Severe osteoporosis, calcium and vitamin D supplementation are not effective, and bisphosphonates may be needed

An elderly friend left a message to Huazi, saying that he has osteoporosis and always suffers from back pain. However, after taking calcium tablets for several months and adding active vitamin D, there has been no obvious improvement in the symptoms. Is it because he is not taking enough calcium?

Huazi told her that she didn't need to increase the dosage of calcium tablets. The problem she encountered was probably that the calcium she took in was not deposited on the bones. After menopause, the estrogen level of elderly women decreases, which will lead to increased osteoclast activity and increased bone destruction. Osteoporosis caused by this reason is difficult to be cured by supplementing calcium and vitamin D alone, and bisphosphonates may be needed.

1. It is difficult for calcium to enter the bones

If bones are a "vault", calcium is the "money" stored in it. Osteoblasts on the bones are responsible for "saving money", while osteoclasts are responsible for "spending money". Normally, the money deposited into the vault and the money spent every day are balanced, but as we age, the activity of osteoclasts increases, and the money spent will increase.

That is to say, the older you are, the faster you lose bone calcium. Especially for women after menopause, the sudden decrease in estrogen secretion will lead to a significant increase in osteoclast activity, making osteoporosis more likely.

Although calcium and vitamin D supplements increase the "liquidity" outside the coffers, osteoclasts are still spending the money in the coffers lavishly, making it difficult for calcium to be deposited in the bones, so the symptoms of osteoporosis cannot be improved.

2. Bisphosphonates that inhibit osteoclast activity

For severe osteoporosis, the first-line treatment is currently bisphosphonates, which can limit the synthesis of structural proteins in osteoclasts, eventually causing osteoclasts to lose their function and die. In other words, bisphosphonates can prevent osteoclasts from "spending money lavishly" and allow more money to be saved in the treasury.

After using bisphosphonates, calcium deposition in bones increases, which can lead to lower blood calcium levels. Therefore, blood calcium levels need to be tested before taking the medicine. If you have hypocalcemia, you cannot take the medicine. You need to supplement calcium and vitamin D. You can only take the medicine after correcting hypocalcemia. You should also pay attention to calcium and vitamin D supplementation during medication.

3. What should I pay attention to when using bisphosphonates?

Among bisphosphonates, oral alendronate sodium is more commonly used, and injectable zoledronic acid is more commonly used.

If there are no contraindications, oral dosage forms are recommended. This type of drug has a strong irritation to the digestive tract and is easy to corrode the digestive tract mucosa. In addition, other drugs and foods may affect absorption. It is necessary to take the drug with no less than 200ml of boiled water 30 minutes before breakfast on an empty stomach. After taking the drug, you should maintain an upright position for more than 30 minutes and cannot lie flat to reduce the risk of reflux damaging the esophagus.

If there are contraindications to oral bisphosphonates, such as achalasia, esophageal stenosis, esophageal varices, Barrett's esophagus, etc., or if the patient is bedridden and cannot stand upright for 30 minutes after taking the medicine, then an intravenous drip formulation can be selected, and the medicine can be given once every 3 to 4 weeks. When bisphosphonates are administered intravenously, symptoms such as fever and muscle pain may occur, and acetaminophen or ibuprofen can be used to relieve the symptoms.

The use of bisphosphonates may cause hypocalcemia, requiring simultaneous calcium and vitamin D supplementation. However, calcium supplements will interfere with the absorption of bisphosphonates, so calcium supplements must be taken at least 1 hour apart.

Bisphosphonates are excreted through the kidneys, which may cause damage to the kidneys and cause a transient increase in blood creatinine. If the creatinine clearance rate of patients with renal insufficiency is less than 35ml/min, bisphosphonates are not recommended.

In summary, for patients with severe osteoporosis, it is difficult to produce effective therapeutic effects by simply supplementing calcium and vitamin D. Usually, bisphosphonates are needed to inhibit the activity of osteoclasts in order to effectively treat osteoporosis. The drugs must be used under the guidance of a doctor. If you have any questions about the use of the drugs, you should consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.