By Stephanie Devaney, MSN, APRN, FNP-C
Osteoporosis is a skeletal disorder characterized by decreased bone mass leading to increased fracture risk. There are many factors that can increase risk of osteoporosis including early menopause, low body weight, family history, smoking, excess alcohol consumption or long-term use of steroids and other medications. Screening for osteoporosis is generally recommended with a bone density (DEXA) scan in all adults older than 50 years of age with a history of fracture. The Preventive Services Task Force recommends screening for osteoporosis in women 65 years or older as well as younger women who are at increased risk for fracture. The Endocrine Society recommends screening all men 70 years of age and older and men 50 to 69 years of age who have additional risk factors for secondary osteoporosis.
Healthy lifestyle is essential in bone health and osteoporosis prevention. Some considerations include maintaining adequate intake of calcium, vitamin D, regular weight-bearing exercises and avoiding smoking and limit alcohol intake. Maintaining healthy body weight is also important for supporting long-term bone health as a low BMI < 19 also increases risk of bone loss. Recommended calcium intake is 1000 mg to 1200 mg daily and can be obtained through calcium-rich foods like dairy, leafy greens and fortified cereals or supplementation when needed. An ideal vitamin D level is between 30 to 50 ng/mL and can be supported through 15 minutes of daily sunlight or supplementation. Regular weight bearing exercise like walking along with resistance or strength training 2-3 x week also helps to support healthy bones. Alcohol consumption and smoking decreases bone density and increases risk of fracture.
When indicated medications may be used to slow down bone breakdown or actively build new bone to prevent fractures. First-line treatments typically include bisphosphonates, followed by biologics or anabolic therapies. Bisphosphonates include Risedronate (Actonel); Alendronate (Fosamax); Ibandronate (Boniva); Zoledronic acid (Reclast). These medications inhibit osteoclast (cells that break down bone) activity, reducing bone resorption and turnover. Denosumab (Prolia) is biologic medication that targets a specific protein involved in bone breakdown reducing bone resorption and turnover. Anabolic therapies include Teriparatide (Forteo) & Abaloparatide (Tymlos) which bind to parathyroid hormone receptors, stimulating new bone formation and increasing skeletal mass and bone strength. Romosozumab (Evenity) is a monoclonal antibody with a dual effect—it blocks sclerostin, a natural protein that normally slows down bone growth increasing bone formation and reduces bone breakdown. Raloxifene (Evista) is a selective estrogen receptor modulator (SERM) that simulates the beneficial effects of estrogen on bone density, decreasing bone resorption and turnover. Treatment plans vary depending on bone
density scan results, fracture risk and potential side effects. It is important for patients to maintain healthy lifestyle to promote bone health, screen for osteoporosis and discuss treatment options with their medical provider when indicated