The complete reversal of osteoporosis is not possible, but treatment can curb it, and help people go back as close to normal as possible, says Dr. Abhishek Kumar Mishra, an orthopaedic and joint replacement surgeon at the Apollo Spectra Hospital in New Delhi.
Osteoporosis, a condition that makes bones fragile and more susceptible to breaking or fractures, impacts both men and women but women are thrice as likely to get osteoporosis compared to men. In India, osteoporosis impacts as many as 46 million women above the age of 50.
- Can you tell us more about the therapy used in treatment of osteoporosis?
- Could you also talk about osteoporosis in men?
We spoke to Dr. Mishra about the treatment of osteoporosis, whether it is reversible, and if it impacts men. Edited excerpts:
Is osteoporosis reversible?
That is a tricky question. You cannot completely reverse it. There is a difference in our bodies at 60 years of age and at 20 years of age. We cannot go back to what our bodies were at 20. The idea of treatment is to make you go back to as close to normal as possible. The other goal is to not let the condition worsen.
There is a difference in our bodies at 60 years of age and at 20 years of age. We cannot go back to what our bodies were at 20. The idea of treatment is to make you go back to as close to normal as possible. The other goal is to not let the condition worsen.
Let’s take an example, let’s say a woman in her 60s gets a DEXA scan (bone density scanning), and the doctor finds that she has severe osteoporosis. Now, the doctor will start hormone therapy, using Teriparatide or Denosumab (medication used for treatment of osteoporosis).
The treatment is in the form of injections. It is recommended that you get a repeat DEXA scan after a year or so. However, patients have to remember that their bone densitometry (bone density test) may not improve significantly, or it may not improve at all. This can be difficult for them, as they immediately start thinking that they have been taking these expensive medicines for a year, and these haven’t helped at all. But at that time they need to understand that this is the result when they have been taking the medicine for one year, the condition could have worsened if they hadn’t been in treatment at all.
What I am trying to say is that osteoporosis is not reversible. The goal is to make it as close to normal as possible by having an active lifestyle, by adding foods in your diet which are rich in calcium, these include foods like soya, tofu, and cereals fortified with calcium, milk and milk products. The other things that help are taking vitamin D and ensuring that you are receiving adequate treatment.
Patients shouldn’t be disheartened by the fact that their DEXA scan or bone densitometry hasn’t jumped dramatically after one year of therapy. That is a very rare scenario, if there is no rapid bone density loss, it is a reason to continue with further therapy as recommended.
What I am trying to say is that osteoporosis is not reversible. The goal is to make it as close to normal as possible by having an active lifestyle, by adding foods in your diet which are rich in calcium, these include foods like soya, tofu, and cereals fortified with calcium, milk and milk products.
Can you tell us more about the therapy used in treatment of osteoporosis?
There are various therapies available. I will divide it broadly for the readers.
The first thing we recommend is taking calcium and vitamin D supplementation.
The second is something called a selective estrogen receptor modifier, which is an estrogen-based therapy. We don’t give estrogen directly as a hormone because it has its own side effects. So either we give selective estrogen receptor modulators (SERMs), these are estrogen-like agents, which are devoid of the side effects of estrogen. Most of them are hormone analogues, which is something like hormones. The most common hormone recommended is calcitonin, which is administered in a subcutaneous patch form or in the spray form.
These days, there are two things which are used most commonly for treatment of osteoporosis — the first one is a group of drugs called Bisphosphonates, which help in the prevention of bone density loss. These can be taken daily as a tablet or in an injectable form.
The other important medicine which is being used now for the treatment of severe osteoporosis is a hormone analogue called Teriparatide. But it has got certain side effects, so it has to be ensured that it is started in those patients whose kidney profile and parathyroid hormone level is normal. This is administered in injectable form as subcutaneous injection; it has to be taken for one-three years. It is like insulin injections which patients can take themselves. This is the best medicine available, provided the patient fulfils the basic safety criteria guidelines for taking it.
The other new drug in the Indian market for osteoporosis is Denosumab, it has been used in the West for a while. It has to be taken once in six months. The administration is easier. It’s safety profile is quite good, it can be given to almost everyone.
Sometimes Denosumab and Teriparatide can be started together as well, depending on the severity of the problem. Denosumab belongs to a category of drugs which works by preventing the movement of calcium out of the bones. Whereas, Teriparatide works by getting calcium to the bone.
Therefore, the treatment depends on the patient profile; we have to judge them individually in order to understand what suits their needs, and for how long should it be used.
Could you also talk about osteoporosis in men?
Men are relatively lucky when it comes to osteoporosis. Their chances of getting osteoporosis is lesser compared to women. Nonetheless we should not think that men are immune to osteoporosis. Routine screening like a DEXA scan is not recommended in men until they have a fracture with a minor injury, or if they have vague aches and pains in the bones or in the back, which does not confirm any known disease pattern. In that case, we should investigate it in elderly men. If men have been taking anti-epileptic medicines or steroids, or had kidney disease or inflammatory bowel disease, they are at risk. The risk factors remain the same as women – race, frame, genetic predisposition. But generally the risk is much lower compared to women.
Men are relatively lucky when it comes to osteoporosis. Their chances of getting osteoporosis is lesser compared to women. Nonetheless we should not think that men are immune to osteoporosis.
Read the first part of the interview about the risk factors, symptoms, and prevention of osteoporosis here.
Dr. Abhishek Kumar Mishra
Dr. Abhishek Mishra is a New Delhi-based orthopaedic, joint replacement and spine surgeon with more than 22 years of experience. A renowned surgeon, he is now serving as a full-time Senior Consultant & Head of department in Orthopedics at Apollo Spectra Hospital.
Ph: +91-9310656999; 011-41655490
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