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London Osteoporosis Clinic makes use of several life-style, non-drug and drug approaches to help patients achieve best outcomes

 

Life style changes and drug Treatments

These suggestions may help reduce your risk of developing osteoporosis or experiencing broken bones:

  • Avoid smoking.  Smoking increases bone loss, perhaps by decreasing the amount of estrogen a woman’s body makes and by reducing the absorption of calcium in your intestine.
  • Avoid excessive alcohol.  Consuming more than one alcoholic drink a day may decrease bone formation and reduce your body’s ability to absorb calcium. Being under the influence also can increase your risk of falling.
  • Prevent falls.  Wear low-heeled shoes with nonslip soles and check your house for electrical cords, area rugs and slippery surfaces that might cause you to trip or fall. Keep rooms brightly lit, install grab bars just inside and outside your shower door, and make sure you can get in and out of your bed easily.

 

For both men and women, the most widely prescribed osteoporosis medications are bisphosphonates. Examples include:

  • Alendronate (Fosamax)
  • Risedronate (Actonel)
  • Ibandronate (Boniva)
  • Zoledronic acid (Aclasta, Zometa)

Side effects include nausea, abdominal pain, difficulty swallowing, and the risk of an inflamed oesophagus or oesophageal ulcers. These are less likely to occur if the medicine is taken properly. Injected forms of bisphosphonates don’t cause stomach upset. And it may be easier to schedule a quarterly or yearly injection than to remember to take a weekly or monthly pill.

Long-term bisphosphonate therapy has been linked to a rare problem in which the middle of the thighbone cracks and might even break completely. Bisphosphonates also have the potential to affect the jawbone. Osteonecrosis of the jaw is a rare condition mostly occurring after a tooth extraction in which a section of jawbone dies and deteriorates. You should have a recent dental examination before starting bisphosphonates.

 

Hormone-related therapy

Oestrogen, especially when started soon after menopause, can help maintain bone density. However, estrogen therapy can increase a woman’s risk of blood clots, endometrial cancer, breast cancer and possibly heart disease.

Raloxifene (Evista) mimics estrogen’s beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen. Taking this drug may also reduce the risk of some types of breast cancer. Hot flashes are a common side effect. Raloxifene also may increase your risk of blood clots.

In men, osteoporosis may be linked with a gradual age-related decline in testosterone levels. Testosterone replacement therapy can help increase bone density, but osteoporosis medications are better studied in men with osteoporosis and are recommended instead of or in addition to testosterone.

 

Less common osteoporosis medications

If you can’t tolerate the more common treatments for osteoporosis — or if they don’t work well enough — your doctor might suggest trying:

  • Teriparatide (Forteo). This powerful drug is similar to parathyroid hormone and stimulates new bone growth. It is given by injection under the skin. After 18-24 months of treatment with teriparatide, another osteoporosis drug may be required to maintain the new bone growth.
  • Denosumab (Prolia). Compared with bisphosphonates, denosumab produces similar or better bone density results while targeting a different step in the bone remodeling process. Denosumab is delivered via a injection under the skin every six months. The most common side effects are back and muscle pains.

 

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The graph is a DEXA, it showing bone strength over time

Following treatment there has been an improvement in the bone strength.