Question

My doctor wants to put me on Prolia, but the list of possible reactions are frightening. Do you have any suggestions on osteoporosis prevention without medication? If medication is required, are there any safe options? I exercise daily and take calcium and vitamin D supplements.

Answer

There are many ways to prevent and treat osteoporosis from worsening without taking medications. One way is through your diet. It is important to get adequate amounts of calcium and vitamin D because they help build and preserve your bone strength. Older female adults should get 1,200 mg of calcium per day and 600-800 IU/day of vitamin D. Calcium and vitamin D work together as vitamin D helps your body absorb calcium. Calcium is found in dairy products, leafy green vegetables, sardines, almonds and other calcium-fortified foods. You can also get vitamin D from daily sun exposure. Many foods are fortified with vitamin D, including various cereals and milk. If necessary, vitamin D supplements are available. Exercise is another way to help prevent osteoporosis. Per the National Osteoporosis Foundation, weight-bearing and muscle-strengthening exercises are both important for building and maintaining bone density. Examples of weight-bearing exercises include hiking, jogging, and stair climbing. Examples of muscle-strengthening exercises include weight lifting and weight machines but even using your own body weight can work. It’s also important to avoid smoking and excessive alcohol consumption to preserve bone health.

Drug treatments are available if alternative prevention and treatment methods are not working. Prescription medications include hormones, bisphosphonates, Selective Estrogen Receptor Modulators (SERMs) and monoclonal antibodies. Long-term use of bisphosphonates increases the risk of fractures so they should not be used beyond 3-5 years. Prolia, with the generic name Denosumab, is a type of monoclonal antibody, which stops the natural breakdown of bones. Prolia is injected two times per year. It should only be used if other treatment methods have failed or by post-menopausal women who have severe osteoporosis. The National Women’s Health Network suggests women try other FDA-approved osteoporosis medications prior to trying Prolia. This drug has a long list of side effects and it’s also important to note that long-term risks are unknown. The FDA Medication Guide lists the potential health problems, which include serious infections, thighbone fractures, and jaw bone problems. It is unclear if the benefits outweigh the risks.

Independent medical experts recommend that women get a bone density screening once they are 65 years old. If you have a condition that puts you at higher risk of osteoporosis, only then is it necessary to be screened earlier. Reasons for early screening include long-term steroid use and/or if you are at high risk for bone fractures. The screening tool most commonly used is a DEXA X-ray scan, which measures bone mineral density (BMD). It’s worth noting that it has become increasingly common to over-diagnose osteoporosis and over-advertise osteoporosis medications. You should consult with your healthcare provider to discuss what osteoporosis treatment method is right for you, whether that includes a medication or non-drug alternative. Be sure to ask your doctor about the safety and efficacy of osteoporosis medications you are considering.

For more information on osteoporosis prevention and treatment methods, refer to these resources:

Osteoporosis fact sheet - https://www.nwhn.org/osteoporosis/

NIH Osteoporosis and Related Bone Diseases National Resource Center - https://www.niams.nih.gov/health_info/Bone/

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