We are looking into all ways to treat osteoporosis for my aging father. He had what they call a low-energy fracture (fell from a standing position without being pushed) and broke his arm. I saw on-line that this problem should be treated with diet, exercise, and medications. What are the most commonly used medications and what should we watch out for?

Your father has suffered what is referred to as a fragility fracture. A fragility fracture is a bone break that occurs without significant trauma, which makes it a low-energy fracture. The person could just be lifting a cup of coffee, turning a key in the door lock, or picking up a small book when the bone fractures. Osteoporosis (decreased bone mineral density or “brittle bones”) is usually the reason for these fractures.

Half of all bone fractures that occur each year in the United States are related to osteoporosis. More than 300,000 hip fractures occur in the United States every year. A person with a hip fracture has a 20 percent chance of dying within six months as a result of the fracture. Osteoporotic-related fragility fractures can also affect just the arm. In fact, each year in the United States, one-quarter of a million adults (250,000) experience bone fractures of the arm from this condition.

One-third (34 per cent) of fragility bone fractures of the arm affect the wrist for women. In men, this figure is closer to 17 per cent. But even one osteoporosis-related fracture increases the risk two to four times for another fracture later. This is serious because many people who have a fracture related to osteoporosis spend considerable time in the hospital and in rehabilitation.

As you have discovered, treatment is with dietary supplementation (e.g., calcium and vitamin D), hormones, bisphosphonates (e.g., Boniva, Fosamax, Reclast), and biologic therapy (e.g., monoclonal antibodies). And some patients may want to pursue alternative therapies such as additional drug therapy with calcitonin, strontium, hormone replacement therapy, and/or estrogen receptor modulators.

Contraindications (reasons NOT to prescribe certain drugs) vary for each treatment recommended. For example, anyone with kidney disease, parathyroid disorders, or bone tumors is not a good candidate for dieatry supplementation with calcium and vitamin D. Bisphosphonates (used to prevent bone loss) are not advised for patients who cannot sit up for at least 30 minutes. And hormone therapy may be contraindicated in patients who have had prior radiation treatment to the skeleton or who have mets to the bone from cancer.

Anyone with a low-energy or fragility fracture associated with osteoporosis may be best served by coming under the care of a specialist with advanced knowledge of osteoporosis. This could be a primary care physician, a rheumatologist, or an endocrinologist. They will be familiar with the appropriate medications to prescribe and any contraindications. Having one physician supervise all aspects of care and management of this condition is important to prevent future fractures from occurring.

For more information (especially detailed information on pharmacologic and other treatment), see our document Patient Guide to Osteoporosis.