Common Questions
What are some treatment options for osteoporosis?
For all the options listed below, evidence of preservation of bone mineral density exists. Remember, though, that preservation of bone mineral density (a secondary endpoint) does not necessarily translate ito fracture prevention (the primary endpoint). Trials showing reduction in fracture risk with these interventions have ensured adequate calcium and vitamin D in the study subject.
| Option | Effects on Bone Mineral Density (BMD) | Effects on Fractures |
|---|---|---|
| Calcium | Preserves BMD--the effect may be most substantial in older women. | Effect size is uncertain but likely reduces fracture risk by at least 10%. |
| Vitamin D | Studies pairing therapy with calcium show modest preservation of BMD. | In patients who are vitamin D deficient, vitamin D plus calcium leads to a reduction in fracture risk of greater than 15%. |
| Exercise | Short-term studies indicate BMD preservation. | No direct evidence of a reduction in fracture risk. |
| Estrogen replacement therapy | Preserves BMD. However, when therapy is stopped, bone loss may accelerate. | Estimated to decrease the risk of vertebral fracture by 50% and the risk of other fractures by 25%. |
| Bisphosphonates | Preserves or increases BMD--a gain that may be preserved after treatment is stopped. | Alendronate, risedronate (not necessarily etidronate) reduce fracture risk by approximately 50%. |
| Selective estrogen receptor modulators | Both raloxifene and tamoxifen preserve or increase BMD. | Raloxifene decreases vertebral fracture risk 30% to 50% but has not yet been proven to reduce non-vertebral fracture risk. |
| Calcitonin | BMD preservation has been demonstrated in the spine but not clearly at other sites. | Although controversial, therapy probably reduces vertebral fracture risk. |
| Fall prevention | Not applicable | Hip pads have been demonstrated to reduce fractures. Other modalities are controversial. |