For some people, having a heart attack can be life changing, spurring patients on to healthier life choices, like regularly exercising, starting a heart-healthy diet, and taking medication.
A bone fracture is not unlike a heart attack - they are both a sign that something is wrong. In the case of a fracture, it could mean you have osteoporosis or a weaker form of bone loss called osteopenia.
Bones shouldn't break with low-energy falls such as from standing height or less. When they do, your doctor may want to run blood and bone density tests to determine if you have osteoporosis. If diagnosed, patients should learn about weight-bearing exercise, fall prevention, and nutrition for healthy bones.
In addition, many patients may be candidates for starting an osteoporosis medication.
There are several medications available to treat osteoporosis:
Bisphosphonates make up the largest class of drugs. This includes Fosamax (Alendronate), Actonel (Risendronate), Boniva (Ibandronic acid), and Atelvia, which are pill form, and Zometa and Reclast (Zoledronic acid), which are once yearly injections. These drugs have been studied in large clinical trials for up to 10 years, and complications are rare. Patients are typically recommended to cycle on and off bisphosphonates in three- to five-year cycles. Patients take a "drug holiday" with careful follow up and continue with strict attention to weight bearing exercise and good calcium and vitamin D intake.
Prolia (Denosumab) is a newer treatment option that is administered via a shot every six months. It seems to be very effective in protecting bone mass and is well tolerated by patients. There is a theoretical risk in patients who are prone to infection or in patients on immunosuppressive therapy, since it is an antibody therapy. It acts on the same cells as bisphosphonates, so it could have similar risks.
Hormone replacement therapy for women after menopause may help protect bones. Evista (Raloxifene), a pill taken daily, affects the estrogen receptors on breast and bone tissue and helps protect against both breast cancer and osteoporosis.
Forteo (Teriparatide) is the only medicine currently available that increases bone density. It is an injection, self administered by the patient daily. It is limited to two years of use because bone cancer was seen in laboratory rats given Forteo at high doses; however, no human cases of bone cancer have been attributed to Forteo given at the current dose. Once the two years of therapy are complete, patients switch to one of the other medicines to maintain the gains they made in bone density with Forteo.
Most of the medications reduce the risk of having a new fracture by about 50 percent. Patients who have had a fracture as the result of a low-energy injury are candidates for one of these medicines, even if they have been diagnosed with osteopenia instead of osteoporosis.
Osteoporosis is one of the most undertreated diseases of modern times, despite the abundance of good treatments. Osteoporotic fractures can compromise quality of life with each new fracture, compounding the loss of function.
A fracture should be a life-altering event triggering treatment of osteoporosis, just like a heart attack triggers treatment of cardiac disease.
Christina Morganti is an orthopedic surgeon at Anne Arundel Medical Center. You can reach her office at Anne Arundel Medical Group Orthopedic and Sports Medicine Specialists at 410-268-8862.