Pharmacological Treatments for Osteoporosis
Patients meeting criteria for osteoporosis or other high risk patients with a history of osteoporosis related fractures should gain significant benefit from treatment. Therapy should be initiated as soon as it is recognized with your doctors.
Golden Standard: Your T-Score
What Is A T-Score?
A T-Score is a measurement of bone density. It is a number that indicates the health and strength of your bones.
Consideration of pharmacological treatments for osteoporosis in postmenopausal women with fragility fractures and low bone mineral density, women who meet the criteria for osteoporosis, women with a T-score below 1.5 in the presence of risk factors, and women who continue to experience bone less or fragility fractures despite non-pharmacological treatments.
When elemental calcium supply is insufficient calcium is taken from the bone stores to maintain the serum calcium level. Calcium plays an important role in maximizing peak bone mass and decreasing bone turnover and slowing bone loss.
Factors can limit elemental calcium absorption: large amounts of calcium taken at once cannot be absorbed. Supplement doses should be limited to 500 to 600mg of elemental calcium per dose. Pharmacological treatments such as calcium intake greater than 2500mg/day should be avoided due to increased risk of toxicity including hypercalciuria and hypercalcemia.
Calcium carbonate should be taken with food to maximize absorption. Patients receiving PPIs or H2 receptor antagonists may have added difficulty absorbing elemental calcium supplements because of reduced stomach acidity. Better absorption may occur in this setting with calcium citrate because an acid environment is not needed for absorption and can be taken with or without food.
Adverse effects of calcium supplements include constipation, bloating, cramps and flatulence.
Another pharmacological treatment is Vitamin D. Doses above 2000IU/day should be avoided due to risk of hypercalciuria and hypercalcemia.
Vitamin D2 and D3 are available in higher doses and generally reserved for patients with a vitamin D deficiency.