Osteoporosis is characterized by low bone mass, microarchitectural disruption, and increased skeletal fragility. Multiple therapeutic regimens have been designed to prevent or treat bone loss in postmenopausal women and older adults. The first step in the prevention or treatment of osteoporosis is ensuring adequate nutrition, particularly maintaining an adequate intake of calcium and vitamin D. Vitamin D enhances intestinal absorption of calcium and phosphate. Low concentrations of vitamin D are associated with impaired calcium absorption, a negative calcium balance, and a compensatory rise in parathyroid hormone (PTH), which results in excessive bone resorption.Calcium and vitamin D supplementation in the treatment of osteoporosis will be reviewed here. Detailed information regarding pharmacologic therapy for osteoporosis and the role of calcium in the pathogenesis of osteoporosis is discussed separately. (See "Overview of the management of osteoporosis in postmenopausal women" and "Treatment of osteoporosis in men" and "Pathogenesis of osteoporosis".)
The optimal intake of calcium and vitamin D is uncertain. Based upon the meta-analyses discussed below, we suggest 1200 mg of calcium (total of diet and supplement) and 800 international units of vitamin D daily for most postmenopausal women with osteoporosis. Although the optimal intake (diet plus supplement) has not been clearly established in premenopausal women or in men with osteoporosis, 1000 mg of calcium (total of diet and supplement) and 600 international units of vitamin D daily are generally suggested. We recommend not administering yearly high-dose (eg, 500,000 international units) vitamin D.These recommendations are consistent with the Institute of Medicine Dietary Reference Intakes for calcium and vitamin D [1]. The American Geriatrics Society and the National Osteoporosis Foundation recommend a slightly higher dose of vitamin D supplementation (at least 1000 and 800 to 1000 international units daily, respectively), as well as calcium supplements, to older adults (≥65 years) to reduce the risk of fractures and falls [2,3].
(See 'Efficacy' below and "Falls: Prevention in community-dwelling older persons", section on 'Vitamin D supplementation'.)Certain coexisting medical problems may alter these requirements. (See 'Coexisting medical problems' below.)Vitamin D is very important for bone health. It helps build stronger bones, partly by increasing the absorption of calcium. Vitamin D also improves the function of muscles, which in turn improves your balance and decreases the likelihood of falling. Vitamin D is therefore doubly essential in helping protect you against fractures. Vitamin D comes from the sun. The sun’s rays interact with our skin to produce vitamin D that can be used for bone and muscle health. In Canada, because we live in a northern climate, we don’t get as much sun as we need; and when we apply sunscreen in the summer, that disables the skin’s ability to produce vitamin D from sun exposure. Additionally, as we age, the skin’s ability to make vitamin D decreases and for all of these reasons, many Canadians are low on vitamin D.
There are very few food sources of vitamin D. In fact, it is impossible for adults to get sufficient vitamin D from diet alone, no matter how good their nutrition. Therefore, Osteoporosis Canada recommends routine vitamin D supplementation for all Canadian adults year round. Healthy adults between19-50 years of age, including pregnant or breast feeding women, require 400 – 1,000 IU daily. Those over 50 or those younger adults at high risk (with osteoporosis, multiple fractures, or conditions affecting vitamin D absorption) should receive 800 – 2,000 IU daily. These amounts are safe. Taking more than 2,000 IU of vitamin D daily should be done only under medical supervision. The best way to ensure that you are getting sufficient vitamin D is by taking a supplement. The type of vitamin D you should purchase is vitamin D3 (also called cholecalciferol). This is the most common type of vitamin D found in supplements in Canada. Vitamin D by itself comes in 400 and 1000 IU tablets.
Most multivitamins contain some vitamin D but the amounts vary quite a bit, so be sure to read the small print on the label carefully. Some calcium supplements also contain vitamin D3 and again the amounts vary. If you are unclear how much vitamin D your supplements contain, please check with your pharmacist. There is something special about Vitamin D that does not apply to most other vitamins or supplements. Vitamin D is fat soluble. This means vitamin D can be “made up.” If you miss your vitamin D today, for example, you can take double the amount tomorrow. If you miss your vitamin D for a whole week, you can take all the vitamin D that you missed altogether at the end of the week. However, you shouldn’t do this on a regular basis without consulting with your physician and this can only be done with vitamin D. It cannot be done with other medications or supplements. More about nutrition and osteoporosisYou are hereHome > Prevention > Vitamin DA number of different medications are used to treat osteoporosis.
Your doctor will discuss the treatments available and make sure the medicines are right for you. Bisphosphonates slow down the rate at which bone is broken down in your body. This maintains bone density and reduces the risk of fracture. There are a number of different bisphosphonates, including They're given as a tablet or injection. You should always take bisphosphonates on an empty stomach with a full glass of water. Stand or sit upright for 30 minutes after taking them. You'll also need to wait between 30 minutes and two hours before eating food or drinking any other fluids. Bisphosphonates usually take 6 to 12 months to work and you may need to take them for five years or longer. You may also be prescribed calcium and vitamin D supplements to take at a different time to the bisphosphonate. The main side effects associated with bisphosphonates include: Not everyone will experience these side effects. Osteonecrosis of the jaw is a rare side effect that's linked with the use of bisphosphonates, although most frequently with high-dose intravenous bisphosphonate treatment for cancer and not for osteoporosis.
In osteonecrosis, the cells in the jaw bone die, which can lead to problems with healing. If you have a history of dental problems, you may need a check-up before you start treatment with bisphosphonates. Speak to your doctor if you have any concerns. Strontium ranelate appears to have an effect on both the cells that break down bone and the cells that create new bone (osteoblasts). It can be used as an alternative treatment if bisphosphonates are unsuitable. Strontium ranelate is taken as a powder dissolved in water. The main side effects of strontium ranelate are nausea and diarrhoea. A few people have reported a rare severe allergic reaction to the treatment. If you develop a skin rash while taking strontium ralenate, stop taking it and speak to your doctor immediately. SERMs are medications that have a similar effect on bone as the hormone oestrogen. They help to maintain bone density and reduce the risk of fracture, particularly of the spine. Raloxifene is the only type of SERM that's available for treating osteoporosis.
It's taken as a tablet every day. Side effects associated with raloxifene include: Parathyroid hormone is produced naturally in the body. It regulates the amount of calcium in bone. Parathyroid hormone treatments (human recombinant parathyroid hormone or teriparatide) are used to stimulate cells that create new bone (osteoblasts). They're given by injection. While other medication can only slow down the rate of bone thinning, parathyroid hormone can increase bone density. However, it's only used in a small number of people whose bone density is very low and when other treatments aren't working. Nausea and vomiting are common side effects of the treatment. Parathyroid hormone treatments should only be prescribed by a specialist. Calcium is the major mineral found in bone, and having enough calcium as part of a healthy, balanced diet is important for maintaining healthy bones. For most healthy adults, the recommended amount of calcium is 700 milligrams (mg) of calcium a day, which most people should be able to get from a varied diet that contains good sources of calcium.
However, if you have osteoporosis you may need more calcium, which will usually be in the form of supplements. Ask your GP for advice about taking calcium supplements. Vitamin D is needed to help the body absorb calcium. All adults should consume 10 micrograms (mcg) of vitamin D a day.So all adults should consider taking a daily supplement containing 10mcg of vitamin D. For more information, read about who should take vitamin D supplements. HRT is sometimes recommended for women who are experiencing the menopause, as it can help control symptoms. HRT has also been shown to maintain bone density and reduce the risk of fracture during treatment. However, HRT isn't specifically recommended for treating osteoporosis and it isn't often used for this purpose. This is because HRT slightly increases the risk of developing certain conditions, such as breast cancer, endometrial cancer, ovarian cancer, stroke and venous thromboembolism more than it lowers the risk of osteoporosis.