Nonpharmacologic Prevention and Management of Osteoporosis
Osteoporosis is a chronic, debilitating disease that is most distressing to patients and health care providers in the occurrence of fractures of the hip and spine. The lasting effects of vertebral and hip fractures can cause pain, deformity, and emotional distress. Various nonpharmacological modalities may be used adjunctively with prescribed agents to improve the quality of life of patients with fractures due to osteoporosis. Research evidence and clinical experience have determined that nutritional support, exercise and rehabilitation, pain management, orthopedic surgeries, fall prevention, alternative therapies, education, and social support may assist patients in coping with the pervasive effects of osteoporotic fractures. Clinicians need to be informed and encouraged about the use of nonpharmacological measures to assist patients at risk for experiencing the culminating event of this devastating disease.
Key words: osteoporosis, osteoporotic fracture, osteoporosis management.
Introduction
The population is aging and, consequently, the incidence of osteoporosis is increasing. This chronic, debilitating disease is most distressing to patients and health care providers in the occurrence of osteoporotic fractures of the hip and spine as well as various other sites throughout the skeleton. Osteoporotic fractures are typically acutely and then chronically painful. The lasting effects of osteoporotic fractures are pervasive. Depending on the site, osteoporotic fractures can cause physical deformity, respiratory distress, disruption to the gastrointestinal system, emotional anguish, and, eventually, mortality. It has been well documented that those with osteoporotic fractures are at great risk of subsequent fractures, particularly in the first post-fracture year.1 Thus, those who have experienced one osteoporotic fracture must live with the constant threat of successive fractures.
In the past several decades, a great deal of progress has been made in the pharmacological reduction of osteoporotic fracture incidence. Agents such as bisphosphonates, selective estrogen receptor modulators, calcitonin, and, most recently, parathyroid hormone have been shown in a variety of clinical trials to reduce fracture occurrence with varying efficacy. Despite these successes, there is a need for adjunctive therapies to prevent and treat osteoporotic fractures. Osteoporosis is a complex disease requiring multidisciplinary efforts to assist afflicted individuals. This review will present the current and future options for the nonpharmacological management of osteoporotic fractures.
Nutrition
Osteoporosis is a metabolic bone disease; accordingly, nutritional evaluation and support are crucial to both prevent and treat fractures. Nutritional screening for patients at risk for or already diagnosed with osteoporosis should include annual measurement of height, weight at each office visit, and bone mineral density as a baseline and subsequently every year or two to monitor therapy.2 Additional nutritional factors to consider in the evaluation of patients with osteoporosis are noted in Table 1.
Nutritional management of osteoporotic fractures should be primarily focused on efforts to assure adequate calcium and vitamin D through both dietary and supplemental sources. Calcium supplied via dietary sources is as effective as calcium supplements. However, in most countries supplementation is needed to achieve adequate calcium intake.3 Table 2 describes calcium needs throughout the lifespan. Typically, in clinical trials of pharmacologic agents for osteoporosis, both the treatment and placebo groups received calcium supplementation of 500-1,000mg per day. Patients who are prescribed pharmacological agents for osteoporosis treatment must be encouraged to maintain adequate intake of these essential nutrients. Calcium is an essential component of the bone remodeling cycle. Inadequate calcium intake will lead to a net loss of calcium from bone and thus an increased susceptibility to fracture.