Thursday, November 30, 2006

osteoporosis ..... beyond calcium.

The North American menopause society has published new guidelines for the management of post menopausal osteoporosis.

There is much more to management of osteoporosis than calcium and vitamin D. Osteoporosis is a major health problem and some working knowledge about it is essential.

Do you need to get tested for osteoporosis ? I have answered that question in my previous post.

First lets enumerate the non pharmacological methods

  • A balanced diet with adequate calcium and vit D intake.
  • Adequate exercise.
  • Smoking cessation.
  • Avoidance of excessive alcohol intake.
  • Fall prevention.
Drug treatment of osteoporosis is recommended for all postmenopausal women
  • who have had an osteoporotic vertebral fracture.
  • who have bone mineral density values consistent with osteoporosis (ie, T-score worse than or equal to -2.5).
  • who have a T-score from -2.0 to -2.5 plus at least one of the following risk factors for fracture: thinness, history of fragility fracture (other than skull, facial bone, ankle, finger, and toe) since menopause, and history of hip fracture in a parent.
The first line drugs for treating post menopausal osteoporosis are the bisphosphonates. These drugs act by decreasing osteoclast activity. Osteoclasts are the cells that absorb or remove bone. Thus these drugs decrease bone turnover and help maintain bone mass.

The effectiveness of these drugs to reduce fracture rates have been well documented.
They have been shown to increase BMD by 6%-8% at the spine and by 3%-6% at the hip over a three-year period. Both vertebral and nonvertebral fractures were reduced by approximately 50% over this period of treatment. The bisphosphonates commonly used are alendronate, etidronate and residronate.

The most important precaution is to take the drug on an empty stomach. This is because food interferes with its absorption. One should not eat anything for half an hour after taking the drug.

The second important precaution is to take the drug with a glass full of water. The drug is known to cause esophageal irritation so a glass of water is necessary to wash down the drug.

A good advantage is that many of these drugs can be taken only once or twice a week. Alendronate for instance can be taken once a week as a single tablet of 70mg.

One serious complication that has been reported is that of jaw necrosis. There was approximately a 7% incidence in cancer patients treated with bisphosphonates for 3 to 4 years. However the incidence in patients treated with osteoporosis is very low.

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1 comment:

Fosamax Lawyers said...

In fighting osteoporosis, Calcium and Vitamin D works hand in hand. We must not also forget to add a regimen of exercise and proper diet to it