Osteoporosis: Prevention and Treatment

Osteoporosis is a condition in which bones lose mass and become weak and brittle. It affects 10 million people and causes two million fractures in the U.S. per year. Joy Wu, MD, Chief, Division of Endocrinology, discusses the testing, diagnosing, and treatment of osteoporosis. She describes the condition’s risk factors, who should get a bone density test (DXA), and what steps you can take to decrease your risk. Dr. Wu covers common medications such as Fosamax (Alendronate), Boniva (Ibandronate) and other osteoporosis medications, including the pros and cons of each. Finally, Dr. Wu answers many questions from the audience.

Joy Wu, MD, PhD, is a board-certified endocrinologist who specializes in treating osteoporosis and other bone and mineral diseases. Dr. Wu is Chief of the Division of Endocrinology, Gerontology and Metabolism and Vice Chair of Basic Science in the Department of Medicine at Stanford.

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[sharonshea]

The confusion starts by using the term “falls” and “accidents” with the assumption that it means the same thing as fractures. “50 % of people over 50 years experience falls” does Not mean that it translates into fractures.

The actual statistics show only one in a hundred people will get a fracture, and that that one person may be helped by a “bone health” medication only half the time. That is, of 200 people, only two may have a fracture, and only one of them might be helped with medication. That’s one in 200, That’s .05% improvement at best, with quite possibly a pharmaceutical company funded bias. (Often relative statistics are quoted instead of absolute results, which confuses doctors as well as their patients.)

Necrosis of the jaw is Not “rare.” The whole action of a drug such as Fosamax, the bisphosphonates, is to Stop all osteoclasts from continually breaking down old or damaged bone cells while osteoblasts are Stopped from rebuilding it. The result is the old and damaged material that’s not removed builds up, thus making the bone Appear thicker or “denser.” This increase is the result of blocking the osteoclasts from taking out the bone trash, while rebuilding bone naturally is blocked.

With medication, the bone is more dense, but not stronger. It’s actually more porous. For bone under more heavy use in body action, such as the jaw or femur, the blocking of bone building causes eventual disintegration of the bone. This is why patients are put on a drug “holiday”, usually after about three years. The drug is removed before damage is so severe that it will be a problem for every patient. It’s not a rare “if” problem, it’s a matter of when it becomes so damaging that it’s noticed as an eventual “side effect.”

Because bone building is halted, if a break does occur, healing is difficult or impossible. This may be temporary if taken off the medication, or it will have so damaged the ability of osteoblasts to build bone, that trouble building bone and repairing breaks is permanent.

Finally, a break doesn’t necessarily mean a patient has unusually fragile bones. They may be fragile because of a sedentary lifestyle, they broke a wrist or thumb while skiing, or slipped on black ice. These are behavioral issues, not issues that need to be medicated.

[karenBarr-ec]

In Japan they have discovered the microphages that attack the bones that causes osteoporosis. This is great news, as it could mean new treatments and prevention of Osteoporosis in the future.

[AAB]

What about EchoLight? It’s supposed to be much more accurate than DEXA.

[HappyAnt-rqpq]

Are weight vests while walking good for strengthening spinal bones? I saw a couple who I thought were on their walk wearing bullet proof vests as they walked, only to realize they were weight vests.

[heatherhigson]

I’m confused . If my bone density is -2.7 and I’m 58. 7 stone . 4ft 9 in . Do I need medical advise ?
Also if you get osteonecrosis what can they do medically?

[cherlgolja]

Forget calcium ! Do research on minerals, K7 !

[betsymarcum]

I am 77. Took Prolia 5-1/2 yrs. Been on Alendronate 8 months. Need to know how to get off meds in the safest manner. Recent dexascan says I am osteopenic. Have had many side effects from Alendronate, including intense psvt acting up, spasms in my throat, my right hip and many leg night cramps. My concern is that the bone density gained from nefs is not flexible bone but brittle bone.

[parvezparacha]

What is difference between t-score and z-score? Which one is more powerful marker of osteoporosis?

[MaryAnnZimmerman]

Is there any way to reverse osteoporosis?

[patriciajump]

North American Menopause Society has much broader indications for hrt now. And it helps!

[ritasallee]

The how much milk question is ludicrous. There are so
many other sources of calcium. The calcium in milk is poorly absorbed.

[TheWaldzell]

What about osteoporosis I before menopause in younger age about 36?

[ershadkhandker]

Too technical . sequencing of information.could be improved.

[doctorjeff]

Lots of negative reports about Prolia.

[SamuelGardner-li]

Thomas Brenda Thomas Lisa Martin Joseph