This article reviews the latest guidelines and research on the best and safest treatment for osteoporosis in 2023, a condition that affects millions of people worldwide.
The Best and Safest Treatment for Osteoporosis in 2023:
Osteoporosis is a condition that causes the bones to become weak and brittle, increasing the risk of fractures and disability. According to the American College of Physicians (ACP), more than 10 million Americans older than 49 have osteoporosis, and another 43.3 million have low bone mass that could progress to osteoporosis. Osteoporosis can result from aging, hormonal changes, genetic factors, or secondary causes such as certain diseases or medications. The main goal of osteoporosis treatment is to prevent fractures and improve quality of life. However, choosing the best and safest treatment for osteoporosis can be challenging, as there are many options available, each with its own benefits, risks, and costs. In this article, we will review the latest guidelines and research on the best and safest treatment for osteoporosis in 2023.
The ACP shows that clinicians remember preventing bisphosphonates after 5 years of treatment, until there’s a strong indication to continue, as the benefits of bisphosphonates may diminish over time and the risks may increase. The ACP also advises against using bisphosphonates to prevent osteoporosis in people with low bone mass who do not have osteoporosis or a history of fractures.
The Second-Line Treatment
For people who cannot take bisphosphonates or have a very high risk of fractures, the ACP recommends other medications as the second-line treatment for osteoporosis. These include:
This is a type of antibody that blocks a protein called RANK ligand, which stimulates bone resorption. Denosumab is given as an injection every six months and can improve bone density more quickly than bisphosphonates¹. However, denosumab can also cause side effects, such as infections, low calcium levels, skin reactions, and osteonecrosis of the jaw¹. Moreover, the benefits of denosumab fade within months after stopping the drug, unless bisphosphonates are started.
Parathyroid hormone analogs:
These are synthetic versions of a hormone that regulates calcium and bone metabolism. They include teriparatide (Forteo) and abaloparatide (Tymlos). Parathyroid hormone analogs are given as daily injections for up to two years and can dramatically improve bone density and reduce fractures. However, they are also costly and can cause side effects, such as nausea, headache, dizziness, and increased risk of osteosarcoma (a type of bone cancer) in animal studies¹. Furthermore, the benefits of parathyroid hormone analogs are not maintained unless bisphosphonates are used afterward.
This is a new type of antibody that binds to a protein called sclerostin, which inhibits bone formation. Romosozumab is given as monthly injections for one year and can reduce fracture risk more than alendronate alone¹. However, romosozumab can also cause side effects, such as infections, low calcium levels, joint pain, and increased risk of cardiovascular events, such as heart attack and stroke¹. Therefore, the ACP suggests that romosozumab should only be used in women with a very high risk of fracture and no history of cardiovascular disease.
Hormone Replacement Therapy: The Controversial Treatment
Hormone replacement therapy (HRT) is the use of estrogen and progesterone (or estrogen alone in women who have had a hysterectomy) to treat the symptoms of menopause and prevent bone loss. HRT can reduce the risk of fractures in postmenopausal women with osteoporosis, especially if started soon after menopause. However, HRT can also increase the risk of serious adverse effects, such as breast cancer, endometrial cancer, stroke, blood clots, and gallbladder disease.
The ACP recommends that clinicians discuss the benefits and risks of HRT with postmenopausal women who have osteoporosis and menopausal symptoms, and consider HRT as an option until the age of 60 or within 10 years of menopause onset¹. The ACP also advises against using HRT for the prevention of osteoporosis in postmenopausal women who do not have osteoporosis or a history of fractures.
Nonpharmacological Options: The Supportive Treatment
In addition to medications, the ACP recommends nonpharmacological options to support the treatment of osteoporosis and prevent fractures. These include:
Calcium and vitamin D supplementation:
These are essential nutrients for bone health and can help prevent osteoporosis and fractures. The ACP suggests that clinicians prescribe calcium and vitamin D supplements to people with osteoporosis or low bone mass, based on their dietary intake, preferences, and risk of adverse effects. The recommended daily calcium intake is 1,000 to 1,200 mg for adults, and the recommended daily intake of vitamin D is 600 to 800 IU for adults. However, excessive intake of calcium and vitamin D can cause side effects, such as kidney stones, hypercalcemia, and vascular calcification.
This is a physical activity that can improve muscle strength, balance, coordination, and posture, and reduce the risk of falls and fractures. The ACP suggests that clinicians advise people with osteoporosis or low bone mass to engage in weight-bearing and resistance exercises, such as walking, jogging, dancing, lifting weights, or using elastic bands. The recommended amount of exercise is at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity per week, plus muscle-strengthening activities on two or more days per week.
This is a strategy that can reduce the risk of falls and fractures by modifying the environment and behavior of people with osteoporosis or low bone mass. The ACP suggests that clinicians assess the risk of falls in people with osteoporosis or low bone mass and recommend fall prevention interventions, such as removing hazards, installing grab bars, using assistive devices, wearing appropriate footwear, and avoiding alcohol and sedatives.
Osteoporosis is a common and serious condition that affects millions of people worldwide. The best and safest treatment for osteoporosis in 2023 depends on the individual’s risk factors, preferences, and goals. The ACP provides updated guidelines and recommendations for the management of osteoporosis, based on the latest evidence and research. The main options for osteoporosis treatment are bisphosphonates, other medications, hormone replacement therapy, and nonpharmacological options. Each option has its own benefits, risks, and costs, and should be discussed with a clinician before starting or stopping treatment. The ultimate aim of osteoporosis treatment is to prevent fractures and improve quality of life.
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