When it comes to reducing your risk of conditions like osteoporosis, lifestyle changes are usually the first line of defense. They can be effective, are generally very low-risk for side effects, and often have add-on benefits to your health and well-being.

Weight-bearing exercise. Taking vitamin D and calcium together. Maintaining a healthy weight. Not smoking. Eating a healthy, varied (largely Mediterranean) diet. All of these can be helpful in preserving bone health.

However, if these approaches aren’t enough to stop osteopenia from becoming osteoporosis, or if you’ve suffered an osteopenic fracture, it may be time to discuss medical interventions with your doctor.

The truth of it is, says the International Osteoporosis Foundation, one in ten women aged 60 are affected by osteoporosis, and after age 50, a woman’s risk of death from a hip fracture is equivalent to her risk of death from breast cancer. And yet, up to 80 percent of those at the highest risk – those who have already had at least one osteoporotic fracture – have not been identified, nor are they receiving treatment.

Given the potential impact of osteoporosis on longevity and quality of life, we talked to our doctor about it, genneve Director of Health Dr. Rebecca Dunsmoor-Su.

What are our options for managing osteopenia and osteoporosis?

If lifestyle options are insufficient to halt the progression of osteoporosis, there are treatments that have proven effective. However, not every treatment works the same for every woman, and all come with at least some risk of side effects, so it’s good to discuss the range of options with your doc.

And, of course, you may find that a combination of lifestyle behaviors and medical interventions offer you the best health protection.

Bisphosphonates

This class of drugs are “anti-resorptive,” Dr. Rebecca tells us, meaning they prevent your body from reabsorbing calcium from your bones and weakening them. Additionally, bisphosphonates can be partly adsorbed onto the bone surface, helping restructure bones to be stronger.

These treatments can be taken orally, by injection, or via an IV, usually on a monthly, bi-annual, or annual basis. For those at low risk of osteoporosis, up to five years of treatments may be necessary. For those at higher risk, particularly those who have already had a fracture, up to 10 years may be necessary.

There are some risks of side effects with bisphosphonates: skin reactions for those receiving injections, stomach upset, heart burn, joint and muscle aches are the most common. For those on high doses, there is an increased risk of osteonecrosis of the jaw (death of bone tissue from lack of blood supply) and atypical femur fractures (the large bone of the thigh). However, the risk is very slight, even among this population.

Long-term studies (up to 10 years) have been done on bisphosphonates and show reduction of bone turnover (less bone loss) without evidence of adverse effects.

Bisphosphonates can be effective in halting the progression of osteoporosis, but not all work the same way or as well for every person taking them, so have a good conversation with your doc and track your progress.

Hormonal treatments

Replacing the body’s hormones to slow, stop, or even reverse the progression of osteoporosis is one way doctors are helping women (and men) keep bones stronger, longer. However, Dr. Rebecca reminds us, no hormone is risk-free, so it’s important to discuss benefits and risks with your doc to decide which (if any) hormonal treatment is appropriate for you.

Hormone Replacement Therapy (HRT)

Some women do get bone benefits from estrogen with systemic hormone replacement therapy, says Dr. Rebecca, potentially even getting some reversal of bone loss. However, given the problematic nature of hormone replacement therapy (possible increased risk of breast cancer and blood clots), most doctors won’t recommend HRT for a single symptom, she tells us. 

If a woman is at risk of osteoporosis or has already had a fracture, if she doesn’t have a uterus and therefore doesn’t need progesterone (which is associated with breast cancer), and if she has other symptoms such as hot flashes which hormones can help relieve, she may be a good candidate for HRT.

SERMs (Selective Estrogen Receptor Modulators)

SERMs like Raloxifene (Evista) is a “designer” estrogen which acts like estrogen where bones are concerned (protecting density) but unlike estrogen by not having an effect on the uterine lining (and therefore not causing uterine cancer). You may be familiar with another SERM, Tamoxifen, which is used to prevent the recurrence of breast cancer.

Raloxifene has similar side effects to other hormones, namely a slight but increased risk of blood clots in the leg and lung and increased risk of stroke in women with pre-existing heart disease or risk of heart disease. It can also increase the occurrence of hot flashes.

SERM + estrogen  

Duavee is a SERM + conjugated estrogens treatment that can reduce the effects of osteoporosis while also decreasing hot flashes. The estrogens help with vasomotor symptoms (hot flashes/night sweats) and help prevent osteoporosis; the bazedoxifene (BZA) helps protect the uterus from endometrial hyperplasia – a thickening of the uterine lining that can lead to cancer.

Teriparatide (Forteo)

A synthetic version of the human parathyroid hormone, Forteo helps regulate the metabolism of calcium. Unlike most of the other treatments which slow down the reabsorption of bone, teriparatide actually promotes the growth of new bone.

However, because Forteo is a relatively new treatment on the market, there’s not a lot known about the long-term safety of the drug, which is administered by self-injection. At the moment, it’s only FDA-approved for two years of use. Possible side effects include skin reactions at the injection site, depression, leg cramps, back pain, and heartburn.

Calcitonin

Initially this drug had to be given in an injection because if taken orally, too much was digested in the stomach before it made its way to the blood stream. In response, it was formed into a nasal spray, which is well tolerated by most users. Effectiveness is described as “modest,” but it does seem to increase bone mass, if somewhat less effectively than estrogens and bisphosphonates. However, it does seem to reduce pain from fractures.

Denosumab (Prolia)

Bone removal is, of course, part of the natural process of life, but as we age, bone removal far outpaces replacement, and bones become porous and weaker as a result. Denosumab prevents the development of the cells that remove bone. A Prolia injection every six months has been proven to help some women and men strengthen their bones and reduce their risk of fracture.

Prolia can have immune effects, Dr. Rebecca says, so it’s important to communicate fully with your doctor before starting and during treatment.

Another option to explore

The company OsteoStrong has a unique approach to osteoporosis that may well be worth exploring: non-impact osteogenic loading. Osteogenic loading is putting a high load on the bones in order to force bones to strengthen – this is why impact, weight-bearing exercise can help with bone density.

OsteoStrongAccording to Brent Jordan, co-owner of OsteoStrong Mercer Island, OsteoStrong’s equipment simulates that impact without the danger of hitting the ground wrong. Members spend 10 to 15 minutes, three times a week, at an OsteoStrong facility, where there are four different machines to target different fracture-prone areas: arms between the wrist and shoulder, legs between the hips and ankles, core (ribs), and spine. Members pull or push as hard as possible against immovable parts of the machine, putting pressure on the bones and prompting the body’s inherent response – to increase bone density.

Used properly, the machines can also build muscle and improve balance, Jordan says, which can reduce the potential for falling, another benefit for women with osteoporosis.

Information on the effectiveness of OsteoStrong’s machines on bone density is still being gathered, and there is at this point insufficient evidence to recommend it over regular weight-bearing exercise, says Dr. Rebecca. So we suggest that you consult with your doctor before beginning the therapy, just as you would with any other treatment.

Are you dealing with osteopenia or osteoporosis or concerned about your bone density? What are you doing to manage or avoid the condition? We’d love to hear from you, so please comment here, find us on Facebook or in Midlife & Menopause Solutions, our Facebook group. You can also join us, anonymously, if you prefer, on our community forums. 



Shannon Perry

Shannon is a celebrated author and global educator. Whether she’s interviewing a physician or producing a podcast, her appetite for research, facts, and truth culminates in credible health education and programming that women can rely on. An avid runner, cyclist, and climber, Shannon knows a thing or two about thriving in midlife and lives in Seattle with her cat, dog and boyfriend.


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