Nutrition and Supplements
In addition to calcium and vitamin D, I have heard that vitamin K is important for my bones. If I have osteoporosis, should I be taking a vitamin K supplement?–Show More +
At this time, research does not support the practice of taking vitamin K supplements to prevent osteoporosis and broken bones. Taking a supplement doesn’t always have the same effects as eating whole foods that contain that same nutrient. Also, because vitamin K plays a role in blood clotting, getting too much vitamin K could cause problems in individuals who take blood thinning medicines or are at risk of blood clots. More research will help us to determine the amount and type of vitamin K that is necessary for bone health. Until we know more, try to get enough vitamin K from food sources.
Talk to your healthcare provider about any nutrition deficiencies you may have and discuss which supplements you should take for your bone health.
Is there any harmful effect if someone takes more than 1200 milligrams of calcium supplements? If so, what kind of harmful effect could excess calcium cause?–Show More +
Is soymilk a good substitute for milk? How about tofu?–Show More +
If you have osteoporosis, does it mean you’re not getting enough calcium?–Show More +
I am lactose intolerant. Should I drink calcium-fortified soymilk or lactose-free milk?–Show More +
When a serving of milk says it contains 30% calcium, how do I know how much calcium is in that serving?–Show More +
The percent DV helps you determine whether a food is high or low in a nutrient. In general, 5% DV or less is low in a nutrient, while 20% DV or more is high. Daily Values are printed on the “Nutrition Facts” panel on food labels. The percent DV is based on one serving of food. Be sure to read the label carefully to learn the serving size and the number of servings.
The DV for calcium is based on 1,000 mg. This means a serving of milk with a Daily Value of 30% calcium has 300 mg of calcium.
In the case of vitamin D, the DV is based on 400 IU for adults. This means a food serving with a Daily Value of 25% vitamin D has 100 IU of vitamin D. There are few food sources for vitamin D. So, unless an item has been fortified with vitamin D, most food labels do not list the percent of the DV of vitamin D.
BHOF recommends that adults aged 50 and older get 1,200 mg of calcium every day, and adults under age 50 get 1,000 mg of calcium every day. Often, a balanced diet can include up to 250 mg of calcium from trace sources that are difficult to count, such as broccoli and certain green vegetables.
Getting enough vitamin D every day is important to help your body absorb calcium. Adults aged 50 and older need 800-1,000 IU of vitamin D every day, and adults under age 50 need 400-800 IU of vitamin D every day. Older individuals and those with osteoporosis may need more.
Do Vitamin D supplements prevent fractures?–Show More +
Vitamin D plays an important role in building and protecting bones by helping the body absorb calcium. The VITALS study, the largest and most comprehensive vitamin D study of its kind on a community population, reported in 2022 that vitamin D supplementation does not prevent fractures in healthy adults. It did not address whether people with osteoporosis or low bone mass should take supplemental vitamin D along with calcium and a prescribed medication to prevent further bone loss and fractures. Healthy adults with no vitamin D deficiency should be able to get adequate amounts of vitamin D by consuming a well-balanced diet. People with osteoporosis and low bone mass should discuss their vitamin D levels with their healthcare provider to ensure they are getting an optimal amount.
Does caffeine rob the body of calcium? If so, how much is harmful?–Show More +
Can soft drinks cause a problem for my bones?–Show More +
Phosphorus: Phosphorous exists in the human body as phosphate and, like calcium, is a major part of bone. The phosphorus found in food is needed to build healthy bones and other tissues. Because phosphorus is in many foods, it’s rare for healthy people not to get enough.
Phosphorous in the form of phosphate or phosphoric acid is often added to processed foods and soft drinks. As a result, concern has been expressed that Americans may be getting too much phosphorous. Some studies suggest that too much phosphorous can reduce the amount of calcium that the body absorbs. However, there is no scientific agreement about whether the current level of phosphorus in the American diet is harmful to the bones. For people with normal kidney function, getting more phosphorus is believed to be safe as long as they get enough calcium.
Caffeine: Caffeine is found naturally in coffee and tea, and it is often added to soft drinks. Caffeine in high amounts can cause bone loss. It interferes with calcium absorption and causes a slight increase in the amount of calcium in the urine. One study suggests that drinking 330 mg of caffeine, or about 4 cups of coffee every day, increases the risk of broken bones. If you enjoy drinks that have caffeine, you can make up for any calcium loss by getting enough calcium to meet your body’s needs. You can get calcium by eating calcium-rich foods and taking calcium supplements if you need them.
Be careful not to substitute caffeinated drinks for milk and calcium-fortified juices. When drinks that have caffeine take the place of milk and other sources of calcium, bone health may be affected. For coffee drinkers, the addition of milk can help make up for the loss of calcium caused by caffeine.
Carbonation: There is no connection between the carbonation in soft drinks and bone loss. In fact, certain carbonated mineral waters have been shown to improve bone health.
Summary: For bone health, it is best not to drink too many soft drinks or cups of coffee every day. To maintain bone health, BHOF recommends that adults under age 50 get 1,000 mg of calcium every day, and adults age 50 and older get 1,200 mg of calcium every day.
I just read that strontium helps bone density. Is this a new drug or a new treatment for osteoporosis?–Show More +
The mineral forms of strontium are not the same as strontium ranelate, which is a drug sold in Europe and other countries to treat osteoporosis. Chemically, strontium ranelate consists of a combination of strontium and ranelic acid. Strontium ranelate is not available in the U.S. since it has not been approved by the U.S. Food and Drug Administration (FDA).
In summary, strontium is not a new drug or a new treatment for osteoporosis. It is a mineral that is available in dietary supplements. Strontium ranelate is a drug that is not FDA-approved for use in the U.S. It is important to note that a dietary supplement does not substitute for a medicine that has been approved by the FDA for the treatment of osteoporosis. Additionally, dietary supplements are not FDA regulated or tested like drugs, nor are their health claims approved by the FDA.
What are drug-free natural alternative treatments for osteoporosis?–Show More +
It is also important to note that the U.S. Food and Drug Administration (FDA) is not able to approve health claims for dietary supplements. Manufacturers and distributors of dietary supplements and nutrients do not need approval by the FDA to sell their products. The FDA does not regulate or evaluate dietary supplements in the same rigorous way as prescription medicines.
The U.S. Pharmacopeia (USP) is an independent, scientific nonprofit organization focused on setting quality standards for the world’s medicines, dietary supplements and foods. Visit the USP Quality Supplements website here to learn more about verified supplements and where to find them.
The resources below offer additional information about alternative medicine and natural treatments:
National Center for Complementary and Alternative Medicine (NCCAM), National Institutes of Health (NIH)
Phone: (888) 644-6226
Web site: https://www.nih.gov/about-nih/what-we-do/nih-almanac/national-center-complementary-integrative-health-nccih
American Dietetic Association
Phone: (800) 877-1600
Web site: www.eatright.org
Distary Supplements Labels Database
Offers information about the ingredients in more than2,000 selected brands of dietary supplements
Web site: dsld.nlm.nih.gov/
National Institutes of Health (NIH)
Offers information on complementary and alternative therapies
Web site: www.nlm.nih.gov/medlineplus/complementaryandalternativetherapies.html
Office of Dietary Supplements (NIH)
Phone: (301) 435-2920
Web site: www.ods.od.nih.gov
I am a 55 year old woman with osteoporosis. I have read that jogging is one of the best exercises for building strong bones. Is running considered safe for me?–Show More +
Your healthcare provider, who knows your individual medical history and bone mineral density, should be able to provide guidance as to whether jogging is safe for you. A physical therapist can also be an excellent resource for information about exercise and bone health. If you’re interested in working with a physical therapist, your healthcare provider should be able to provide a referral for physical therapy.
I have osteoporosis. Can I do yoga exercises where I bend at the waist and touch the floor? Is it safe to twist from side-to-side?–Show More +
I have osteoporosis and poor balance. I’m worried about falling and breaking a bone. What can I do to improve my balance?–Show More +
Exercise 1. While standing and facing a countertop or the back of a sturdy chair, hold on and stand on one leg at a time for one minute. Switch sides and repeat.
Exercise 2. While standing and facing a countertop or the back of a sturdy chair, hold on and rock up onto your toes for a count of ten. Then roll back onto your heels for a count of ten. Repeat ten times.
Start each exercise at Level 1 below. When you can do it comfortably, move on to the next level.
- Level 1: Hold on with both hands during exercise
- Level 2: Hold on with one hand only
- Level 3: Hold on with one fingertip only
- Level 4: Keep both hands two inches above a countertop or back of a study chair
- Level 5: Close your eyes and keep both hands two inches above a countertop or back of a study chair
Always consult with your healthcare provider before starting an exercise program.
I just read that resistance exercises are important for bones too. What are resistance exercises?–Show More +
Resistance exercises include the use of free weights, wrist weights, weighted vests, exercise bands and weight machines found at gyms and health clubs. You can also do this type of exercise in your home without any special equipment, using your body as the resistance. For example, grasping the arms of a chair and using your arms and shoulders to gradually lift yourself up and lower yourself down is a resistance exercise. Wall and doorway pushes are other examples.
Lifting weights is probably the most familiar type of resistance exercise. With proper supervision and instruction, older adults can also lift weights and increase muscle strength while gaining bone benefits. Initially, the weights should be light, and you should pay close attention to using proper technique and posture to avoid placing too much stress on the spine. You can exercise each muscle group by doing the recommended exercises in repetitions with a brief rest of one to five minutes between each set of repetitions.
Weight-bearing exercises should be done almost every day for at least 30 minutes. Resistance or muscle-strengthening exercises, on the other hand, should only be done two to three times a week, with at least a day of rest to let the muscles recover and grow.
Staying as active as possible provides a benefit to your bones. Daily activities and most sports involve a combination of both resistance and weight-bearing exercises.
Note: Before beginning an exercise program, we recommend discussing guidelines for safety with your healthcare provider.
Are OsteoStrong and high intensity Biodensity exercise programs beneficial?–Show More +
In summary, the scientific community has long known the benefits of high-intensity resistance and impact exercise on BMD. While the high-intensity BioDensity exercise program may be beneficial for increasing BMD in adults, the evidence presented does not demonstrate efficacy of the OsteoStrong™ program on BMD outcomes. Furthermore, we do not know how it compares to the benefits of the current BHOF recommendations for weight bearing and resistance exercise. Further research is warranted before the benefits of the OsteoStrong™ program can be determined.
Will a weighted vest help me build bone?–Show More +
A weighted vest may not be safe for those who have had spine fracture, spine surgery or have high risk of breaking a bone. To prevent injury, before using a weighted vest consult with a healthcare professional or exercise specialist with expertise in osteoporosis to better understand if this may be a good option for you.
I have no family history of osteoporosis. I eat a healthy diet and exercise. How did I get osteoporosis?–Show More +
Can taking thyroid hormones cause me to have a greater chance of getting osteoporosis?–Show More +
When you take a thyroid hormone medicine, your doctor or other healthcare provider will check your thyroid function with a blood test called a thyroid-stimulating hormone (TSH). If the results of the blood test show that you are taking too much or too little thyroid hormone, your doctor will adjust your dosage. Most doctors do a TSH lab test at least once a year for patients taking thyroid hormones.
I have given birth to five children. Am I at greater risk for osteoporosis than a woman who has had only one or two children?–Show More +
According to research studies, women who have been pregnant more than one time have no lasting harm to their bones. These studies include women in the U.S. and other countries. One reason is that women absorb more calcium during pregnancy, especially in the second and third trimesters. This additional absorption of calcium helps to meet much of the developing baby’s calcium needs. Another change during pregnancy that may protect bones is an estrogen surge during the third trimester. Also, a woman carries an increased weight load due to the weight gain of pregnancy.
In fact, studies show that having children, even as many as 10, does not increase a woman’s chance of getting osteoporosis later in life. Research even suggests that each additional pregnancy provides some protection from osteoporosis and broken bones. Women who have never been pregnant might actually be at higher risk for bone loss and osteoporosis compared to women who have given birth according to some findings.
For women who had pregnancies in their teens, the effects on bone health later in life are still not certain. Teens have not yet reached peak bone mass. This is the point at which they have the greatest amount of bone they will ever have. Additional studies are needed to find out if teen pregnancies can affect future bone health.
Breastfeeding for the recommended 6-12 months has great health benefits for both mother and baby. Breastfeeding even longer does not appear to cause lasting influence on bone health.
All women who are pregnant or nursing need to get enough calcium, vitamin D and appropriate exercise to keep their bones healthy. Pregnant or breastfeeding women age 19 years and older need 1,000 mg of calcium and 400-800 IU of vitamin D every day. Pregnant or breastfeeding teens age 18 years and younger need 1,300 mg of calcium and 400-800 IU of vitamin D every day.
How concerned should I be about medicine for gastroesophageal reflux disease (GERD) resulting in bone loss and broken bones?–Show More +
The link between the PPI medicines and the risk of a broken hip appears to be a problem only for people on fairly high doses, equal to 40 mg or more a day, for a long period of time. People who use over-the-counter or even prescription doses once in a while should not be concerned.
Talk to your doctor first before stopping your medicine. Many people take these medicines for serious medical conditions. These medicines are important for people with major health problems, but they are not for everyone. Patients should be prescribed the lowest effective dose available to treat their condition(s). People concerned about taking these medicines should speak with their doctor or other healthcare provider about whether they need to continue using the medicines.
Ask your healthcare provider if you need a bone mineral density test. Long-term use of the PPI medicines may increase your chance of getting osteoporosis and having broken bones. If you are on high doses of these medicines for a long time, speak with your healthcare provider about whether you should have a bone density test.
Your calcium needs. To keep their bones healthy, adults need to have a balanced diet. This includes eating a variety of fruits, vegetables and calcium-rich foods. It is especially important for people taking PPI medicines to get at least 1,200 mg of calcium every day. While some people on these medicines may need a bit more calcium, they should not get more than 1,500 mg a day.
If you don’t get enough calcium from food, you need to take calcium supplements to get the rest of the calcium that you need. If you are taking PPI medicines, you may want to take calcium citrate supplements rather than other calcium supplements. Because these medicines block stomach acid, your body may absorb calcium citrate better than other types of calcium supplements. Unlike other calcium supplements, calcium citrate does not need stomach acid to be absorbed.
If you take another type of calcium supplement, like calcium carbonate, be sure to take it with a meal or snack. Your body makes stomach acid when you eat. Most calcium supplements need stomach acid to dissolve and for calcium to be absorbed.
Bone healthy behaviors. Like calcium, vitamin D is also important for your bone health. It helps your body absorb calcium. People under age 50 need between 400 and 800 international units (IU) of vitamin D every day. People age 50 and older need between 800 and 1,000 IU of vitamin D every day. Some people may need even more. Getting regular weight-bearing and muscle-strengthening exercise helps keep your bones strong and healthy. Drinking too much alcohol and smoking is harmful to your bones.
Abstract of the PPI Study
View the abstract of the study reported in JAMA.
I used Depo-Provera® for about three years for birth control. How concerned should I be about my bone density?–Show More +
In the case of teen girls and young women, it is not known if Depo-Provera® will reduce peak bone mass or increase the risk of osteoporosis and broken bones later in life. Peak bone mass is the point when a person has the greatest amount of bone she or he will ever have. A study funded by the National Institutes of Health (NIH) found that bone density appears to recover in teen girls after they stop using Depo-Provera®. The results of this study were published in 2005. Other studies have had similar findings, but the effects on bones might be different in women who use Depo-Provera® for a long time, especially five or more years. </p>
<p>Because of concerns about its effect on bones, the FDA has advised that Depo-Provera® should not be used longer than two years if other forms of birth control are available and appropriate.
You may wonder when you should have a bone density test. That depends on your risk factors for osteoporosis. There are no guidelines suggesting routine bone density testing of premenopausal women. Bone density tests are usually only recommended for premenopausal women if they break several bones easily or break bones that are unusual for this age group. For example, breaking a hip or breaking a bone in the spine is unusual. Health care providers may also recommend a bone density test for young premenopausal women who need to take a glucocorticoid (steroid) medicine.
Young women with a major family history of osteoporosis or with other risk factors for osteoporosis may want to choose a different form of contraception.
Because of your past use of Depo-Provera®, bone healthy behaviors are especially important. Be sure to get your calcium and vitamin D every day and exercise regularly. If you smoke, give it up, and don’t drink too much alcohol.
I take Arimidex® for my breast cancer, but I have read that it can cause bone loss and osteoporosis. Is there anything I can do?–Show More +
While AIs are very effective treatments for breast cancer, drugs in this class can cause bone loss and an increased chance of breaking a bone. When women have estrogen sensitive-breast tumors, estrogen can cause the cancer to grow and spread. AIs help women with this type of cancer by reducing the estrogen levels in the body. Even though a postmenopausal woman already has low levels of estrogen, it is this additional decrease in estrogen that can cause bone loss.
AIs are different from other hormone related medicines used to treat breast cancer, such as tamoxifen. For example, tamoxifen does not cause bone loss in postmenopausal women, although it can cause bone loss in premenopausal women.
Before starting cancer treatment. Some healthcare providers recommend that women have a bone density test of the hip and spine before they start cancer treatment. The results of this test can serve as a baseline. When a bone density test is repeated in the future, it can be compared to the results of the baseline test to find out if any bone density has been lost. Women who have low bone density or osteoporosis should consider taking an osteoporosis medicine, such as a bisphosphonate, when starting treatment with an aromatase inhibitor. Women who develop low bone density or osteoporosis while taking an aromatase inhibitor should also consider starting an osteoporosis medicine. Osteoporosis medicines help prevent further bone loss and reduce the risk of breaking a bone.
Other tests that may be useful are blood and urine tests that show changes in bone turnover. These tests are sometimes called bone turnover marker tests or biochemical marker tests. The results of some of these tests, such as serum bone alkaline phosphatase or urine N-telopeptide, might increase during cancer treatment. This could be a sign that bone loss will occur and can suggest the need for an osteoporosis medicine.
Risk factors you can control. Other steps you can take to protect your bones during cancer treatment include having a balanced diet with fruits and vegetables and getting enough calcium and vitamin D. Adults under age 50 need 1,000 mg of calcium and 400 – 800 IU of vitamin D every day. Adults age 50 and older need 1,200 mg of calcium and 800 – 1,000 IU of vitamin D every day.
Both weight-bearing exercises and muscle-strengthening exercises can benefit your bones. Examples of weight-bearing exercises are walking and playing tennis. Examples of muscle-strengthening exercises are lifting weights or using elastic exercise bands. Inactivity and lack of exercise contribute to bone loss. Smoking and drinking too much alcohol are also bad for your bones.
Remember that if you have low bone density, your bones will break more easily. Older people especially should be aware of ways to prevent falls.
Does androgen deprivation therapy lead to bone loss?–Show More +
To maintain bone health during prostate cancer treatment, it is important to get enough calcium and vitamin D every day*and to exercise regularly. You should do weight-bearing exercises, like walking or playing tennis and muscle-strengthening activities, like lifting weights or using elastic exercise bands. Also avoid smoking and don’t drink three or more alcoholic drinks a day, since smoking and alcohol greatly increase the risk of bone loss for men undergoing ADT.
Have your bone density tested before starting ADT to serve as a baseline. When your bone density test is repeated after you’ve been on ADT, the results can be compared to your baseline test to see if you’ve lost bone density.
If your bone density is already low on the baseline test, it’s helpful to start taking an osteoporosis medicine at the same time as starting ADT. Men usually take either alendronate (Fosamax®), risedronate (Actonel®) or zoledronic acid (Reclast®), which are all in a class of drugs known as bisphosphonates. Research shows that men taking an osteoporosis medicine while receiving treatment for prostate cancer are able to maintain or even increase bone density and reduce their risk of breaking a bone.
If you have already been treated with ADT and have not had a bone density test, talk to your healthcare provider and request a test. It’s never too late to take action to protect your bone health.
*Men age 70 and younger need 1,000 mg of calcium and men age 70 and older need 1,200 mg of calcium every day. Men under age 50 need 400 – 800 IU of vitamin D and men age 50 and older need 800 – 1,000 IU of vitamin D every day. Some people may need even more vitamin D. A blood test of 25-hydroxy vitamin D is an easy way to make sure you are getting enough vitamin D.
A friend told me that weight loss can rob the bones of density. Is that true?–Show More +
- Exercise regularly. Include both weight-bearing and muscle-strengthening exercises to help support your bone health. For people trying to lose weight, it is best to lose the weight gradually and to exercise regularly as part of a weight loss program. Exercise not only helps you lose weight, but it helps maintain bone density too.
- Be sure to eat a balanced diet. A balanced diet that includes a variety of fruits, vegetables and calcium-rich foods will help you meet your nutrition needs. It is especially important to get enough calcium and vitamin D. While protein is important for health, a very high protein diet causes an additional loss of calcium through the kidneys. Getting an adequate amount of calcium will offset these losses.
- Avoid smoking and drinking too much alcohol. Remember that both smoking and drinking too much alcohol are harmful to the bones. To keep your bones healthy, don’t drink more than two – three alcoholic drinks a day. Also, inactivity and a sedentary lifestyle can cause bone loss.
- Find out which weight loss program is right for you. Talk to your doctor or other healthcare provider before you start to diet. Ask for guidance on a weight loss diet that is appropriate for you.
- Set a realistic target weight. People with low body weight are at greater risk for osteoporosis, so aim for a moderate goal. In older women and men, some studies have shown that a weight loss of 10 percent or more also places them at greater risk for breaking a hip.
- Ask if you need a bone density test. Talk to your healthcare provider about whether a bone density test should be done before you start and/or during your weight loss program. It will help you find out if an osteoporosis medication should be considered to support bone health during and/or after your diet.
I have been taking alendronate (Fosamax®) for many years. Is there a test for osteonecrosis of the jaw (ONJ) that I can take before having a tooth pulled?–Show More +
What drug is best for perimenopausal bone loss?–Show More +
Do bisphosphonate medicines help people with osteoporosis to get better or just keep them from getting worse?–Show More +
Do bisphosphonates actually increase the risk of broken bones in the thigh and/or hip?–Show More +
For people with osteoporosis who take bisphosphonate medicines, unusual fractures of the thigh bone are uncommon, unlike fractures of the hip, spine and wrist. BHOF is closely evaluating ongoing research in this area so that we can learn more about these fractures. This will help us to better understand the potential relationship between unusual thigh fractures and bisphosphonate medicines. BHOF believes the benefits of bisphosphonate treatment in patients at high risk of osteoporotic fracture strongly outweigh the risks from treatment for most individuals. As with all medicines, the risks and benefits of treatment must be carefully considered. All decisions related to treatment should be made under the guidance of each person’s healthcare provider.
My doctor recommended the IV medicine Reclast® for my osteoporosis. Are the side effects worse when it’s given only once a year?–Show More +
Reclast® belongs to a class of drugs called bisphosphonates. In general, its side effects aren’t any more serious than those of the bisphosphonate medicines that are taken as pills to treat osteoporosis. These other medicines are Actonel® (risedronate), Boniva® (ibandronate) and Fosamax® (alendronate).
Side effects that are different from those seen with the bisphosphonate pills can occur shortly after receiving Reclast®, usually within one or two days. These side effects include flu-like symptoms, fever, headache and pain in muscles or joints. They are temporary and usually last only two or three days. You are less likely to have them the next time you have an IV infusion of Reclast®. Also, the side effects you may experience after taking IV Boniva® are similar. Most people who have taken bisphosphonate pills in the past do not have these side effects when they receive the IV Reclast® medicine.
Rare side effects, such as severe bone, muscle or joint pain and osteonecrosis of the jaw (ONJ), are not any different from those of the other bisphosphonate medicines. Because Reclast® is given directly into the bloodstream, it does not cause any stomach or throat irritation.
A healthcare provider gives Reclast® as an IV dose of 5 mg in a doctor’s office or other outpatient setting. It takes at least 15 minutes for the yearly infusion. Patients need to have two blood tests before each IV dose. One is a test for creatinine to check the kidneys. The other is a test to check blood calcium levels.
As you would with any medicine, it’s important to tell your healthcare provider if you think you are having a side effect. People can have unexpected side effects with any medicine.
For Reclast® to work, you need to get enough calcium and vitamin D and to exercise regularly. BHOF recommends that adults under age 50 get 1,000 mg of calcium and 400-800 IU of vitamin D every day. Adults age 50 and older need 1,200 mg of calcium and 800-1,000 IU of vitamin D every day.
Should I be concerned about articles I have read that say some osteoporosis medications can cause an irregular heartbeat?–Show More +
In 2007, the results of a major research study (4) suggested an increased possibility of atrial fibrillation in a small number of postmenopausal women given zoledronic acid (brand name Reclast®). The study’s findings were not conclusive and after reviewing the research results, the Food and Drug Administration (FDA) approved zoledronic acid to treat osteoporosis in postmenopausal women. A second study (5) of this same medicine in older people with more medical problems did not show any increase in atrial fibrillation.
Atrial fibrillation is more commonly found in people 65 years and older, which is the age range of many women in these studies. Both alendronate and zoledronic acid are in a class of drugs called bisphosphonates. To-date, the FDA has approved four bisphosphonate medications to treat osteoporosis.
Due to concerns about atrial fibrillation, the FDA began a safety review of bisphosphonates in 2007. Until more information becomes available, the FDA says there is no need to stop using bisphosphonates. Based on what is currently known, most experts agree that the benefits of taking these medications for osteoporosis outweigh the possible risk of atrial fibrillation.
BHOF encourages you to discuss concerns about possible side effects from a medication with your healthcare provider. Let your healthcare provider know if you have any heart problems or other health conditions. People taking an osteoporosis medication should review and discuss their treatment plan each year with their healthcare provider.
Always report any possible medication side effects to your healthcare provider and the FDA. The toll free number for the FDA is (800) 332-1088. To complete a report online, the FDA Web site is www.fda.gov/medwatch/report.htm.
For additional information about the FDA’s ongoing safety review of bisphosphonates, visit the FDA Web site at http://www.fda.gov/Drugs/DrugSafety/ucm229009.htm.
Studies Mentioned Above:
1. In a letter to the editor, a review of the FIT study results was published in the <em>New England Journal of Medicine</em>, May 3, 2007. The name of the article is “Alendronate and Atrial Fibrillation.”
2. This study was published in the <em>Archives of Internal Medicine</em>, April 28, 2008. The name of the article is “Use of Alendronate and Risk of Incident Atrial Fibrillation in Women.”
3. This study was published in the <em>British Medical Journal</em>, April 12, 2008. The name of the article is “Use of Bisphosphonates Among Women and Risk of Atrial Fibrillation and Flutter: Population Based Case-Control Study.” It is available for free at www.bmj.com.
4. The HORIZON study was published in the New England Journal of Medicine, May 3, 2007. The name of the article is “Once-Yearly Zoledronic Acid for Treatment of Postmenopausal Osteoporosis.” It is available for free at www.nejm.com
5. The HORIZON Recurrent Fracture Trial was published in the New England Journal of Medicine, November 1, 2007. The name of the article is “Zoledronic Acid and Clinical Fractures and Mortality after Hip Fracture.”
Note: This article was published in The Osteoporosis Report, Fall 2008.
How can I tell if my treatment is working?–Show More +
For some people, medicines lead to an increase in bone density. For others, these medicines help individuals maintain bone density and prevent further bone loss. Each person responds differently, but by preventing decreases in bone density, these medicines reduce the likelihood of broken bones.
Sometimes if the bone density does not show the expected changes over a reasonable period of time on treatment (which varies depending on the formulation, dose and prior treatments) , measuring the biochemical markers of bone turnover through lab tests can be helpful to see if there are the changes one would expect. Sometimes new or newly mineralized bone may not show up on a bone density scan.
Whenever one does not have an expected response to an osteoporosis medication, it’s important to assess any changes in an individual’s health history, such as a new medical condition or new medication. It may indicate a need to be re-evaluated for underlying causes of osteoporosis and assessment of calcium and vitamin D intake.
To be effective, osteoporosis medication must be taken as prescribed. It is also important to have adequate blood levels of calcium and vitamin D for the medicine to work optimally and to perform weight bearing exercise. If you decide that a particular treatment is not right for you, discuss your concerns with your healthcare provider before stopping or interrupting treatment to make sure you do not experience rapid bone loss contributing to fractures.
Am I able to stop Prolia after my bone density increases?–Show More +
Can larger people have bone density tests?–Show More +
As your mother was told, most central DXA machines cannot measure bone density in people who weigh over 300 pounds, and some central DXA machines have a weight limit of 250 pounds. Although new central DXA machines have recently been introduced that measure BMD in people who weigh up to 400 pounds, they are not widely available yet.
For people who cannot have a bone density test by a central DXA machine, there are several other ways to measure bone density. These are called peripheral bone density tests. These tests measure bone density in the extremities, including the heel, wrist, finger or forearm (between the wrist and elbow). A peripheral test can be used with a person who is too heavy for a central DXA test of the hip and/or spine. Some healthcare providers recommend having both a peripheral DXA test of the radius bone of the forearm and a peripheral test of the heel or another bone. Doing both of these tests might give more complete information.
All of these tests are non-invasive. This means there are no needles or instruments placed through the skin or in the body. They usually take only a few minutes, and the patient remains fully dressed for the test.
People having a peripheral test should be aware that there are some limitations with this type of test. Comparisons between a peripheral test and a DXA test of the hip and/or spine may not be reliable. Bone density in the hip and spine are important because they are the bones most likely to break due to osteoporosis. These types of broken bones are the most serious.
Peripheral tests are suitable for screening and predicting the risk of breaking a bone, but experts prefer the DXA test for diagnosing osteoporosis and monitoring treatment in patients with osteoporosis.
My mother is recovering from surgery for a broken hip caused by a fall. What can be done to help her become independent again?–Show More +
One medicine has been specifically tested in patients who have recently broken a hip. This medicine is zoledronic acid (Reclast®). It can reduce the risk of more broken bones and even extend the life of women and men who have broken a hip due to osteoporosis.
Your mother also needs to get 1,200 mg of calcium and 800-1,000 IU of vitamin D every day. Getting enough calcium and vitamin D are important to help keep her bones strong and healthy. Vitamin D not only helps absorb calcium, it plays a role in muscle strength and balance and may help reduce the risk of falling.
If your mother needs to take an osteoporosis medication, it’s still important that she get enough calcium and vitamin D every day. Many older patients are at high risk for not getting enough vitamin D. There is a possibility she might need more vitamin D than the recommended amount above. One way to find out is with a simple blood test of her 25-hydroxy vitamin D level. It is also important for her not to smoke or drink too much alcohol. Smoking and having three or more alcoholic drinks a day are not good for people’s bones.
Rehabilitation and a slow return to exercise are important after breaking a bone, especially a hip bone. At first, walking may be difficult. For this reason, many patients are transferred from a hospital to a rehabilitation facility. A good rehabilitation center has staff specially trained to help your mother become stronger and more active every day. She may start out using a walker to move herself a few steps, but slowly her balance and strength will improve. Then she will likely use a cane for a while. Sometimes this is not easy, as she may have some pain, discomfort and feel tired. She may need to continue physical therapy once she returns home, and that too is important for her recovery.
Before your mother returns home, you may wish to check her home to make sure it is fall-proof. A few basic home safety tips include:
- Remove all clutter from the floors including loose throw rugs, long electrical cords and phone cords.
- Install grab bars on bathroom walls beside tubs, showers and toilets.
- Use 100 watt bulbs in place of low level lighting.
- Add night lights in the bedroom, hall and bathroom.
- Make sure your mother wears supportive, low-heeled shoes even at home. She should not walk around in socks, stockings or scuffs. And she should not wear backless shoes or slippers.
- Consider subscribing to an at-home monitoring service.
- Use a portable phone in the home. It’s easy to take from room to room. It prevents rushing for the phone when it rings, and it’s handy if there’s a need to call for help.
- Review all medications with her doctor as some can cause dizziness and increase the chance of falling.
Have your mother talk to her doctor about seeing a physical therapist to check her balance. Balance problems can cause a person to fall. Certain exercises help many people improve their balance. A physical therapist can teach her these exercises. Physical therapy can have many other benefits including improved muscle strength and posture.
Is the stiffness and pain in my legs and back due to my osteoporosis?–Show More +
Osteoporosis is called a “silent disease” because there are generally no symptoms or pain until you break a bone. For the pain you are having, we encourage you to speak with your doctor or other healthcare provider to determine the cause and to help you find relief from your pain.
When a person with osteoporosis in the spine has back pain, this may be caused by a broken bone in the spine. When you have osteoporosis and are having back pain, you should see a healthcare provider to find out if you have broken a bone in the spine. A lateral x-ray of the spine or a vertebral fracture assessment (VFA) can be used to look for broken bones in the spine.
For people with osteoporosis in the spine, it is important to protect the spine from broken bones by moving properly during exercise and daily activities. For example, do not bend over from the waist and avoid twisting motions of the trunk. Also, don’t carry packages that are too heavy or reach for objects on a high shelf.