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Spring 2009

New Drugs Improve Osteoporosis Treatment

Milk Osteoporosis TreatmentAn estimated 44 million people in the United States, and more than half the population over age 50, have osteoporosis or its precursor, osteopenia.

But new medications, a focus on increased intake of calcium and vitamin D, and more vigilant assessment of bone-mineral density and future fracture risk are among the latest treatments for the skeletal disorder, which is characterized by compromised bone strength that predisposes a person to greater risk of fracture.

“This is a very common problem. Patients should discuss their risks with their physicians,” says UCLA endocrinologist Sheila Ahmadi, M.D. About half of all white women will experience a fracture associated with osteoporosis in her lifetime. Osteoporosis also occurs in older men, who are less likely to be screened or treated for the condition, and who have a higher death rate as a consequence of hip fractures.

Regular weight-bearing exercise and getting adequate amounts of calcium and vitamin D can help prevent the development of osteoporosis, and should start at an early age, says Aurelia Nattiv, M.D., director of the UCLA Osteoporosis Center in Santa Monica. “People used to think of osteoporosis as a geriatric problem, but bone health begins in childhood,” she says.

Adequate intake of calcium and vitamin D are particularly important preventative factors. The National Osteoporosis Foundation updated recommended daily requirements in 2008: 1,200 mg of calcium and 800-1,000 IU of vitamin D for adults 50 years or older; 1,000 mg of calcium and 400-800 IU of vitamin D for adults under 50; and 1,300 mg of calcium and 400 IU of vitamin D for children and adolescents ages 9-18. Doses for younger children vary by age. Most people, however, fail to meet the recommended daily requirements, and daily supplements often are necessary to reach those levels, Dr. Nattiv says. Most current guidelines recommend screening for osteoporosis in all women over the age of 65 and for younger women and older men with risk factors for osteoporosis. The “gold standard” for diagnosis, assessment of risk and monitoring of treatment is dual-energy X-ray absorptiometry (DXA), a noninvasive scan.

Skeletol ScanSeveral drugs can slow and in some cases reverse the process of bone loss. The mainstays are the drugs known as bisphosphonates — pills that are taken daily, weekly or in some cases monthly. A once-a-year injectable medication also is available, and other promising new drugs are currently in clinical trials.

Despite the growing number of treatment options, a general lack of awareness about osteoporosis seems to exist among large segments of the at-risk population, says geriatrician Deborah Kado, M.D. “Osteoporosis, much like hypertension, is something you can walk around with and not realize you have,” Dr. Kado explains. “Many people don’t know they have low bone density until they have a fracture — and even then, they may not realize that there is more that can and should be done than getting a cast or having surgery.”

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