This year, World Osteoporosis Day celebrates on the theme “Love Your Bones: Protect Your Future!”. Observed annually on 20 October, this programme is a global effort aimed at raising awareness on the diagnosis, treatment and prevention of the disease1. In conjunction with the campaign, we take a look at three essential components in successfully managing osteoporosis.

1. New osteoporosis guidelines offering more treatment options

Earlier this year, the American College of Physicians (ACP) released an updated version of their guidelines on the treatment of osteoporosis after nearly a decade, since the first release in 20082.

One notable recommendation advocates the prescription of alendronate, zoledronic acid, risedronate or denosumab for at least five years in women who have confirmed osteoporosis. Bone density monitoring during this period is not recommended. Additionally, bisphosphonates should also be offered to men with known osteoporosis2.

Osteoporosis drug usage plummeted by 50% between 2008 and 2012 ever since the release of reports on their adverse effects. Gruesome stories of rotting jawbones and femurs (osteonecrosis) left patients willing to take their chances with the disease3.

Physicians hope that this recommendation may increase patients’ confidence in medical treatment. “Physicians should prescribe generic drugs to treat patients with osteoporosis whenever possible and they should discuss the importance of medication adherence, especially for bisphosphonates,” comments Jack Ende, MD, president of the ACP4.

Dr Allison Hahr, director of the Bone Health and Osteoporosis Program at Northwestern University's Feinberg School of Medicine, explaining the effects of osteoporosis on her spine. Photo credit: William Camargo/Chicago Tribune
Dr Allison Hahr, director of the Bone Health and Osteoporosis Program at Northwestern University's Feinberg School of Medicine, explaining the effects of osteoporosis on her spine. Photo credit: William Camargo/Chicago Tribune

Another change echoed in the updated guideline is the recommendation against menopausal oestrogen therapy only, or with progestin or raloxifene. The risks of cerebrovascular accidents and venous thromboembolic events were deemed to outweigh their potential benefits2,4.

2. Nutrition vital in maintaining bone health

Bone thinning is an ongoing process that begins during young adulthood and cannot be halted. Therefore, maintaining a healthy diet from as early as the third decade of life is vital in ensuring bone health. Calcium and vitamin D are without a doubt the most important nutrients. Daily calcium requirements for premenopausal women between ages 19 and 50 and men between ages 19 and 70 lie at 1000mg/day – with requirements increasing to 1200mg/day in post-menopausal women and men beyond 70 years of age5.

Dietary calcium can be obtained from dairy, soft-boned fish and fortified breakfast cereals. Similarly, vitamin D can be gained from food but is best obtained via sun exposure. Adequate protein intake from lean meat and dairy is also crucial in building up optimal bone mass in youth, and to preserve bone mass in the elderly5. A large study of over 15,000 people in the United States found that hypoalbuminemia was independently associated with osteoporosis of the femoral neck, hip and lumbar spine6. Minerals such as magnesium, and vitamins B, A and K have also been found to play important roles in ensuring healthy bones5.

3. High-intensity resistance and impact training (HiRIT) safe and effective for osteoporotic women

High intensity impact and resistance training consists of intense strength and cardiovascular exercises.
High intensity impact and resistance training consists of intense strength and cardiovascular exercises.

Regular exercise has long been known to protect against bone loss. Besides strengthening supporting muscles, weight-bearing and resistance exercises have been proven to increase bone thickness by indirectly stimulating their growth. However, there is much debate over the appropriate intensity of such exercises, as there is fear of accidental damage to fragile osteoporotic bones.

A recent study in Australia has shown that HiRIT exercises are safe and beneficial in building muscle and improving bone strength in post-menopausal women with osteoporosis. Half of the women performed HiRIT, while the other half performed low intensity exercises. HiRIT consisted of 30-minute sessions of intense exercises including squats, jumping chin-ups, drop landings, deadlifts and overhead presses. Both groups underwent training twice a week for eight months7.

Interestingly, at the end of the study, patients who received HiRIT showed an increase in bone mineral density (BMD) of 3% in their spines, and an increase of 2.2% in their hips. This contrasted strongly against the other group, where women instead lost 1.2% BMD in their spines, and more than 2% lost in their hips7.

Although promising, further research is necessary to validate these results, ideally in a larger study group. Dr Ethel Siris, a physician with the New York Presbyterian Hospital not involved with the study cautioned against unsupervised routines. “You don’t want someone with poor bone health to overdo repetitions because they can get a stress fracture,” remarked Siris7. MIMS

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Sources:
1. https://www.iofbonehealth.org/world-osteoporosis-day-2017
2. http://annals.org/aim/article/2625385/treatment-low-bone-density-osteoporosis-prevent-fractures-men-women-clinical
3. http://www.chicagotribune.com/lifestyles/health/ct-hlth-osteoporosis-treatment-0830-story.html
4. https://www.sciencedaily.com/releases/2017/05/170508184914.htm
5. https://www.iofbonehealth.org/preventing-osteoporosis
6. https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2016-1099#60340597
7. https://in.reuters.com/article/us-health-osteoporosis-resistance-fitnes/intensive-resistance-training-safe-effective-for-women-with-osteoporosis-idINKBN1CL31D