Osteoporosis: Nonpharmacologic Treatments

•Elemental calcium 1,500 mg/day
•Vitamin D 400-1,000 IU/day

If the parathyroid hormone level is elevated, a higher dose of vitamin D might be warranted (50,000 IU once or twice a week for 3-6 months with careful monitoring of serum calcium levels and a repeat testing of vitamin D and parathyroid levels at 3-6 months).

In women with symptomatic osteoporosis, calcium and vitamin D supplementation alone do not reduce the risk of vertebral fractures, but they do increase the efficacy of osteoporosis medications.

Other Measures:
Encourage exercise.Weight-bearing exercise for 30 to 60 minutes at least 3 times a week improves muscle strength and balance, reducing the risk of falling.(20)

Manage depression. This patient's depression should be managed with counseling, antidepressants, or both. This may help increase appetite and physical activity.

Remove hazards at home, such as throw rugs, which are easily slipped on.

Adjust current medications if necessary. This patient's antihypertensive and sedative medications should be changed or the dosages adjusted to help avoid dizziness and postural hypotension.

Consider hip protectors to reduce the impact of a fall.(21)

Several Medications Available
This patient has vertebral fractures and low bone density in the hips and spine, and therefore she requires medication. (In general, patients with a T score of less than -2.0, or less than -1.5 with risk factors, should be considered for management with medication.) Several medications are available in the United States for treating postmenopausal osteoporosis (Table 3). Which one to prescribe depends on how effective it is, how quickly benefits are realized, and how well the patient tolerates it. Patients must comply with treatment over the long term to benefit.

The most clinically relevant measure of a medication's efficacy is how well it reduces fracture risk. Although bone density is a good predictor of fracture risk and can determine the need for osteoporosis treatment, the increases in density that are associated with medications do not completely explain how they protect against fractures.(22-24)

Table 4 compares the efficacy of different medications in clinical trials.

Cleveland Clinic Journal of Medicine
Volume 71, Number 10, October 2004

The author has indicated that he has received grant or research support from the Wyeth, Pfizer, Proctor and Gamble, Sanofi, NPS, and Alexis corporations and is on the speakers' bureaus of the Abbott, Merck, and Proctor and Gamble corporations. This paper discusses treatments that are experimental or are not approved by the US Food and Drug Administration for the use under discussion.