Supplements that Help in Osteoporosis

Which are the Supplements that Help in Osteoporosis?

Calcium: In the initial stages of treatment, calcium supplements probably prevent bone destruction without affecting bone formation and thereby improve calcium balance, but this positive bone balance lasts only for a period of 3 to 6 months. Supplementation with calcium is required in people having inadequate dietary intake of calcium. The dosage of calcium is as given in Table 3.2. Calcium carbonate is the most widely used. It contains 40 per cent elemental calcium. However it might be constipating in some patients or may produce flatulence. Calcium phosphate or citrates are more soluble than carbonate but they contain only 17-24 per cent of elemental calcium. There are some studies to suggest that calcium supplementation may induce sedation and provide sound sleep. People suffering from insomnia or sleeplessness can, therefore, try taking calcium supplements with their night meal. 

Vitamin D : There is decreased synthesis (formation) of Vitamin D by skin in old age. This is accompanied by reduced absorption of the vitamin from the gut and decreased conversion of Vitamin D to the active form in the liver. Vitamin D treatment has to be continued for a long time to be effective. Activated form of Vitamin D is effective for treating conditions where bone loss exceeds bone formation. Calciferol ( high dose Vitamin D) can also be given in the dose of 50,000 U every week for 3-4 weeks.

What are the Drugs that can be Taken in Osteoporosis?
Hormonal Replacement Therapy (HRT) is commonly prescribed to help prevent osteoporosis in post – menopausal women supplementing oestrogen from outside to compensate for the reduction in secretion that takes place after menopause. 

Merits and uses of HRT: It remains the mainstay of treatment in post-menopausal osteoporosis and has been shown to prevent bone loss from both spine and hip. Early commencement of HRT following menopause will maintain the highest bone density. Delay in administration will stop bone loss, but will not restore bone density to the extent that was present at the time of menopause. At least 5 years of treatment appears necessary to reduce the incidence of fractures and increase bone density in older women. HRT is also useful because of the following advantages:

· Helps in keeping skin supple
· Maintains normal vaginal moisture
· Eliminates mood swings
· Helps to retain sexual function.
· Earlier claimed to slow down atherosclerosis ( hardening of arteries) but it has been disproved recently. 

Demerits and side effects of HRT: HRT can increase risk of uterine and breast cancer. However, if it is given in natural (as opposed to synthetic oestrogen) form in combination with another hormone called progesterone it can lower the incidence of uterine cancer. If HRT is taken, monthly self-breast examination and six monthly examinations by a doctor is essential as also frequent mammographies (X-ray to detect cancer of the breast) and PAP smears. (PAP smear is a simple painless test in which some cells are collected by scraping from the outer part of the uterus called the cervix). These cells are shed from the uterus and by examining them under the microscope early indication of cancer of predeposition may be revealed. 

· HRT also doubles the risk of gall bladder problems. 
· Causal vaginal bleeding 
· Breast tenderness
· Nausea
· Bloating due to fluid retention
· Liver problems
· Headache and migraine
· Blood clots
· Changes in shape of eyes ( due to fluid retention)
· Dizziness and depression. 

Where HRT should not be used: In the following conditions HRT, should not be used. 

· Undiagnosed vaginal bleeding. 
· Genetic predisposition to uterine or breast cancer
· Thromboembolic disease ( block in vessels)
· History of endometriosis ( uterine inner lining grows inwards into muscles)
· Liver and gall bladder disease. 
· Menstrual migraine ( those patients who used to get migrainous headache during periods.)

In case of above complications or conditions, consultation with the doctor is necessary before taking HRT, after carefully weighting the merits and demerits.

Alternatives to HRT: There are some drugs available now which act like HRT, two of which have been discussed here.

Tibolone : Tibolone is a synthetic steroid that exhibits properties of oestrogen, progesterone ( female hormones) and testosterone (male hormone). Due to its oestrogen – like action, it prevents hot flushes and osteoporosis and due to progesterone – like action there is less or no ‘period-like’ bleeding. Due to its weak testosterone – like action it leads to improvement in mood swings and libido. Since there is no breast stimulation, there is no increase in risk of cancer of breast. Tibolone should be started 12 months after cessation of menstruation. The prescribed dosage is 2.5 mg a day. It can be continued for 5-10 years. Effects on bone density are similar to that of oestrogen. 
The side effects can be enumerated here:
· Water retention leading to weight gain, nausea, vomiting,
· Vaginal bleeding, migraine, depression, hirsutism ( increase in body hair)
· Eczema. 

It is contradicted in case of following conditions:
· In combination with anticoagulants (blood thinners), and aspirin-bleeding can occur. 
· Liver disorders
· Disturbed lipid profile. 
· Any cardiac problem
· Diabetes
· Kidney problem
· History of stroke ( paralytic attack).

Raloxifene: It is a drug that has the benefits of HRT without its harmful effects on breasts and uterus. The prescribed dose is 60 mg a day. it has oestrogen – like action. It is, therefore, said to belong to a group of drugs called Selective Oestrogen Receptor Modulators ( SERM). It helps in improving bone density but does not help in relieving hot flushes, which may in fact even worsen. It may also aggravate thrombo-embolic disease ( blood clotting) like oestrogens. It has a beneficial effect on lipid profile since it reduces blood levels of LDL cholesterol and lipoproteins ( harmful fats).
It is contradicted in case of pregnancy, children, breast feeding liver disorders and thrombo – embolic disorders. 
The side effects include hot flushes, leg cramps, oedema, weight gain, skin rash, insomnia and myalgia ( muscle pain).

Calcitonin : Calcitonin is secreted in mammals by C cells of the thyroid gland. It prevents bone destruction. Salmon ( fish) calcitonin is of value as preventive treatment for osteoporosis, functioning in this role as an alternative to oestrogen therapy. It also has a pain-reducing effect. Safety is an outstanding characteristic of calcitonin administration. It is perhaps the safest of currently available therapies for osteoporosis. It is available as injections and nasal spray. Side effects relating to nasal spray include nasal irritation and increased sneezing. The recommended daily dosage is 200 IU by nasal spray continued for a few weeks. 
The injectable form is prescribed as per the patient’s need. 

Biphosphonates : These act by inhibiting bone destruction, thus preventing bone loss. They are available as etidronate and allendronate. Orally administered etidronate in post-menopausal osteoporosis has revealed a significant 4 per cent improvement in lumbar spine bone mineral density, and reduction in the incidence of new vertebral fractures. Alendronate has revealed an increase in the femoral ( thigh bone) BMD by 4 per cent in one year and 5 per cent at 2 years with 10 mg daily dosage is 200 IU by nasal spray continued for a few weeks.
The injectable form is prescribed as per the patient’s need. 

Biphosphonates : These act by inhibiting bone destruction , thus preventing bone loss. They are available as etidronate and allendronate. Orally administered etidronate in post-menopausal osteoporosis has revealed a significant 4 per cent improvement in lumbar spine bone mineral density, and reduction in the incidence of new vertebral fractures. Alendronate has revealed an increase in the femoral ( thigh bone) BMD by 4 per cent in one year and 5 per cent at 2 years with 10 mg daily dosage . it can also be given in a weekly dose of 70 mg for 4-6 weeks. 

Side effects : Side effects include GI upset and diarrhoea. It has to be taken on empty stomach and the patient is advised not to lie down or eat for one hour after that. Treatment should not be continued beyond 6 months. High doses may produce a toxic reaction where bony pains may worsen and paradoxically fractures may be caused. Alendronate seems to be the safest in this group. 

Anabolic steroids: Nandrolone decanoate is an anabolic steroid ( anabolic means it helps in building tissues like bone and muscles) that has potential benefit in preservation of spinal bone mass. It has generally been thought to function by preventing bone destruction. It could also function as a bone-stimulating agent. Intramuscular injections of 25 mg or 50 mg are given about once in two to three months, but not more than four in a year. 

Side effects : it can cause masculinisation in females ( muscular and hairy look) and enlargement of heart muscles, leading to weakness of the hearat, when it is used in excessive doses.