The primary goal of osteoporosis therapy is to reduce the risk of fractures. A comprehensive osteoporosis treatment program focuses on nutrition, exercise and safety precautions to prevent falls that may result in fractures and, if necessary, medication to slow or stop bone loss, increase bone density and reduce fracture risk. If you are at risk for or have osteoporosis, your health care professional may recommend several treatment and preventive measures, including:

• Adequate amounts of calcium and vitamin D, either from diet or supplementation

• Regular weight-bearing exercise

• Avoiding smoking and excessive alcohol consumption ("Moderate drinking" levels for women and older people are defined by the National Institute on Alcohol Abuse and Alcoholism as one drink per day—one drink equals: 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine or 1.5 ounces of 80-proof distilled spirits—are considered safe).

• Medications to stop bone loss, to stop bone loss, improve bone density and prevent fractures.

• Surgery to repair fractured bones. For example, patients with an acute vertebral fracture and pain that does not respond to standard treatment approaches—medication, increased calcium intake and back-strengthening exercises to improve muscle support—may be candidates for balloon kyphoplasty.

  Balloon kyphoplasty is similar to a technique known as vertebroplasty, in which acrylic cement is injected into the fractured vertebral bone to stabilize it and relieve pain. During balloon kyphoplasty, however, a small orthopedic balloon is inserted into the vertebrae and inflated with liquid. This additional step helps restore the natural shape and height of the bone. The balloon is then deflated and removed, creating a cavity into which bone cement may be applied.

• Hip protectors or pads, especially if you are thin or have fallen before.

Medical Approaches to Treating Osteoporosis

The U.S. Food and Drug Administration (FDA) has approved several medications for postmenopausal women to help slow or stop bone loss, build bone and reduce the risk of fractures. These medications work well, but only when they are taken regularly. Plus, as with any medication therapy, there are certain risks and side effects.

• Menopausal Estrogen Therapy and Combination Estrogen-Progestin Therapy

  Although not approved by the Food and Drug Administration (FDA) for the treatment of osteoporosis, oral and transdermal forms of estrogen, called estrogen therapy (ET), and combined estrogen-progestin, called hormone therapy (HT), are approved for preventing bone loss in recently menopausal women.

  Studies find that ET increases bone mass and reduces the incidence of vertebral, wrist and hip fractures. However, because of the long-term risks associated with hormone replacement therapy—risks identified within the last several years by the federal Women's Health Initiative (WHI)—the FDA recommends that women first consider other osteoporosis medications and warns that hormone therapies should be used at the lowest possible dose for the shortest possible time. The overall consensus among medical experts is that taking hormone therapy early in menopause for a short time is not likely to have a long-term effect on the risk of fractures.

• Alendronate (Fosamax),

  from the bisphosphonate class of drugs, is a bone-specific medication approved by the FDA to treat and prevent osteoporosis. Studies find alendronate increases bone mass and reduces the risk of spine, hip, wrist and other fractures by up to 50 percent in women with osteoporosis.

  Alendronate has also been approved for the treatment of glucocorticoid-induced osteoporosis and the treatment of osteoporosis in men. Alendronate tablets should be taken on an empty stomach in the morning and with eight ounces of water at least 30 minutes before the first food, beverage or medication of the day. To minimize side effects—which can include heartburn or irritation of the esophagus—remain in an upright position for at least 30 minutes after taking this medication. Alendronate can be taken daily or as a weekly medicine regimen.

• Calcitonin (Miacalcin)

  is approved for the treatment of osteoporosis in women who are five years postmenopausal and cannot tolerate estrogen therapy. Studies find that this medication helps slow bone loss, increases spinal bone density and may relieve fracture pain. It may also reduce the risk of hip fracture. Because calcitonin is a protein, it cannot be taken orally, so it is taken as a nasal spray or, in some instances, an injection, Possible side effects include nasal irritation and inflammation, bloody nose, headache and backache. Injectable calcitonin may cause an allergic reaction and flushing of the face and hands, frequent urination, nausea and skin rash.

• Raloxifene (Evista),

  available in pill form, is a medication approved for the prevention and treatment of osteoporosis in postmenopausal women. Raloxifene has positive estrogen-like effects on bone but not on the breast or lining of the uterus, and may reduce the risk of estrogen-dependent breast cancer by 65 percent over four years.

  Initial results of the Study of Tamoxifen and Raloxifene (STAR), one of the largest breast cancer studies ever, found that Raloxifene was as effective as Tamoxifen for reducing breast cancer risk (both drugs reduce risk by about 50 percent). But women assigned to the Raloxifene group had 36 percent fewer uterine cancers and 29 percent fewer blood clots than women assigned to the Tamoxifen group, indicating that Raloxifene may be a safer choice, especially for women at risk for these conditions.

  It is part of a class of drugs called selective estrogen receptor modulators (SERMs) that appear to prevent bone loss at the spine, hip and other points in the body. Studies find that raloxifene reduces the risk of spinal fracture by half in women with osteoporosis, but there are no data confirming that it reduces the risk of any other fractures. Possible side effects include hot flashes, blood clots in the veins (similar to estrogen) and leg cramps. The pill is taken once a day, with or without meals.

• Risedronate (Actonel),

  another type of bisphosphonate drug, is approved to treat and prevent osteoporosis in postmenopausal women and to prevent and treat glucocorticoid-induced osteoporosis in women and men.

  Studies find it increases bone mass and reduce the risk of spinal, wrist, hip and other nonspinal fractures in women with osteoporosis.

  Take on an empty stomach in the morning with eight ounces of water, 30 minutes before eating or drinking. To minimize side effects—which can include heartburn or irritation of the esophagus—remain in an upright position for at least 30 minutes after taking. Take any vitamins, calcium and antacids at least 30 minutes after you take risedronate.

• Ibandronate (Boniva)

  is another biphosphonate that has been approved by the FDA for prevention and treatment of osteoporosis in postmenopausal women. It reduces the incidence of vertebral fractures by up to 52 percent and to increase bone mineral density in the spine. Ibandronate also prevents bone loss in recent menopausal women but who do not yet have osteoporosis. Ibandronate must be taken on an empty stomach, first thing in the morning, with eight ounces of water (no other liquid) at least 60 minutes before eating or drinking. Patients must remain upright for at least one hour after taking this medication.

• Teriparatide (Forteo),

  a form of parathyroid hormone, is the first medication that actually stimulates bone formation instead of slowing the breakdown of bone. It is approved for postmenopausal women and for men (for vertebral fracture only). It increases bone mineral density and reduces fractures in postmenopausal women. The drug is administered by injection once a day (for up to 24 months) and carries an FDA "black box" special warning because in laboratory tests it caused cancerous bone tumors in rats. However, such tumors were not observed in the 2,000 people who tested the drug in clinical trials. Side effects may include nausea, dizziness and leg cramps.

• Zoledronic acid (Reclast)

  has just been approved by the FDA as the first once-yearly treatment for women with postmenopausal osteoporosis. Reclast works by strengthening bones and protecting against osteoporosis-related fractures, including those of the spine and hip. A study published in the New England Journal of Medicine found that Reclast reduced hip fractures by 41 percent and spine fractures by 70 percent. Because it is given only once a year as a 15-minute intravenous infusion, Reclast is a good option for women who have trouble remembering to take daily medications. Side effects include fever, muscle pain, pain in the bones or joints, flu-like symptoms, and headache. These symptoms usually set in within the first three days of receiving Reclast and generally resolve within three to four days.

Clinical trials find that increasing your calcium intake—either from your diet or supplements—reduces the risk of all fractures when used in conjunction with medication therapies.

Preventing Falls is Key

Falls due to bone weakness are one of the most common causes of hip, wrist and vertebral fracture in people over age 60 according to the Surgeon General's Report 2004 report.

Environmental hazards, such as slippery floors or loose carpeting, can increase your risk for falls. Physical issues such as impaired vision and/or balance; chronic diseases that impair mental or physical functioning; and certain medications may also put you at risk.

Consider making some of these changes to help eliminate environmental factors that could lead to falls:

• Indoors: Keep floor surfaces smooth but not slippery and clear of clutter and loose wires; wear supportive, low-heeled shoes even at home; avoid walking in socks, stockings or slippers; be sure stairwells are well lit, and that stairs have handrails on both sides; install grab bars on bathroom walls near tub, shower and toilet; and use a rubber bath mat in the shower or tub.

• Outdoors: If necessary, use a cane or walker for added stability; wear rubber-soled shoes for traction; walk on grass when sidewalks are slippery; use caution on highly polished floors that are slick when wet. Use plastic or carpet runners when possible. Some older women at high risk of falls and hip fracture might want to consider hip protectors. These devices are thin shields that can be incorporated into underwear.

Muscle-strengthening and balance-retraining programs are also effective in preventing falls.

The American Geriatrics Society (AGS) has also developed a companion consumer guide that shares tips on reducing the risk of falls. For more information, visit the AGS Web site: http://www.americangeriatrics.org.