Find out about the different ways to manage your bone health, including the importance of prevention of bone loss through diet and a healthy lifestyle.
You will also find discussions on the different types of medication for osteoporosis such as bisphosphonates, raloxifene and also the positive effects of the oral contraceptive pill (OCP) and hormone replacement therapy (HRT) on bone.
Osteoporosis is loss of bone strength because of reduced bone mineral density, which means bones are thinner and have a greater risk of fracture. This usually occurs with age, so the focus from early on is to:
Prevention, maintenance and treatment all benefit from:
Lifestyle management for bone health
Illness, disease & medications
Medical management of bone health
Eating disorders
Lifestyle influences bone health and can be an important area to focus on both for prevention of bone loss and management of bone health. For more information go to healthy living & bone health, calcium and vitamin D.
If you have an illness or take medication, which increases your risk of osteoporosis, it is important to:
| Who might be helped by taking the OCP | The OCP may help extreme athletes, women with current eating disorders, or those with low oestrogen levels for other reasons who have either stopped having their periods, or have periods very infrequently. A lack of periods is associated with low oestrogen levels, which reduces bone density. |
| How it works | Using the OCP can restore oestrogen levels to normal, and research has shown that this may allow bone density to be better preserved. |
| Possible side effects/risks | There is a small increased risk of deep vein thrombosis (DVT) (blood clots in the veins) with the OCP Women who smoke should not take the OCP as the risk of DVT is increased It is not clear whether the OCP improves bone mass in those with already lowered bone density |
| Who might be helped by taking HRT | HRT can help women around the time of menopause because with menopause there is a dramatic fall in oestrogen levels and the loss of bone is accelerated. |
| How it works | HRT can lead to higher levels of oestrogen which can increase bone density and this reduces the risk of fractures. |
| Possible side effects/risks | The use of HRT is for menopause symptoms and is not currently recommended as a first line therapy for osteoporosis in postmenopausal women. HRT has been linked to a slight increase in risk of breast cancer after 4-5 years of use in those who take combined oestrogen and progesterone. The effects of HRT last only whilst you are taking it and as soon as you stop, the rate of bone loss returns to the rate it was progressing before you started HRT |
Taking bisphosphonates can assist women at high risk of fracture, with a history of low trauma fracture and who have other risk factors for osteoporosis.
There are several kinds of bisphosphonates:
| How they work | These medications are taken up by the skeleton and reduce the rate of bone loss. Bisphosphonates reduce the risk of spinal and hip or other fractures. These drugs usually become effective within 6-12 months |
| Possible side effects/risks | They are generally well tolerated. Some women, particularly women who suffer from heart burn and/or have a hiatus hernia, may experience: - heartburn - abdominal discomfort - ulceration of the oesophagus – but when taken correctly the chance of oesophageal ulceration is low |
For bisphosphonates to be effective in increasing bone mineral density, it is important to have an adequate intake of calcium and vitamin D. It is also important to have a dental check-up and tell your dentist you are taking bisphosphonates as they can affect the bone in your jaw if you need to have a tooth removed.
You can have the cost of bisphosphonates subsidised if you:
Taken as a daily tablet
| How it works | This is a selective oestrogen-receptor modulator drug or SERM that improves bone density and reduces the risk of spinal fractures. It acts like oestrogen at some sites in the body and as an anti-oestrogen in other sites (such as the breast and uterus and so reduces the risk of breast cancer) |
| Possible side effects/risks | Hot flushes, which can make it difficult for women who are going through menopause There is a slightly increased risk of deep vein thrombosis (DVT or blood clot in a vein deep in the body), so if you are going to be immobile for some time such as a long air trip you should get your doctor's advice about whether to stop this treatment |
Other medications used to treat osteoporosis include:
| Strontium Ranelate (brand name Protos) |
| Taken daily as granules mixed with water. For patients with severe osteoporosis. Should not be used in those at significant risk of cardiovascular events, unless otherwise advised by their doctor. |
| Parathyroid hormone (PTH) - Teriparatide (brand name Forteo) |
| A daily injection for 18 months. For patients with severe osteoporosis who have been on other osteoporosis medications but: - continue to have fractures and - have very low bone mineral density There may be an increased risk of bone cancer with long-term use. |
| Denosumab (brand name Prolia) |
| An injection given twice a year. Available for use in postmenopausal women with osteoporosis. There may be a slightly increased risk of skin infections. |
For more information on any medications to treat osteoporosis please see your doctor.
If you have an eating disorder, it is vital to get help to treat the eating disorder to ensure:
If you have a past history of an eating disorder, it is vital to assess your bone strength as therapies are available to assist you.
The Butterfly Foundation supports people with eating disorders and provides many resources to help.
** Currently under review **
This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at December 2013.
