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General Lifestyle Advice

Patients with osteoporosis should be given general lifestyle advice to help reduce their future risk of fracture. Measures which are appropriate in most patients included:

Optimising dietary calcium and Vitamin D intake

Stopping smoking

Maintaining alcohol intake to within recommended limits (<14 units/week in women; < 21 units/ week in men)

 

Our calcium questionnaire can be accessed by clicking here. Link opens in new windowCalcium Questionnare 

Additionally if a patient with osteoporosis appears to be at increased risk of falls (has fallen more than 3 times in the last year or is unable to get out of a chair without using the arms of the chair) then appropriate falls advice should be given. This includes:

assessments for the medical causes of falls such as postural hypotension, Parkinson?s disease and cerebral vascular disease

Eye sight assessments

Physiotherapy assessments

Home modifications to provide a safe environment.

 

Medications

The aims of medical treatments for osteoporosis are to reduce fracture risks. Medications which do this do so either by preventing osteoclastic bone resorption (antiresorptive drugs) or by stimulating bone formation (anabolic drugs). The most appropriate medication fro osteoporosis are those which prevent both vertebral and hip fractures. NICE guidelines promote the use of generic Alendronic acid, other medications are only suggested at certain risk cut offs: please see http://www.nice.org.uk/ advice section.

 

Calcium and Vitamin D

Calcium and vitamin D supplements are generally used as adjunct therapy to other osteoporosis medications. They do not appear to be effective in reducing fractures when used alone, except in those at high risk of vitamin D deficiency, such as nursing home patients and potentially the house bound elderly. Additionally Vitamin D supplements may have a role in improving muscle function and hence falls reduction.

The UK recommendations for calcium intake are 700 mg in adults. USA recommendations are higher (up to 1000 mg per day).

Most international pharmaceutical studies co prescribed calcium and vitamin D in all their subjects-normally with 1000 mg calcium and 800 IU vitamin D.

 

The following medications are all licensed for use in osteoporosis

Bisphosphonates:

Alendronic acid 10 mg daily, 70 mg weekly

Risedronate 5 mg daily, 35mg weekly

Ibandronate 150 mg monthly, 3 mg IV 3 monthly

Cyclical etidronate therapy 400mg daily for 2 weeks in every 12

Hormone Replacement Therapy

Oral, or patch: with/ without progestogens depending of whether previous hysterectomy or not

 

Raloxifene Therapy

60 mg daily

Strontium Ranelate

2 gram sachets daily

Calcitriol

250ng twice daily

Calcitonin

IM (50 units/ml) or nasal (200 units/day)

Parathyroid Hormone Analogues

Teriparatide (Forsteo) daily SC injection for 18 months

Parathyroid Hormone (Preotact) daily SC injection for 24 months

 

Denosumab (Prolia) 60mg sc injection 6 monthly (recetly approved for use in primary and secondary care for those women unable to take a bisphosphate after specialist advice)