Understanding Osteoporosis: Protecting Your Bone Health

Most of us don’t think about our bones until we face issues. In the past, osteoporosis and osteopenia weren’t widely discussed because there were limited options for treating thinning bones, aside from taking calcium. However, we now understand much more about how bones build up and thin out, and we have effective treatment options available to slow or even reverse bone loss.

Bone Remodeling: The Constant Cycle

Our bones continuously build and rebuild throughout our lives. We actually turn over about 10% of our bone mass each year through a process called remodeling. This means we essentially replace all the bones in our body approximately every 10 years! There are two types of bone cells that play a key role in this remodeling process: osteoclasts and osteoblasts. Osteoblasts are responsible for creating new bone, while osteoclasts absorb old, worn-out, or damaged bone. Various factors influence this process, but hormones play a crucial role.

First and foremost, as women, we should focus on building as much bone density as possible during our younger years. This can be achieved by consuming adequate calcium and engaging in weight-bearing exercises that stress the bones. It’s important to avoid habits that can harm bone development, such as smoking and excessive alcohol consumption. Additionally, there are concerns about the effects of consuming too much soda due to its phosphoric acid content and the tendency to substitute soda for milk. Following an eating plan that is high in calcium and incorporating weight-bearing exercises can help maximize bone density into our early thirties.

Both women and men should be concerned about bone loss, but for women, this process begins about twenty years earlier than for men. This is primarily due to menopause. As women experience a decline in estrogen levels, the balance of bone remodeling is disrupted. Osteoclasts, the cells responsible for bone reabsorption, become more active, while osteoblasts, responsible for forming new bone, slow down. This imbalance can lead to osteopenia, the initial sign of bone loss, and eventually lead to osteoporosis.

Lifestyle Strategies for Strong Bones

To protect your bones, focus on healthy eating and regular exercise. This advice might seem repetitive, but both will aid in managing blood glucose levels and strengthening your bones.

When it comes to healthy eating, your bones require both calcium and vitamin D. Foods rich in calcium include dairy products (so your mom was right about drinking milk), dark green leafy vegetables, and certain types of fish like salmon. 

Vitamin D can be a bit more challenging to obtain from food alone, but it is important for bone health because it helps our bodies absorb calcium from food, which is necessary for bone formation. Many dairy products are fortified with vitamin D, and you can also find it in salmon and sardines. Additionally, our bodies produce vitamin D when exposed to sunlight, but many of us use sunscreen to reduce the risk of skin cancer. Unfortunately, this reduces our ability to produce vitamin D naturally, so we may need to get enough through our diet or supplements.

Exercise is also important for bone health, particularly weight-bearing activities. Remember those osteoblasts that are responsible for building bone? When you exercise, the stress placed on your bones stimulates these osteoblasts to lay down more bone tissue, helping to heal the stressed areas and ultimately increasing bone density. So, keep up with those walks; they benefit both your blood glucose levels and your bone strength.

Medical Treatments for Osteopenia and Osteoporosis

Despite our best efforts, we may not always be able to avoid the aging process, genetic factors, or certain circumstances, such as medications for chronic illnesses that can negatively impact bone health. If osteopenia or osteoporosis does occur, we now have a range of medications available to help treat these conditions and support bone health. 

The standard recommendation for managing osteopenia includes increased intake of calcium and vitamin D. Additionally, treatments such as an estrogen receptor modulator (like Evista), estrogen therapy for menopausal women, or calcitonin (like Miacalcin) may also be considered.

A bisphosphonate – such as Fosamax, Boniva, or Actonel – may be prescribed in the more advanced stages of osteopenia and osteoporosis. These medications work by slowing the reabsorption of bone by osteoclasts, allowing osteoblasts the opportunity to produce new bone. Bisphosphonates can be taken daily, weekly, or monthly, depending on the medication. As with any treatment, there are potential side effects. The most commonly reported side effect of oral bisphosphonates is a burning sensation in the esophagus. To minimize this effect, taking these medications with a full glass of water, 30 minutes before any food, and remaining upright for at least 30 minutes afterward is advised. There have also been reports of unusual bone fractures and jawbone deterioration, which may occur due to the disruption of the bone remodeling process caused by inactivating osteoclasts. Therefore, it is generally recommended that patients take a “holiday” from bisphosphonates after five years of use.

An alternative option is Reclast, a bisphosphonate administered intravenously once a year. This option eliminates the issue of esophageal burning but does carry the same other potential side effects.

Another treatment available is Prolia, which is a RANK ligand inhibitor. This medication stops the stimulation of osteoclasts, which leads to bone reabsorption. Prolia is given as an infusion every six months. Because it only temporarily stops osteoclast activity and does not inactivate them permanently, ongoing treatment is necessary for continued effectiveness. The potential side effects of Prolia are similar to those of bisphosphonates, except for esophageal burning.

Another effective way to slow osteoporosis and rebuild bone is by stimulating osteoblasts to produce new bone tissue. Forteo was the first medication designed to achieve this, administered through a daily injection for two years. The second medication in this category is Tymlos, which is also a daily injection but is taken for 18 months. After the rebuilding phase, it is recommended that patients transition to an antiresorptive medication, as previously discussed.

The newest medication available is Evenity. This drug primarily stimulates osteoblasts to lay down new bone but also offers some antiresorptive effects by slowing down osteoclast activity. Evenity is given as a monthly injection for 12 months, and, like Forteo and Tymlos, it should be followed by an antiresorptive medication. Although bone fractures and jaw deterioration are rare side effects associated with these medications, they are still potential risks. Additionally, Evenity carries a risk of increased cardiovascular disease.

You can find a detailed osteoporosis medication chart outlining treatment options here.

It is fantastic that we have effective options to maintain our bone health. However, you play a significant role in this process by eating healthy and exercising. So, why not “kill two birds with one stone” by filling your plate with dark green leafy vegetables and walking after dinner?

Dr. Staci-Marie Norman, PharmD, DCES, received her bachelors from Purdue University (’94) and her Doctor of Pharmacy from the University of Oklahoma (’96). In 2000 Dr. Norman added to her credentials by becoming a Certified Diabetes Care and Education Specialist. She is currently the Clinical Coordinator and staff pharmacist for Martin’s Pharmacy. Dr. Norman is a national faculty member for the American Pharmacist Association, teaching certificate programs in both diabetes and cardiovascular disease. She serves on the advisory board that oversees development and revision of these programs. Along with teaching and development responsibilities for APhA, Dr. Norman serves as a peer reviewer for research grants and publication submissions. Dr. Norman has also spoken for Abbott, Bayer, Lilly, Mannkind, and Lifescan as a diabetes specialist.