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 The leading web portal for pharmacy resources, news, education and careers November 18, 2017
Pharmacy Choice - Osteoporosis Disease State Management - November 18, 2017

Osteoporosis Disease State Management

Osteoporosis and Nutritional Supplements
by JoAnne Conrad, M.S., L.D.

Osteoporosis is often referred to as the silent disease because bone loss is gradual and painless and usually there are no symptoms to indicate a person is developing this condition. Often the first symptom is a fracture (International Osteoporosis Foundation).

Over 44 million Americans have osteoporosis of which 80% are women. The majority of cases are in women greater than 50 years of age. One in two women will have an osteoporosis-related fracture during her lifetime. Fractures of the hip typically result in long-term nursing care and a 20% death rate within a year. (U.S. Preventative Services Task Force)

There are two types of osteoporosis:

Type 1 is postmenopausal or estrogen/androgen deficient osteoporosis and occurs in women within a few years of menopause. Men may also develop Type 1 during adulthood if they have a significant decline in androgen production.

Type 2 is age-related and occurs around age 70 and beyond. It affects both sexes.

Secondary osteoporosis results when a medication or disease process causes loss of bone tissue. Some medications are: corticosteroids, phenytoin, aluminum- containing antacids and PPIs. A recent study reported in the BMJ January 31, 2012 found that long-term use of PPIs increases the risk of hip fractures by 35 to 50 percent for postmenopausal women who are either current or former smokers. Some medical conditions that can increase the risk of osteoporosis are diabetes, hyperthyroidism, and COPD.

Conventional osteoporosis therapy includes bisphosphonates, calcitonin, SERMs and parathyroid hormone. Nutritional supplements are also available.

Calcium and Vitamin D: Most research supports the combination of vitamin D and calcium for the reduction of bone fractures in older adults. The National Osteoporosis Foundation recommends 400 IU to 800 IU vitamin D daily for adults under age 50 and 800 IU to 1000 IU daily for older adults. The recommended calcium intake for adults under age 50 is a total of 1,000 mg /day of calcium from all sources. Adults 50 and older need a total of 1,200 mg/day of calcium from all sources.

Conflicting data pertaining to calcium supplementation with or without vitamin D and the risk of cardiovascular events has resulted in a recent recommendation to reassess the role of calcium supplementation in osteoporosis management. A reanalysis of WHI Calcium and vitamin D study and a meta-analysis of eight other studies reported in the BMJ 2011, showed a modest increase in the risk of cardiovascular events, especially MI. A study published in the May 2012 issue of the journal, Heart, did not find an increased risk of heart attack with the use of calcium-rich foods.

Calcium supplements in doses greater than 1000-1300 mg/day for adults may increase risk. Further studies are warranted. Food remains the best source of calcium. Calcium supplements should only be used when adequate dietary intake cannot be achieved.

A calcium and vitamin D supplement should be taken when using a bisphonate medication in order to maintain adequate serum calcium levels. Take these supplements two hours after a dose of bisphosphonate.

Ipriflavone is a semisynthetic isoflavone manufactured from daidzein, a compound derived from soy. It has estrogen like effects and stimulates osteoblast activity. When used orally and appropriately, ipriflavone seems to be safe for up to 3 years. However, in one study, subclinical lymphocytopenia occurred in about 13% of patients, particularly after 6 months. It is important to monitor white blood cell counts. It is often found as a supplement (usual does of 600 mgs) combined with calcium. Ipriflavone is thought to competitively inhibit CYP1A2 and CYP2C9. Drugs affected include cyclobenzprine, haloperidol, imipramine, amitriptyline, warfarin and diazepam.

The exact role of magnesium in bone health is not known but it is involved in enzymatic processes that build bone. Some evidence suggests that a magnesium deficiency may be a risk factor for postmenopausal osteoporosis. Magnesium deficiency alters calcium metabolism and the hormones that regulate calcium. A low level can also result in impaired synthesis of vitamin D. You will frequently see magnesium included in calcium supplements. Drugs that can reduce serum magnesium are digoxin, diuretics, and long-term use of PPIs.

Soy supplements contain isoflavones that are estrogen-like compounds with the potential to exert some beneficial estrogenic effects on bone. A recent study published in the Archives of Internal Medicine found that women in the first five years of menopause who took soy supplements had no differences in bone-mineral density than women who took a placebo. Fermented soy products such as tofu contain tyramine; these products should be avoided if one is taking a MAOI.

Supplements with less research include copper in combination with zinc, manganese and calcium; evening primrose oil in combination with fish oil and calcium; and fluoride. (Natural Medicines Comprehensive Database)

Links - Osteoporosis
National Osteoporosis Foundation. Established in 1984, the National Osteoporosis Foundation (NOF) is the nation’s leading voluntary health organization solely dedicated to osteoporosis and bone health.

Medline Plus MedlinePlus will direct you to information to help answer health questions. MedlinePlus brings together authoritative information from NLM, the National Institutes of Health (NIH), and other government agencies and health-related organizations. Foundation for Osteoperosis Research and Education - As a non-profit resource center, we are dedicated to preventing osteoporosis through research and education of the public and medical community to increase awareness of risk, detection, prevention and treatment.

If you would like to contact us please go to our Contact Page.


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