How Do I Know If I Have Osteoporosis?
Osteoporosis is sometimes diagnosed incidentally after an X-ray has been taken for a fracture or an illness. If your health care provider suspects you have osteoporosis, they may measure you to check for a loss of height. The vertebrae are often the first bones affected, causing a loss in height of half an inch or more. Your health care provider may also recommend that your bone density be measured.
Diagnostic tools more likely to catch osteoporosis at an early stage include various forms of a technique called DEXA (dual energy X-ray absorptiometry), which is specifically designed to measure bone density. Another diagnostic tool called quantitative computerized tomography is also an accurate method of measuring bone density anywhere in the body, but it uses higher levels of radiation than the other methods so is rarely used. Some facilities are also equipped with specialized ultrasound machines that can detect early signs of osteoporosis.
What Are the Treatments for Osteoporosis?
Because osteoporosis is difficult to reverse, prevention is the best treatment.
Calcium is the cornerstone of osteoporosis treatment. To help with the absorption of calcium, vitamin D supplements may need to be taken. A regular exercise program -- including weight-bearing exercises, such as walking and aerobics -- can help keep your bones strong and free of fractures.
Other osteoporosis treatments include:
- Alendronate (Binosto, Fosamax), ibandronate (Boniva), risedronate (Actonel, Atelvia), and Zoledronic acid (Reclast, Zometa), treat osteoporosis by inhibiting cells that break down bone. There are strict ways to take these medications, because if taken incorrectly, they can lead to ulcers in the esophagus.
- Evista is a drug that has some actions similar to estrogen, such as the ability to maintain bone mass. However, studies have shown that it doesn't increase the risk of breast or uterine cancers as estrogen does. Evista can cause blood clots and often increases hot flashes.
- Abaloparatide (Tymlos), romosozumab-aqqg (Evenity), and teriparatide (Forteo) are drugs used for the treatment of osteoporosis in postmenopausal women and men who are at high risk for a fracture. A synthetic form of the naturally occurring parathyroid hormone, Forteo and Tymlos are shown to stimulate new bone formation and increase bone mineral density. They are self-administered as a daily injection for up to 24 months. Side effects may include nausea, leg cramps, and dizziness.
- Denosumab (Prolia, Xgeva) is a monoclonal antibody -- a fully human, lab-produced antibody that inactivates the body's bone-breakdown mechanism. It's the first "biologic therapy" to be approved for osteoporosis treatment. Prolia, a twice-a-year injection, is approved for postmenopausal women at a high risk of fracture when other osteoporosis drugs have not worked.
Menopausal hormone therapy -- either estrogen alone or a combination of estrogen and progestin -- can prevent and treat osteoporosis. The drug Duavee (estrogen and bazedoxifene) is a type of HRT approved to treat menopause-related hot flashes. Duavee may also prevent osteoporosis in high-risk women who have already tried non-estrogen treatment.
A landmark study called the Women's Health Initiative revealed that hormone therapy increases the risk of breast cancer, heart disease, and stroke in some women. Hormone therapy is known to help preserve bone and prevent fractures, but is not generally recommended at this point for osteoporosis because the risks are thought to outweigh the benefits.
In women who have been on menopausal hormone therapy in the past and then stop it, the bone begins to thin again -- at the same pace as during menopause.