Not so long ago, it took a broken hip or a permanently curved spine to tell if someone had osteoporosis. Now, the bone-thinning disease can be diagnosed in its earliest stages with a painless bone-density scan.
Patients today have more options. New drugs — and you can't miss them if you watch TV at all — promise to stop bone loss, increase bone density and prevent crippling fractures.
One problem: Getting patients to take their medication.
"If they don't hurt, folks don't take it," says Dr. Joel Silverfield, an osteoporosis specialist with Tampa Medical Group. That's why Silverfield and other physicians are enthusiastic about Reclast, just approved by the FDA for use once every two years for preventing osteoporosis in postmenopausal women with the precursor condition osteopenia (it already had been approved for use once a year to treat osteoporosis).
Says Silverfield: "It guarantees compliance."
Since being diagnosed with osteoporosis three years ago, Mercedes Karl tried pills taken daily, once a week and once a month, hoping to hit on one she could remember to take. But nothing clicked with her routine.
Last year, she decided to try Reclast, which takes 15 minutes to infuse intravenously at a doctor's office or infusion center. "It's easy for me to do," says Karl, 70. "I don't have to take a pill every day. I'm notified in advance of my appointment. It's very short and relatively painless."
According to the National Osteoporosis Foundation, 10 million Americans have osteoporosis. Most patients are women, but men get it, too. More than half of all Americans over age 50 are at risk for the disease, the foundation estimates, making it a major public health threat.
Unlike oral medications for osteoporosis, Reclast is unlikely to cause stomach problems. And it's an option for patients who can't remain fully upright for at least 30 minutes, a requirement with some of the oral drugs.
Reclast is approved for use in post-menopausal women with osteoporosis and osteopenia; it's also for men with osteoporosis, and for people at risk for osteoporosis caused by steroid medication use.
Silverfield explains it's not appropriate, for example, for a woman with normal bone density whose major risk factor is family history. "The risk-benefit ratio doesn't make sense," he says. Some side effects include flu-like joint pain that goes away, more serious bone pain, abnormal heart rhythms and rarely, jaw pain and jaw fracture.
Helpful as Reclast can be, doctors agree the real key is prevention. "The problem with osteoporosis, especially early on, is it's painless and you can't see it,'' said Dr. Jodi Shields, a physical medicine specialist at Florida Orthopaedic Institute in Tampa.
Preventing bone loss starts in childhood, she said.
• Make sure children, especially adolescent, teen and college-age girls, get adequate calcium, vitamin D and weight-bearing exercise every day.
• There may be a correlation between osteoporosis and fizzy beverages, both diet and regular. Until all the research is in, Shields recommends limiting soda consumption to no more than two a day.
• Smoking and drinking more than two alcoholic beverages a day are also bad for your bones.
"All things in moderation,'' she said. "Except smoking, that's never okay.''
Irene Maher can be reached at firstname.lastname@example.org or (813) 226-3416.