Treating Osteoporosis: What a... Video Transcript

Participants

, David R. Marks MD, Michelle Warren MD

Summary

The primary goal of osteoporosis treatment is to reduce the risk of fracture. Diet and exercise play an important role in treatment, but it's important to understand the medical options as well, as there are medications that can greatly reduce the rate of bone loss, and even increase bone density. Join us as we discuss the various treatment options for osteoporosis.

Webcast Transcript

DAVID R. MARKS, MD: Hi, and welcome to our webcast. I'm Dr. David Marks. The treatment of osteoporosis is focused on one goal: reducing your risk of fractures. Diet and exercise play a big role, but it's important to know about your medical options, as well, because they can greatly reduce your rate of bone loss and even increase bone density.

Joining me today to discuss these options is Dr. Michelle Warren. She's the director of the Center for Menopause Hormonal Disorders and Women's Health at Columbia University in New York City. Welcome.

MICHELLE WARREN, MD: Thank you.

DAVID R. MARKS, MD: What role does diet play in osteoporosis?

MICHELLE WARREN, MD: It's an important role, particularly when you're young. If you haven't had enough calcium, you don't reach your peak bone mass. We see terrible osteoporosis in people who have had eating disorders. Later on, if you don't take in enough calcium, it can affect your bones. If you take in too much alcohol or caffeine, it encourages the bone to break down and you lose bone. If you don't take enough vitamin D or you're not in the sun enough, which helps the body produce the active form of vitamin D, it could cause vitamin D deficiency and have a severe effect on bone.

DAVID R. MARKS, MD: Now, if somebody does have osteoporosis, when does a doctor decide that medical treatment is necessary?

MICHELLE WARREN, MD: There are two times when it really worries us. One is if you've had a fracture and the other one is if you're over 65. We feel that in those two instances, patients should be evaluated for osteoporosis because they're at high risk.

DAVID R. MARKS, MD: Which factors go into your decision-making on what you recommend for a patient?

MICHELLE WARREN, MD: The first thing we do is to do a bone density test, and then we look to see how severe the bone loss is. Then it's an issue of how old they are, what sex they are and what fits their lifestyle best. There are several options that are available, and it really depends on the patient.

DAVID R. MARKS, MD: What are the options?

MICHELLE WARREN, MD: They include hormone replacement therapy, the bisphosphonates -- alendronate (also known as Fosamax), risedronate (also known as Actonel), and the SERMs -- selective estrogen receptor modulators, and calcitonin. Then there are a few other drugs that have not been approved yet.

DAVID R. MARKS, MD: Let's back up and take these one at a time. You mentioned first the estrogens. Talk about those.

MICHELLE WARREN, MD: Estrogens are a very good way to prevent bone loss. They unfortunately have side effects and they are not good for everybody. There are benefits and risks. There are patients who worry about getting breast cancer. The risk is small, but it is a risk, particularly if a patient has been on hormones for more than five years. It's very small.

DAVID R. MARKS, MD: But it's a legitimate concern?

MICHELLE WARREN, MD: It's a legitimate concern, and my feeling is that most patients are not at risk, but there are patients who should not be on hormones. Also, if the osteoporosis is very severe, I tend to use one of the other drugs, the bisphosphonates, either Fosamax or Actonel.

DAVID R. MARKS, MD: How good are those medicines? That's the standard of care now.

MICHELLE WARREN, MD: It's the standard of care, and they're excellent medicines. They increase bone density. They reduce fracture, both in the spine and the hip, and they probably reduce overall fracture. You can see a result within a year, so the effect is very rapid. It's probably the best kind of drug to use with severe osteoporosis.

DAVID R.