Many older women have some degree of osteoporosis, a degenerative disease that affects bones. Osteoporosis treatments are available but their chance of success is far higher the earlier the problem is tackled. By far the best osteoporosis treatment is prevention – the more that you can do in terms of lifestyle changes to avoid osteoporosis, the less likely your bones are to become brittle in later life.

This article on osteoporosis treatment is by Kathryn Senior, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.

What is osteoporosis?

Osteoporosis is a bone condition that results in weaker, more brittle bones, especially in post-menopausal women. It is the cause of the characteristic stoop in the gait of many old people. It can actually reduce a person’s height quite significantly, as the vertebrae struggle to support the body’s weight.

The amount of minerals deposited in the bones is controlled by sex hormones, such as oestrogen in women and testosterone in men. As the amount of sex hormones drops rapidly following the menopause, the density of women’s bones becomes reduced and the bones become thinner. This leaves them less flexible and less able to bear weight.

Who needs this treatment?

Osteoporosis affects over 3 million people in the UK alone and around 20% of women over 60. It is estimated that up to ¼ million fractures a year occur as a result of osteoporosis, including 60,000 hip fractures. What’s more, 15%-20% of people who suffer an osteoporotic hip fracture will die within a year from causes related to the fracture. The need for effective osteoporosis treatment is therefore quite substantial.

Unfortunately, osteoporosis often goes undetected until the patient has a fall or other accident that results in a broken bone. However, it can be detected in the early stages using dual energy X-ray absorptiometry (DEXA). This scan will analyse the density of your bones and show whether you have got, or are likely to develop, osteoporosis, long before any outward symptoms can be seen.

What treatments are available?

The main aim of osteoporosis treatment is to slow down the mineral loss through medical intervention, and try, where possible, to strengthen the bones and surrounding muscle tissue through improvements in diet and exercise.

The main osteoporosis treatments include:

  • Hormone replacement therapy (HRT) - This was once very widely prescribed for osteoporosis treatment, however this is less commonplace now, as the hormones involved have been linked to an increased risk of stroke, heart disease and breast cancer. Selective oestrogen receptor modulators (SERMs) are sometimes used to mimic the role of the hormone oestrogen in osteoporosis treatment. Testosterone replacement is still used as an osteoporosis treatment for men.

  • Biphosphonates - These are non-hormonal drugs that slow that rate at which bone is broken down by osteoclasts and stimulate the production of new bone.

  • Strontium ranelate and the thyroid hormone calcitonin can also be used to prevent and reverse bone loss.

  • Dietary changes are also recommended as part of osteoporosis treatment, with a daily intake of at least 700mg of calcium. This equates to roughly the calcium in a pint of milk. Vitamin D supplements also play an important role.

NICE rules on osteoporosis treatments

As with a great many conditions, the osteoporosis treatments made available to the general public through the NHS are regulated by the Nations Institute for Clinical Excellence (NICE), a government body which decides which drugs the government will and will not pay for.

With 3 million people requiring osteoporosis treatment, NICE’s decisions regarding drug treatment obviously have vast financial implications and have inevitably run into controversy in recent years.

In 2007, NICE came under fire from many doctors when it only approved one first-line osteoporosis treatment – alendronate. This drug is unsuitable for one in four women and has serious side effects.

More recently, in December 2009, NICE was criticised by Juliet Compston, Professor of Bone Medicine at Cambridge University, as having a restrictive and outdated approach to osteoporosis treatment. She pointed out that women under 75 have to wait until they have a lower bone density than their over 75 counterparts, before they are allowed access to alendronate, while access to alternative drugs is even more stringently controlled.

Remarkably, there are no NICE constraints for osteoporosis treatment in men! Therapeutic decisions and the option to buy the expensive treatments required are left in the hands of GPs. Their tight budgets may not allow them to treat every patient, but at least there is the choice.

Clearly osteoporosis treatment is one area in which private medical care is not only faster and more convenient, but can also offer a wider range of treatments than you would find available on the NHS.

Preventive treatment

The fight against osteoporosis cannot begin soon enough in your life. Regular exercise and careful attention to diet can go a long way towards maintaining healthy, strong bones that repair themselves properly. Smoking has also been linked to an increased risk of osteoporosis, giving you yet another good reason to quit.

Weight-bearing exercises, such as running, dancing and aerobics, and resistance exercises, such as those found in a typical gym, are ideal for strengthening the entire musculo-skeletal system. Regular exercise of around 30 minutes, three or four times a week will put you in the best possible position to fight the bone changes that lead to osteoporosis.

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