Treatment Options

There are a number of treatment options for individuals diagnosed with osteopaenia (low bone mass) and osteoporosis.

Firstly all patients should have a sufficient vitamin D and calcium intake in addition to whatever treatment they are taking.  Sufficient calcium dietary intake is possible in people with high intake of milk and dairy produce but others may require supplemental calcium. The aim is to have a total intake of Calcium of 1200mg to 1500mg a day.  In northern climates and particularly in countries like Ireland, vitamin D deficiency and sub-optimal levels of vitamin D  are very common in the general population.  For this reason,  vitamin D supplements are widely prescribed in bone health clinics. We normally recommend an intake of 800 units of vitamin D per day for all of our patients.

Bisphosphonates: These are the most commonly prescribed medications for the treatment of osteoporosis.  Alendronate, Risedronate, and Zolendronic Acid have also been approved for the treatment of steroid-induced osteoporosis for those who require long-term use of medications to treat inflammatory conditions, which can contribute to osteoporosis.  If you are taking bisphosphonate in tablet form, take the drug upon arising in the morning after an overnight fast, with one full glass of water. Stay in an upright position and avoid food for at least 30mins after taking the dose.  Side effects of bisphosphonates are uncommon, but may include abdominal, bone, or muscle pain. These medications may also cause nausea or heartburn. Contact your doctor if you have these symptoms.

Denosumab (Prolia®): Denosumab is a potent anti-resorptive and it is given as a sub-cutaneous injection every six months. It is highly effective in preventing hip, vertebral and peripheral fractures and is used as an alternative to bisphosphonates. It is well tolerated and like all bone health treatments it should not be stopped suddenly without considering alternative therapies.

Strontium Ranelate (Protelos®): Strontium reduces the risk of broken bone by slowing bone loss and increasing bone mass. It is used for treatment of Osteoporosis in postmenopausal women to reduce the risk of spine and hip fractures. It is usually dispensed as a sachet of powder which is mixed with water and taken at bedtime. The most common side effects includes nausea, diarrhoea and headache.

As Servier have decided to cease the distribution of Strontium Ranelate (Protelos) from August 2017 patients are advised to speak with their doctor for alternative therapy.

Selective Oestrogen Receptor Modulators (SERMs) – Raloxifene: These drugs work by acting on oestrogen receptors in the bone tissue, where it mimics the natural effects of oestrogen. This gradually reverses the excessive breakdown of bone that happens at menopause and causes an increase in bone mineral density, making bones stronger.  Raloxifene is taken in pill form, once a day, with or without meals. While uncommon, side effects may include hot flashes, leg cramps, or blood clots in the legs or lungs. Raloxifene is not recommended for pre-menopausal women.

Recombinant Parathyroid Hormone Therapy (rPTH) – Forsteo: Recombinant Parathyroid Hormone therapy (Forsteo) stimulates new bone formation, rather than preventing bone breakdown and it is the only anabolic (bone building) drug currently available to us. This drug is used in men and women with severe osteoporosis who have a high risk of fractures. It is given as a daily, self-administered injection for two years. Side effects are uncommon but may include leg cramps, headaches, and dizziness.

Hormone Replacement Therapy (HRT): HRT is designed to replace a woman’s depleting hormone levels at menopause. HRT is commonly prescribed to relieve menopausal symptoms, such as hot flashes and vaginal dryness. It is not used as a first line treatment for Osteoporosis but can be a used in some circumstances.