Osteoporosis: Nonpharmacologic Approaches

Peter L. Salgo, MD: If we decide that maybe it’s a good idea to simply say everybody over 65 is either at high risk or has it, and there are some low-cost nonpharmacologic therapies we can recommend for everybody, what would you recommend? Who wants to give me a list? What do you want to do, exercise?

Claire Gill: Yes, absolutely. The treatment plan actually involves more than just pharmacologics, because actually we know that if people’s calcium and vitamin D levels aren’t at the adequate amounts, the medication won’t work as well as it should. So we do have to get patients to make sure that they’re taking the recommended calcium and vitamin D, hopefully from food first. Obviously, supplementation is a big issue, but food first and then supplement only for the shortfall in the diet. And then we need weight-bearing exercise and muscle strengthening exercise.

That’s where patients want to focus, unfortunately. They want to change all of their lifestyle factors before they do pharmacologic therapy. And that’s fine. We absolutely encourage people to do that. But the conversation I have with patients is, if that were how we solved the problem, then I wouldn’t have any patients who were fit, active, and had great healthy diets telling me they have osteoporosis. That’s not the case.

Peter L. Salgo, MD: Because it’s a real disease.

Claire Gill: It is.

Peter L. Salgo, MD: It’s not just a disease of lack of exercise, right? But it doesn’t hurt to eat better, get vitamin D, and do all of this, right?

Andrea J. Singer, MD, FACP, CCD: It doesn’t really hurt anything, does it?

Peter L. Salgo, MD: Is it easy to make patients do all of that?

Andrea J. Singer, MD, FACP, CCD: What do you think?

Peter L. Salgo, MD: Of course it’s hard. Everybody gives lip service to it, but nobody does it. Why is that?

Thomas P. Olenginski, MD, FACP, CCD: I don’t know. One of the things that I try to tell my patient, and it’s silly, right: “I don’t want you to trip, slip, or fall.”

Peter L. Salgo, MD: Good luck with that.

Thomas P. Olenginski, MD, FACP, CCD: No one wakes up wanting to do that, but 95%-plus of every hip fracture is because someone does that. They fall on a weak femur, and they break their hip. When I make a recommendation that a patient might need some physical therapy, because of cost often, it’s something that they have a hard time embracing. I think, in a way, they’re a little bit embarrassed. It takes time for some patients to accept a walker, a traditional cane, or a 4-pronged cane.

Peter L. Salgo, MD: But people are more willing to go to the gym than to go to physical therapy. Maybe it’s just nomenclature.

Andrea J. Singer, MD, FACP, CCD: Though it’s hard to sometimes get people to do all of the things we want them to do, what we have learned from some of the surveys is patients want to be treated as complete beings. I know we’re going to talk about medications afterward, but if you start with a medication first, they tend to be a little bit turned off. So the approach really needs to be that we talk about treating the whole person. That means nonpharmacologic things. It also gives them some power, right? They can be proactive and take a role in the course of their own disease. And then we also talk about medication in people when it’s appropriate.