They have the same objective: to prevent the occurrence of fractures and the associated complications. However, treatments for osteoporosis are far from consensus. Between the various kinds of drugs and the popular belief that dietary intakes of calcium as well as vitamin D are enough, Why Doctor takes stock.
- In the management of osteoporosis, calcium and vitamin D can only be adjunctive treatments
- Good treatment of osteoporosis can reduce the risk of fracture by 70%
Faced with osteoporosis, a disease that causes bone fragility in some people over the age of 50 – affected by early menopause, having had previous pathologies, or presenting risk factors – there is no universal treatment. .
Raloxifene, denosumab… Faced with the range of drugs available to us, Professor Bernard Cortet, rheumatologist at the University Hospital of Lille, mentions bisphosphonates, one of the classes often used in first intention. “These are drugs that have the characteristic of gradually incorporating into the bone matrix, so that it is not necessarily necessary to give them throughout life”he explains to why doctor.
Thus, after an initial cycle of 3 to 5 years – depending on the molecules and the route of administration used – a reassessment will be carried out to see if the treatment can be suspended, continued or changed.
Vitamin D and calcium: “add-on” treatments
At the same time, it is commonly accepted that taking vitamin D regularly is effective in treating osteoporosis since it plays a role in bone metabolism. “It’s an adjunctive treatmentsays Professor Bernard Cortet. It is necessary in an osteoporotic patient, but it is not sufficient”. Same observation for calcium: if you have to try to optimize your intake since you lose it every day, especially in the urine, it is not a treatment for osteoporosis in its own right.
“The older we get, the greater the calcium intake must be; in the age group that concerns us, that is to say beyond 50 years, it is theoretically 1,200 mg per day”, indicates the health professional. A quantity he deems “a little excessive”since it recommends at least 800 mg of calcium daily to obtain a good balance.
Calcium in drugs: “not to be prescribed to everyone”
To get an idea, a one liter bottle of milk corresponds to about 1 g of calcium while a yoghurt contains nearly 60 mg. Some mineral waters are also rich in calcium and can provide up to 500 mg per day. Thus, to take a sufficient daily dose, it is ideally advisable to ingest two dairy products and to drink water rich in calcium.
For people who do not like dairy products or who are intolerant to them, the rheumatologist recommends consuming calcium in medicinal form as a supplement. “The drugs are effective but they should not be prescribed to everyone”he warns, however.
Decrease the risk of vertebral fracture by 70% with adequate treatment
Indeed, drug treatments should only concern patients presenting a high risk of fracture, such as those who have a very low bone density, who have already had a fracture, or who present risk factors for osteoporosis while having a level potentially problematic bone density. “If the treatments are given wisely, the benefit/risk ratio is quite favorable”emphasizes the Professor Bernard Cortetregretting that “this message, for the moment, has not passed”.
Thus, with adequate treatment, the reduction in the risk of vertebral fracture is of the order of 70%. It reaches 50% for hip fractures and 20% for other non-vertebral fractures. In contrast, a few cases of osteonecrosis of the jaw have been reported with bisphosphonate use; 1 in 10,000 people are affected.
“Consequently, in all the recommendations, it is indicated that an oral check-up should be done beforehand.says the rheumatologist. These are the monitoring conditions identical to those of the general population; that is to say, go see your dentist once a year”.
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