Endocrinology

Your bone density test tells your physician if your bone density is normal, osteopenic (low bone mass) or osteoporotic. 

Treatment for Women

Prevention: No matter what your bone density is, all women should optimize their lifestyle to help prevent bone loss. This includes:

• Adopting a regular exercise regimen of weight-bearing exercises, such as walking or jogging, dancing, weight lifting, racquet sports and using resistance machines.
• Additionally, it is important to get enough vitamin D. A daily intake of 400 IU, but no more than 800 IU, each day is recommended – or as directed by your physician. Obtaining adequate amounts of vitamin D from our food may be difficult. The main sources of dietary vitamin D are fortified milk (100 IU/cup), egg yolks (25 IU/yolk) and oily fish (vitamin D content varies). Sunlight exposure causes vitamin D production in the skin, but this effect is blocked by sunscreen. Many people will need vitamin D supplements to achieve an adequate intake. Most multi-vitamins contain 400 IU of vitamin D.
• Ensuring a daily calcium intake of 1,000 mg per day to age 50, and 1,200 to 1,500 mg per day for those over age 65 also is recommended.
   

Treating Fractures: Our goal is to prevent fractures from occurring. But sometimes, despite all our efforts, they occur. The most common osteoporotic fractures are in the wrist, spine and hip. Wrist and hip fractures may require casting, hospitalization or surgery depending on how the bone is broken. Vertebral fractures can be very painful and there are now some options to treat them.

Medication: If your bone mass and risk factors put you at high risk for fracture, your doctor also may want you to take medication either to treat or prevent osteoporosis. There are many medications available. All have risks and benefits. Only you and your doctor can select which medication is right for you.

• Estrogen: The female hormone estrogen is very effective at preventing bone loss, especially around the time of menopause. It also can help regain bone mass in older women. Estrogen reduces hip and spine fractures by about 30 to 40 percent. There is a small increase in risk for breast cancer and vascular disease such as heart attacks and strokes. There also is a small risk of developing blood clots on estrogen therapy. The risks and benefits of estrogen therapy must be weighed carefully for each woman.
• Bisphosphonates: These medications are very effective in increasing bone mass at all ages and reduce fractures by about 40 to 50 percent. Current bisphosphonates approved for osteoporosis include alendronate (Fosomax®) and risidronate (Actonel®). These medications can be hard to absorb and they must be taken on an empty stomach first thing in the morning with water only. You then must remain upright for at least 30 minutes before eating or drinking anything else. Rarely, these medications can cause esophageal irritation and ulceration. There are daily and weekly regimens of bisphosphonates; both appear equally effective at increasing bone density.
• Calcitionin: This medication is a nasal spray and some evidence suggests it may reduce vertebral fractures although the studies are small. Unlike other medications, it appears to help reduce the pain associated with fractures.
• Raloxifene (Evista®): This medication acts like estrogen at some parts of the body (bone, heart) and opposes estrogen effects at other parts (breast, uterus). It reduces the risk of vertebral fractures by 40 percent. Similar to estrogen, it increases the risk of blood clots and can increase hot flashes if used around the time of menopause. It appears to reduce the risk of breast cancer in low-risk women by about 75 percent. It has not been tested for effects on hip fracture.
• Parathyroid hormone (PTH): Teriparatide, a form of parathyroid hormone, has been shown to stimulate bone formation and increase bone mineral density. In postmenopausal women who took the drug, fracture reduction of 50 to 70 percent was seen in the spine, hip, foot, ribs and wrist. Teriparatide is self-administered as a daily injection for up to two years.

Kyphoplasty: A new treatment for osteoporosis spine fractures is called kyphoplasty. It is a minimally invasive procedure (only tiny incisions are used). Through an incision, a small balloon is inserted into the collapsed bone to restore its shape. It is then filled with a substance that hardens and helps the bone expand. Long-term trials of this procedure are ongoing.

Treatment for Men

Prevention: No matter what your bone density is, all men should optimize their lifestyle to help prevent bone loss, including: 

• Adopting a regular exercise regimen of weight-bearing exercises, such as walking or jogging, weight lifting, racquet sports and using resistance machines.
• Having an adequate vitamin D daily intake of 400 IU, but no more than 800 IU each day also is recommended. Obtaining adequate amounts of vitamin D from our food may be difficult. The main sources of dietary vitamin D are fortified milk (100 IU/cup), egg yolks (25 IU/yolk) and oily fish (vitamin D content varies). Sunlight exposure causes vitamin D production in the skin, but this effect is blocked by sunscreen. Many people will need vitamin D supplements to achieve an adequate intake. Most multi-vitamins contain 400 IU of vitamin D.
• Ensuring a daily calcium intake of 1,000 mg per day to age 50, and 1,200 to 1,500 mg per day for those over age 65 is recommended.

Treating Fractures: Our goal is to prevent fractures from occurring. But sometimes, despite all our efforts, they occur. The most common osteoporotic fractures are in the wrist, spine and hip. Wrist and hip fractures may require casting, hospitalization or surgery depending on how the bone is broken. Vertebral fractures can be very painful and there are now some options to treat them.

Medication: If your bone mass and your risk factors put you at high risk for fracture, your doctor also may want you to take medication either to treat or prevent osteoporosis. There are many medications available. All have risks and benefits. Only you and your doctor can select which medication is right for you. 

• Bisphosphonates: These medications are very effective in increasing bone mass at all ages and reduce fractures by about 5 percent. Current bisphosphonates approved for osteoporosis include alendronate (Fosomax®) and risidronate (Actonel®). Your doctor may recommend taking bisphosphonates with supplemental calcium and vitamin D. These medications can be hard to absorb and they must be taken on an empty stomach first thing in the morning with water only. You then must remain upright for at least 30 minutes before eating or drinking anything else. Rarely, these medications can cause esophageal irritation and ulceration. There are daily and weekly regimens of bisphosphonates; both appear equally effective at increasing bone density.
• Calcitionin: This medication is a nasal spray and some evidence suggests it may reduce vertebral fractures although the studies are small. Unlike other medications, it appears to help reduce the pain associated with fractures. While calcitionin is currently only FDA approved for the treatment of osteoporosis in postmenopausal women, evidence suggests that it may have similar effects of men.
• Testosterone replacement therapy: This medication may be prescribed to men with low testosterone levels and has been shown to increase muscle mass and strength, libido, bone mass and hair growth.
• Parathyroid hormone (PTH): Teriparatide, a form of parathyroid hormone, has been shown to stimulate bone formation and increases bone mineral density. Teriparatide is self-administered as a daily injection for up to two years.

Kyphoplasty: A new treatment for osteoporosis spine fractures is called kyphoplasty. It is a minimally invasive procedure (only tiny incisions are used). Through an incision, a small balloon is inserted into the collapsed bone to restore its shape. It is then filled with a substance that hardens and helps the bone expand. Long-term trials of this procedure are ongoing.