Osteoporosis: Understanding Bisphosphonate Therapy

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What Is Osteoporosis?Osteoporosis is a disease in which bones become thin and fragile. When osteoporosis is left untreated, it may lead to broken bones or fractures, usually in the hip, spine, and wrist.

Bone is constantly renewed throughout life. After the age of 25 t

o 30, however, people begin to lose bone more quickly than they build it.

When women reach menopause, they may experience increased bone loss because of the lack of estrogen, which plays an important role in maintaining bone density. It is important to remember that some bone loss is a normal part of aging, but osteoporosis is not.

How Is Osteoporosis Prevented and Detected?The recognition and the correction of modifiable risk factors are vital to reducing the risk of osteoporosis. Modifiable risk factors for osteoporosis include:

? A sedentary lifestyle

? Low calcium or vitamin D intake

? Excessive alcohol use

? Tobacco smoking

Weight-bearing exercise as well as adequate calcium and vitamin D intake should be emphasized to all people who are at risk for osteoporosis.

Osteoporosis is often called the ?silent thief? because bone loss can occur without symptoms. In fact, many people do not know that they have osteoporosis until the disease weakens their bones so significantly that a sudden strain, bump, or fall causes vertebral collapse or a fracture of the hip, wrist, rib, or another bone. Therefore, early detection is of considerable importance for people with osteoporosis. Peripheral bone density testing is a cost-effective screening test for osteoporosis and may be used to assess risk in people with numerous risk factors. If peripheral testing produces lower than expected results, follow-up diagnostic testing should be recommended.

How Is Osteoporosis Treated?Lifestyle therapy for osteoporosis, including the elimination of risk factors, and adequate calcium and

vitamin D intake are essential even when pharmacologic therapy is used for treating osteoporosis.

Several types of medication?including alendronate sodium, risedronate sodium, calcitonin-salmon, and ralox-ifene hydrochloride?are used to treat osteoporosis. Alendronate and rise-dronate belong to a class of medications called bisphosphonates.

BisphosphonatesThe bisphosphonates are used both to prevent and to treat osteoporosis. They help reduce the risk of fractures by slowing bone resorption (loss), thereby increasing bone mass. Bisphosphonates prevent and treat osteoporosis for as long as they are taken, even though the person taking the medication will not be able to detect a difference in the way he or she feels or looks.

The majority of people who take bisphosphonates do so without problems, but a few side effects may occur, tablet should be taken (swallowed whole) with 6 to 8 oz of plain water (no juice, tea, coffee, or milk). The patient must remain upright for at least 30 minutes, and until after the first food of the day is eaten, before lying down. No food, beverages, vitamins, calcium, or antacids should be taken during this 30-minute interval because they can interfere with bis-phosphonate absorption.

Who Should Not Take Bisphosphonates?The following groups of patients should not take these medications:

? People with disorders of the esophagus

? People who cannot remain upright for 30 minutes

? People who have hypocalcemia (ie, low blood calcium), severe kidney disease, or bisphosphonate allergy Pregnant and nursing patients should discuss this therapy with their physicians.

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