Osteoporosis Archive

Today's high-tech procedure offers more benefits.

Here's another reason to get that knee replacement you've been debating: A new study presented at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons finds that adults with osteoarthritis face lower odds of developing heart failure by having a total knee replacement. The study did not show a direct cause and effect or prove definitively that a total knee replacement (TKR) could improve cardiovascular health. However, the procedure does allow the recipient to exercise again, which can lead to better heart health.

And that's just one of the benefits of today's TKR.

Calcium supplements are being called on the carpet after new research showed they significantly increased risk of heart attack among women getting extra calcium from pills, but not among those who got their calcium from food. What’s the connection? Over time, calcium can accumulate in arteries. It also builds up in plaque, the cholesterol-filled pockets that can cause angina or a heart attack. Three Harvard professors say the new study doesn’t prove that calcium supplements cause heart disease, but advocate that it’s almost always best to get vitamins and minerals from food, not pills.

Since bisphosphonates such as alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel), and zoledronic acid (Reclast) were first introduced in the mid-1990s, they’ve become a staple of osteoporosis treatment. Yet an FDA review recently published in The New England Journal of Medicine questions whether there’s any benefit to staying on these drugs long-term—especially considering their potential for side effects. A report released today in the Archives of Internal Medicine highlights one of those side effects, linking bisphosphonate use to a higher risk of unusual fractures in the femur (thighbone). If you’ve been taking bisphosphonates long-term, you may be wondering, “What now?” If you’ve been taking bisphosphonates for less than five years you probably don’t need to change what you’re doing. But if you’ve been on these drugs for more than five years, talk to your doctor about whether it’s worth continuing.

A study suggests that many older women don't need frequent testing.

Bone mineral density (BMD) testing assesses bone strength and is one of the most important factors considered in evaluating a woman's risk for an osteoporotic fracture. Current screening guidelines recommend BMD testing at the hip and spine with dual-energy x-ray absorptiometry (DXA) for all women ages 65 and over — and earlier in women whose 10-year risk of fracture is 9.3% or greater. (You can calculate your 10-year fracture risk with the Fracture Risk Assessment Tool, or FRAX, at www.shef.ac.uk/FRAX. FRAX takes into account several risk factors in addition to BMD.) But until recently, there's been little scientific evidence on how often a woman should be screened.

There are many ways to play it safe while gaining the health benefits of exercise.

Whether it comes after a broken bone or a low bone density reading, a diagnosis of osteoporosis spurs you to rethink your relationship with exercise. Do I need to take it easy or change my current activities to avoid falls and fractures? What exercises will help protect my bones? If I haven't been very active in the past, how should I start?

Good vibrations may work for dancing on the beach or for romance, but they don’t seem to do much to strengthen bones. Results of a clinical trial published in the Annals of Internal Medicine showed that older women who stood on a vibrating platform for 20 minutes a day experienced just as much bone loss over the course of the year-long trial as women who didn’t use the platform.

Q. I'm looking for information on Prolia and Reclast as alternatives to Boniva.

A. All of the drugs you mention are used to treat postmenopausal women with osteoporosis, although they're in different drug classes. Ibandronate (Boniva) and zoledronic acid (Reclast, Zometa) are bisphosphonates; denosumab (Prolia) is a monoclonal antibody. Bisphosphonates interfere with the activity of osteoclasts, bone cells that are involved in normal remodeling. Osteoclasts break down (resorb) old bone. Bisphosphonates work by reducing the rate of resorption. Denosumab also reduces bone resorption but does so by inhibiting the formation of osteoclasts rather than their activity.

Heart disease, stroke, diabetes, asthma, osteoporosis and other common chronic diseases are often blamed on genes, pollution, or the wear and tear caused by personal choices like a poor diet, smoking, or too little exercise. An intriguing hypothesis is that these and other conditions stem from a developing baby’s environment, mainly the womb and the placenta. During the first thousand days of development, from conception to age 2, the body’s tissues, organs, and systems are exquisitely sensitive to conditions in their environment during various windows of time. A lack of nutrients or an overabundance of them during these windows, so the thinking goes, programs a child’s development and sets the stage for health or disease.

Can gentle vibration improve bone density and prevent fractures after menopause?

Soon you may be hearing a lot about low-intensity vibration therapy for strengthening bones and reducing the risk of fractures. Two low-intensity oscillating devices designed for home use are coming onto the market, and the Agency for Healthcare Research and Quality (AHRQ), which advises the federal government on health care matters, is expected to issue a report highlighting the evidence as well as the many unanswered questions about this unique approach to bone health.

A panel discussion at Harvard School of Public Health called “Boosting Vitamin D: Not Enough or Too Much?” highlights the current controversy over the once-overlooked sunshine vitamin. A panel of experts assembled by the Institute of Medicine recommends a daily dose of 600 IU per day for everyone from ages 1 to 70 and 800 IU for those over 70. Other experts think the IOM recommendation is too low. One way to get vitamin D is to spend a few minutes a day outside in the sun, but that’s a hot-button issue because sun exposure is a cause of skin cancer.