The diagnosis of osteoporosis is usually established by DEXA scanning or after a patient presents with a fracture of the spine (vertebral crush fracture), ribs, wrist, or hip. Once established, appropriate treatment should be initiated as soon as possible and should include adequate amounts of calcium (1500-1800 mg daily) and vitamin D (400-800 IU). Calcium can be increased through diet and/or calcium supplementation. Understandably, the treatment of secondary osteoporosis involves treatment and management of the underlying disorder or condition and is, therefore, more complicated than the management of primary osteoporosis.
- Drug (pharmacologic) treatment can improve bone strength and reduce the incidence of fractures. Choices include:
- For woman, either traditional estrogens or SERMs (selective estrogen receptor modulators) may be an appropriate choice depending on a variety of individual factors.
- For women and men, bisphosphonate compounds such as alendronate (Fosamax) and risedronate (Actonel) are very useful drugs for many patients.
- Also for both women and men, calcitonin is a drug occasionally used in the treatment of osteoporosis and is available by a nasal spray or by injection.
- Newer agents promise to increase bone mass to an even greater degree than those currently used and will be available soon.
- Nonpharmacologic treatment has also shown evidence includes:
- Weight-bearing exercises such as walking one mile a day at least three days a week (important to cardiovascular fitness and the preservation of bone strength).
- Exciting new modalities such as mechanical stimulation devices, which promise to broaden treatment options and heighten the challenge for individual and optimal management of osteoporosis.