Why osteoporosis should be actively prevented with drugs rather than diet


“Calcium and vitamin D are essential for bone health, but cannot be a ‘cure’”
“It is important to take a treatment for osteoporosis and take an appropriate amount of vitamin D”

Yongin Severance Endocrinology Department Professor Kyungmin Kim

Calcium and vitamin D are very important nutrients for bone health. Calcium plays a crucial role in forming and maintaining bones, and vitamin D helps the absorption of calcium. If so, can we expect to improve bone loss and prevent osteoporosis by consuming calcium and vitamin D through our diet?

In this regard, Professor Kim Kyung-min (Department of Endocrinology, Severance Hospital, Yongin) said, “In young people, bone health can be managed to some extent through diet management, but in older women or especially postmenopausal women, diet alone cannot restore the deteriorated bone condition.” emphasizes that

-The reason why active bone management is necessary from the initial stage of osteopenia

Although it is known that a high fracture rate is stochastic in the osteoporotic stage, the absolute number of fractures is much higher in the osteopenic stage. The important thing is that it is very difficult to restore the bone to its previous healthy state once it has been damaged. Therefore, the best treatment for osteoporosis is ‘prevention’, and in particular, if osteopenia is confirmed during menopause, active treatment and management should be initiated.

-Can diet management improve bone loss?

Some people think that consuming vitamin D and calcium through diet can improve bone loss or prevent osteoporosis, but it is absolutely difficult to meet the required intake of vitamin D and calcium through Korean diet alone. It is true that calcium and vitamin D are important factors for bone health, but it should be recognized that they cannot be a treatment by themselves. If necessary, it is recommended to take osteoporosis drugs, calcium, and vitamin D.

Why is raloxifene widely used to prevent osteoporosis in postmenopausal women?

This is because raloxifene is a drug that has been proven effective not only in the treatment of osteoporosis, but also in the prevention of osteopenia.
Usually, when selecting a treatment for osteopenia/osteoporosis, the rate of bone deterioration is predicted and reflected by checking the increase or decrease of bone resorption/osteogenesis through bone marker tests as well as bone density. Even if the T-score is the same -2.0, the rate of bone loss is different for each patient.

When raloxifene is used in patients with rapid bone loss, bone marker levels are stabilized to a level appropriate for their age, so I think raloxifene can be actively used for the prevention and treatment of osteoporosis.

What are the other benefits of raloxifene in the treatment of postmenopausal osteopenia/osteoporosis?

Unlike other oral medications for osteoporosis, raloxifene can be taken at any time before or after a meal, and there are no restrictions on water intake or posture maintenance after taking it. It has the advantage of being very convenient from the perspective of the patient, as only one tablet per day needs to be taken.

In addition, since osteoporosis is not a disease that can be improved at once, the safety of the treatment is also required in terms of long-term use. Raloxifene has few side effects and can be used for a long time without a separate drug holiday.

In addition to its action on bones, it is also one of the reasons why raloxifene is often used in postmenopausal women with osteopenia/osteoporosis, as it slightly lowers cholesterol levels and prevents breast cancer.

-What are the benefits of taking raloxifene + vitamin D combination (Evista Plus)?

As mentioned earlier, vitamin D supplementation is essential for osteopenia/osteoporosis. However, what is important at this point is not simply whether or not to take vitamin D, but whether or not to take the correct vitamin D.

According to the 2008 National Health and Nutrition Examination Survey, the daily intake of vitamin D for most Koreans was reported to be far below the recommended amount of 800 to 1000 IU. However, these days, the problem of overuse of nutritional supplements is greater than that of deficiency. This is because there are many people who arbitrarily overdose on nutritional supplements without a professional diagnosis on their body. In fact, there were patients who took up to 5,000 IU of vitamin D a day at the actual clinic.

The problem is that too much vitamin D intake can cause side effects. Therefore, rather than emphasizing the unconditional vitamin D intake, it is important to adjust the appropriate intake according to the nutritional status of the patient. For patients who overdose on nutritional supplements at the time of diagnosis, we will organize the nutritional supplements they are taking and change them to appropriate medications.

Recently, many osteoporosis drugs have been released in combination with vitamin D based on the importance of taking vitamin D. When prescribing an osteoporosis treatment and vitamin D complex to a patient, it has the advantage of being able to conveniently take the appropriate amount of treatment and vitamin D with just one tablet.

In addition, since most osteoporosis patients are older and take many drugs, if they take osteoporosis treatment and vitamin D separately, their adherence to the medication may decrease. Considering this, the use of combination drugs has a positive effect on patient adherence to medication and improvement of treatment outcomes.

-If you would give advice to patients with postmenopausal osteopenia/osteoporosis

Bone is one of the organs most sensitive to aging. Assuming that 100% of bone deterioration occurs after menopause until death, it is known that about 50% of bone deterioration occurs within 5 to 10 years immediately after menopause. If you block it well, you can protect your bone health to some extent. If this period is missed and osteopenia/osteoporosis worsens and fractures occur, treatment may not be easy, and more expensive drugs may be required.

Of course, not all osteopenia patients go straight to treatment. However, it is important to keep in mind that if the bone health starts to deteriorate after menopause due to a sharp drop in female hormones, it cannot be recovered through lifestyle therapy or diet alone. If a diagnosis has been made that active management is necessary through consultation with the attending physician, we urge you to start treatment and management without delaying the timing.

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