Osteoporosis primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2], Raviteja Guddeti, M.B.B.S.[3]
Overview
Changes in lifestyle and calcium supplementation are the best early and long-term measures for the prevention of osteoporosis. There are also medications available that can be used to prevent worsening of osteoporosis. Pharmacologic treatment can stabilize bone mineral density, prevent further bone loss, and reduce the risk of fractures, however it is unlikely to restore bone quality and strength. The prevention of osteoporosis is particularly important because the microarchitechtural changes that occur in osteoporosis are largely irreversible.
Primary prevention
Lifestyle
There are various lifestyle modifications that can be implemented to help prevent the development of osteoporosis.
- Exercise - exercise promotes the mineralization of bone, and bone accumulation particularly during growth. High impact exercise in particular has been shown to prevent the development of osteoporosis, however high impact exercise can have a negative effect on bone mineralization in cases of poor nutrition, such as in anorexia nervosa and celiac disease
- Nutrition - a diet high in calcium and vitamin D prevents bone loss. Patients at risk for osteoporosis, such as persons with chronic steroid use are generally treated with vitamin D and calcium supplementaton. In renal disease, more active forms of Vitamin D such as paracalcitol or (1,25-dihydroxycholecalciferol or calcitriol are used, as the kidney cannot adequately generate calcitriol from calcidiol (25-hydroxycholecalciferol) which is the storage form of vitamin D.
- Quitting smoking helps prevent osteoporosis, as well as other diseases
- Not drinking alcohol, or drinking only in moderation
- Only taking certain medications linked to osteoporosis (anticonvulsants, corticosteroids) at the minimum dose and for the minimum amount of time needed
Secondary Prevention
Pharmacologic Therapy
- Estrogen- with or without medroxyprogesterone can be used to prevent osteoporosis, however in general the risks outweigh the benefits, so it is not used as a first-line therapy. It is used in women who have a significant risk of osteoporotic fractures and cannot take non-estrogen medications.
- Bisphosphonates- these are potent agents which inhibit resorption of bone. In turn they increase bone mineral density and decrease the risk of fractures. They include drugs called alendronate, risendronate, ibandronate, and zoledronic acid.
- Selective Estrogen Receptor Modulators- otherwise known as SERM's, is approved for the prevention of post-menopausal osteoporosis. They have been shown to increase bone mineral density and decrease the risk of vertebral fractures. Raloxifene is the only SERM approved for use in the United States.
References