For many people, hearing "You have osteoporosis" is startling.
Some hear it in the hospital after breaking a hip. Others get the news after getting a bone density test.
Cutting that risk is crucial. About half of women and a quarter of men over age 50 will have an osteoporosis-related fracture, notes the National Osteoporosis Foundation. Fractures most often affect the hip, spine, and wrist, but can affect any bone.
Often, the first question patients ask their doctors is, Can I reverse osteoporosis?
Here, bone health experts answer that and other osteoporosis questions.
1. Can You Reverse Osteoporosis?
Not exactly. But you may be able to curb it.
''Realistically, we are not talking about complete reversal," says Felicia Cosman, MD, clinical director of the National Osteoporosis Foundation (NOF) and medical director at the Clinical Research Center of New York's Helen Hayes Hospital.
"A realistic goal is to prevent fractures from occurring," says Cosman, who researches osteoporosis treatments and has consulted and spoken for the drug companies Eli Lilly, Novartis, Merck, and Amgen, which make osteoporosis drugs.
2. So What Can I Do About Osteoporosis?
You can make fractures less likely by maintaining or improving your bone density, Cosman says.
That is, "you can reverse theconsequences of osteoporosis," says Robert Heaney, MD, vice president for research and professor of medicine at Creighton University in Omaha, Neb. A bone biologist, Heaney has spoken for Merck and Amgen.
3. What Will Osteoporosis Drugs Do for Me?
Depending on the state of your bones, "you can build some bone and get out of the osteoporosis range with drug therapy," says Jeri Nieves, PhD, a Columbia University associate professor of clinical epidemiology.
"You can slow down the bone loss, [but] it's not the same as reversing it," says Nieves, who also works at New York's Helen Hayes Hospital.
There are several types of osteoporosis drugs, which are available by prescription only:
- Bisphosphonates, such as Fosamax, Boniva, Actonel, and Reclast
- Calcitonin, sold as Fortical and Miacalcin
- Hormone therapy, or estrogen
- SERMS (selective estrogen receptor modulators), such as Evista (raloxifene)
- Parathyroid hormone (Forteo or teriparatide)
- Prolia, a biologic drug
Some types of osteoporosis drugs slow bone breakdown, which is part of bone's natural and ongoing remodeling process. Others spur new bone growth.
How good is the resulting bone? "The quality of the new bone is probably very good," Cosman says. "But the quality of your overall bone may not be back to normal."
4. What About Side Effects?
All classes of osteoporosis drugs have possible side effects.
For instance, there have been rare reports of "jaw death" (osteonecrosis of the jaw) in patients taking bisphosphonates, the most widely used type of osteoporosis drug. There have also been rare reports of thigh bone (femur) fractures in people taking bisphosphonates for a long time, but it's not clear if the drugs caused that. And the newest osteoporosis drug, Prolia, may cause low blood calcium levels and could increase infection risk, because it targets a chemical in the immune system.
As with any drug, you and your doctor need to weigh the risks and benefits.
5. What Lifestyle Measures Help?
If you have osteoporosis, doctors often recommend that you do the following, besides taking osteoporosis drugs:
- Get enough vitamin D and calcium. Both are needed for bone health, and many people don't get enough of either. The Institute of Medicine is reviewing its vitamin D and calcium guidelines. Meanwhile, ask your doctor what you need in terms of supplements and exposure to sunlight, which helps your body make vitamin D.
- Physical activity. Weight-bearing exercise -- such as walking or weight training -- is key for bone health. Check with your doctor about what's appropriate for you.
- Don't smoke. Smoking can weaken your bones.