicine correctly to still have stomach upset or heartburn.
Rarely, eye redness and eye pain can occur, and that needs to be evaluated immediately. Some people experience pain or aching in their bones while taking bisphosphonates, in particular. This might be due to other factors, but it's still important to talk with your doctor if you experience these side effects after starting therapy.
Bisphosphonates also have the potential to affect the jawbone. Osteonecrosis of the jaw is a rare condition in which a section of jawbone dies and deteriorates. This occurs primarily in people who take very large doses of the medication by vein (intravenously) — much larger than the doses typically used for osteoporosis — because they have cancer in their bones. In these individuals, a small number have poor healing of the jawbone after a dental extraction, after trauma to the jaw or sometimes even just spontaneously.
Before you start taking a bisphosphonate, make sure your teeth are healthy. You don't need to stop taking the medication before a dental procedure — unless directed to do so by your doctor — but tell your dentist you're taking a bisphosphonate and follow his or his recommendations for good oral hygiene.
Can medication alone successfully treat osteoporosis?
Don't rely entirely on medication as the only treatment for your osteoporosis. These practices also are important:
- Exercise. Weight-bearing physical activity strengthens bones and improves your balance. The more active and fit you are as you age, the less likely you are to fall and break a bone.
- Good nutrition. Practice healthy-eating habits and make certain that you're getting enough calcium and vitamin D. Being underweight or losing a lot of weight unintentionally is associated with poorer bone health and a higher risk of fracture — even if you're taking a bisphosphonate.
- Quit smoking. Smoking cigarettes speeds up bone loss.
- Limit alcohol. If you drink alcohol, consider limiting it to one drink a day or less, on average, for optimal health.
What kind of follow-up tests are recommended while undergoing osteoporosis treatment?
Follow-up bone density testing may be done one or two years after you start a medication for osteoporosis. A bone density check can reassure you that the medication is working. If your bone density has gone down dramatically, it may prompt your doctor to re-evaluate you, in case an undiscovered medical problem could be weakening your bones.
Beyond that first follow-up bone density test, you don't really need any further testing. However, it's common for women to continue to have bone density tests to monitor their bone health. It's one tangible measure that tells a woman her medication is working. But if you're doing well on your medication — not experiencing fractures, for instance — it's not necessary.
If you decide to have regular bone density tests done, you'll probably be tested every two years initially. If you're doing well on the medication, the interval between tests may increase to every three to five years.
How do you know if your osteoporosis treatment is working?
If you've not had any fractures, your medicine is working.
But it's hard to trust in the medication and its benefit when you don't have a tangible measure of effectiveness. If you wonder what you're getting out of treatment or how well it's working, regular bone density checks and reviewing with your doctor the reasons for continuing medication are reasonable ways to monitor your treatment.
What happens if you experience a broken bone while taking an osteoporosis medication?
Osteoporosis medications lower the chance of fracture, but they don't eliminate all risk of breaking a bone. If you have a fracture while on treatment, your doctor will reassess you to check for new conditions that cause fractures, such as unsteadiness or falling.
Depending on the outcome of that assessment, you may be a candidate to switch to a more aggressive bone-building therapy such as parathyroid hormone, manufactured as teriparatide (Forteo). This treatment is typically reserved for women who are at very high risk — those with very low bone density or who have had fractures. Teriparatide has the potential to rebuild bone and actually reverse osteoporosis, at least somewhat.
Do you need to take a calcium or vitamin D supplement when you're undergoing osteoporosis treatment?
Nearly every study of bisphosphonates has also included calcium and vitamin D supplementation. Most experts cautiously agree that for those medications to work effectively — to get the same results the studies produced — women need adequate amounts of calcium and vitamin D.
The guideline for the recommended daily amount of calcium remains 1,500 milligrams, but that includes dietary intake. If you're already consuming a generous amount of calcium in your diet — such as by having three to four servings of dairy products or fortified foods a day — taking more via a supplement may not do you any good. Likewise, a woman who has liberal sun exposure, or other sources of vitamin D, may not need extra vitamin D.
But if you're not getting adequate amounts of calcium and vitamin D in your diet, it's a good idea to take a supplement.
What should you look for in a calcium supplement?
Look for two things in a calcium supplement:
- Make sure it contains vitamin D. Women with osteoporosis often have vitamin D deficiency. Most calcium supplements do contain this vitamin.
- Find a supplement that's easy for you to take. For instance, get chewable tablets if you don't think you can swallow large pills.
Pay less attention to the type of calcium — calcium citrate versus calcium carbonate — in the supplement and whether it's a brand name or generic. The day-to-day difference of how much calcium you absorb from various supplements is inconsequential compared with your consistency in taking the supplement. You might notice that different types of calcium may affect your bowels differently, which would be a good reason to choose one type over the other.
Some experts recommend that a calcium supplement also should contain magnesium. But magnesium is everywhere in our diet. It's unusual for someone to really need a magnesium supplement.
If you have osteoporosis, how can you make sure you're exercising safely and not increasing your risk of an osteoporosis-related fracture?
Take a common-sense approach to physical activity:
- Make sure you can perform an activity without risk of falling or awkward lifting.
- Skip an activity that makes you strain beyond your usual limits or increases your risk of falling.
- Avoid doing an activity in poor weather or under other unsafe conditions.
- Seek instruction from a physical therapist for safe exercises and correct technique if you're unsure.
(2 of 2)
- Kennel KA (expert opinion). Mayo Clinic, Rochester, Minn. July 14, 2009.
- Rosen HL, et al. Overview of the management of osteoporosis in postmenopausal women. http://www.uptodate.com/home/index.html. Accessed May 26, 2009.
- Rosen HL. Bisphosphonates in the management of osteoporosis in postmenopausal women. http://www.uptodate.com/home/index.html. Accessed May 26, 2009.
- Bilezikian JP. Efficacy of bisphosphonates in reducing fracture risk in postmenopausal osteoporosis. The American Journal of Medicine. 2009;122(suppl):S14.
- Rabenda V, et al. Adherence to bisphosphonates therapy and hip fracture risk in osteoporotic women. Osteoporosis International. 2008;19:811.
