Impact of nutrition on medications for osteoporosis

Abstract

Nutrition is clearly important for skeletal health. Yet, in many cases, depending on bone density and fracture risk, nutrition alone is not enough, and pharmacologic treatment may be required to prevent bone loss and osteoporosis-related fractures. It is important to stress that nutrition still plays an important role even in individuals being treated for osteoporosis. There are a number of options for treatment of osteoporosis. Many of the available osteoporosis treatments are capable of improving bone mass by 1-10 % at various skeletal sites over 3-5 years. However, there must be an adequate nutritional supply of calcium and vitamin D in order to promote bone growth, similar to the amount that the skeleton needs during growth in childhood. The best approach is to reduce all possible risk factors, optimize nutrition, particularly calcium and vitamin D, and encourage an exercise program, which has an overall health benefit as well as impact on the skeleton and muscle. Pharmacologic therapies should be initiated in patients with osteoporosis and those at highest risk. Different pharmacologic therapies might be appropriate for women at different ages and according to their personal and family medical history. All pivotal phase III studies of the efficacy of treatments for osteoporosis have taken place in patients who were given calcium and vitamin D. There may be a minimal level of serum 25(OH)D required for optimal response to osteoporosis medication, likely between 25 and 33 ng/ml. The impact of calcium and vitamin D on pharmacologic therapy is inconsistent but in no cases was the efficacy reduced with adequate calcium and vitamin D. Therefore the recommendation to obtain adequate calcium and vitamin D through diet and/or supplements should maximize the beneficial effects of pharmacologic treatments.