Osteoporosis: Diagnosis, Management, Bisphosphonates and Hormone-related Therapy

Diagnosis

Osteoporosis is diagnosed based on clinical suspicion and is then confirmed by performing a specific test.

This test is called a bone density scan which uses low levels of radiation (X-rays) to measure the proportion of mineral density in specific bones of the body. The bones which are examined are those of the wrists, the spine and the hips.

Management

Lifestyle changes and home remedies

In low risk patients, the management of this condition will be conservative. This would include the following suggestions:

• Lifestyle changes - such as increasing one's physical activity and increasing the intake of calcium through dietary inclusions or supplementation. Calcium supplements combined with vitamin D are a good choice as they offer more benefits and minimal complications. 
• Modification of risk factors - such as reduced alcohol consumption to less than 2 drinks every day, and stopping tobacco use.
• Prevention of falls - patients with osteoporosis should make sure they wear shoes that have flat heels and are non-slip. They should also remove any small items of furniture which they can bump into, and rugs that they could slip on. Any electrical cords or wires should be removed so that one can't trip over them. Handle bars should also be installed around baths and showers, too.

READ Osteoporosis Is No More a Women-Only Disease

Bisphosphonates

Patients who are at high risk of sustaining fractures are prescribed medications such as the bisphosphonates, of which Alendronate is the most commonly used.

Bisphosphonates can cause a patient to experience issues such as the following:

• Nausea.
• Difficulty swallowing.
• Abdominal pain.
• Oesophageal ulcers.
• Inflamed oesophagus.

These side-effects can be limited by swallowing the medication while in an upright position and then remain standing for 30 minutes. Sometimes these effects are still present despite taking the medication properly. In this case, intravenous forms of the medication, such as zoledronic acid, would be more appropriate for these patients. Another benefit of this form of the medication is that it is given yearly instead of the patient having to drink pills every week.

READ Beyond Osteoporosis: How To Promote Bone Health

Hormone-related therapy

Estrogen supplementation, after menopause, can help the body maintain the density of bone. Estrogen shouldn't be prescribed to only maintain bone health if the patient isn't menopausal, as the increased hormone levels can increase the risk of the patient developing breast and/or uterine cancer as well as cardiovascular complications.

Raloxifene is a medication which has the bone density benefits of estrogen without many of the increased risks. Some side-effects include hot flashes and an increased risk in developing blood clots.

In men, osteoporosis is associated with reduced testosterone levels. Therefore, testosterone supplementation combined with osteoporosis medication can help increase the bone density in men.