Your bone density can be measured by a machine that uses low levels of X-rays to determine the proportion of mineral in your bones. During this painless test, you lie on a padded table as a scanner passes over your body. In most cases, only a few bones are checked — usually in the hip and spine. Treatment recommendations are often based on an estimate of your risk of breaking a bone in the next 10 years using information such as the bone density test.
If your risk isn't high, treatment might not include medication and might focus instead on modifying risk factors for bone loss and falls. For both men and women at increased risk of fracture, the most widely prescribed osteoporosis medications are bisphosphonates.
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Side effects include nausea, abdominal pain and heartburn-like symptoms. These are less likely to occur if the medicine is taken properly. Intravenous forms of bisphosphonates don't cause stomach upset but can cause fever, headache and muscle aches for up to three days.
It might be easier to schedule a quarterly or yearly injection than to remember to take a weekly or monthly pill, but it can be more costly to do so. Compared with bisphosphonates, denosumab Prolia, Xgeva produces similar or better bone density results and reduces the chance of all types of fractures.
Denosumab is delivered via a shot under the skin every six months. If you take denosumab, you might have to continue to do so indefinitely.
Merck manual of diagnosis and therapy osteoporosis in men
Recent research indicates there could be a high risk of spinal column fractures after stopping the drug. A very rare complication of bisphosphonates and denosumab is a break or crack in the middle of the thighbone.
A second rare complication is delayed healing of the jawbone osteonecrosis of the jaw. This can occur after an invasive dental procedure such as removing a tooth. You should have a dental examination before starting these medications, and you should continue to take good care of your teeth and see your dentist regularly while on them.
Why the DEXA Bone Density Test Doesn't Work
Make sure your dentist knows that you're taking these medications. Estrogen, especially when started soon after menopause, can help maintain bone density. However, estrogen therapy can increase the risk of blood clots, endometrial cancer, breast cancer and possibly heart disease. Therefore, estrogen is typically used for bone health in younger women or in women whose menopausal symptoms also require treatment.
Raloxifene Evista mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen. Taking this drug can reduce the risk of some types of breast cancer.
Hot flashes are a common side effect. Raloxifene also may increase your risk of blood clots. In men, osteoporosis might be linked with a gradual age-related decline in testosterone levels.
Testosterone replacement therapy can help improve symptoms of low testosterone, but osteoporosis medications have been better studied in men to treat osteoporosis and thus are recommended alone or in addition to testosterone. Bone-building medications If you can't tolerate the more common treatments for osteoporosis — or if they don't work well enough — your doctor might suggest trying:.
There is limited evidence that certain supplements, such as vitamin K-2 and soy, can help lower fracture risk in osteoporosis, but more studies are needed to prove benefits and determine risks. Your family doctor might suggest bone density testing. Screening for osteoporosis is recommended for all women by age Some guidelines also recommend screening men by age 70, especially if they have health issues likely to cause osteoporosis.
If you have a broken bone after a minor force injury, such as a simple fall, a bone density may be important to assess your risk of more fractures. If the bone density test is very abnormal or you have other complex health issues, you might be referred to a doctor who specializes in metabolic disorders endocrinologist or a doctor who specializes in diseases of the joints, muscles or bones rheumatologist.
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This content does not have an Arabic version. Diagnosis Your bone density can be measured by a machine that uses low levels of X-rays to determine the proportion of mineral in your bones. More Information Conventional treatment for osteoporosis Osteoporosis treatment: Medications can help Osteoporosis: How long must I take bisphosphonates?
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Show references Osteoporosis overview. Accessed May 23, Goldman L, et al. In: Goldman-Cecil Medicine. Philadelphia, Pa. Rosen HN, et al.
Overview of the management of osteoporosis in postmenopausal women. Accessed May Merck Manual Professional Version. Frequently asked questions. Women's health FAQ American College of Obstetricians and Gynecologists.
Risks of bisphosphonate therapy in patients with osteoporosis. Morrison RS, et al. Hip fracture in adults: Epidemiology and medical management.
Accessed May 24, Vitamin D fact sheet for health professionals. Calcium fact sheet for health professionals.
OSTEOPOROSIS DIAGNOSIS AND TREATMENT
Shams-White MM, et al. Dietary protein and bone health: A systematic review and meta-analysis from the National Osteoporosis Foundation. American Journal of Clinical Nutrition. Iwaniec UT, et al.
Influence of body weight on bone mass, architecture and turnover. Journal of Endocrinology. Natural medicines in the clinical management of osteoporosis.
Natural Medicines. Kearns AE expert opinion. Mayo Clinic, Rochester, Minn.
Osteoporosis and Men
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