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Steps you can take to build stronger bones

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Osteoporosis is a silent disease. In most other conditions, people may notice signals the body sends, indicating something isn’t quite right. But when developing osteoporosis, the condition doesn’t rear its head until an external event causes a catastrophic outcome. It progresses slowly and steadily in the background as we continue our daily lives. The lucky ones may never even notice that they’ve developed osteoporosis. It’s a different and potentially life-changing experience for those not so lucky. A stumble, fall, or sharp bump against a hard object can produce more stress than the fragile bones can stand. Before the body starts developing osteoporosis, it can handle normal bumps with bruises –  but the reality of a more advanced stage of osteoporosis can result in a crippling fracture that could end up requiring a whole slew of medical interventions.

So, what is osteoporosis?Doctor-explaining-bone-health-to-older-patient

Osteoporosis can be defined in just a few words. Osteoporosis is a condition in which structural bones in the skeleton become fragile. The term osteoporosis itself means “porous bone” and describes the result when bones lose their density as a person ages or when changes in their body’s metabolism cause this. 

How are bones built and kept healthy?

Bones are living structures that form in the womb and grow most during childhood and adolescence as the body matures. Each cubic centimeter of bone contains millions of mature bone cells, known as osteocytes, that form a lattice that gives bone its strength and shape. There is continuous recycling of bone cell contents as they die, and their contents are scavenged (resorption.) The old cell contents are reabsorbed, and vital minerals such as calcium are released into the bloodstream.  In healthy bones, there is a process in which new cells replace the old ones through the activity of osteoblasts, and the net result is that the bone retains its shape and strength. This destruction and rebuilding process is vital for maintaining bone strength and flexibility so that the body can support all the normal skeletal functions like movement, lifting, or stretching.

How does the process of bone recycling get disrupted?

In a healthy body, these processes work together, ensuring the replacement of bone cells. However, in a body with an imbalance between bone formation and bone resorption and more cells are being destroyed than laid down, bones become steadily less dense. Then more and more gaps appear between individual cells in the lattice.  You can imagine a similar process by picturing a soft stone under a high-pressure stream of water (or chalk cliffs at the ocean’s edge). Initially, the stone is hard and smooth and can withstand any pressure you can subject it to. As it spends more and more time under the constant stream, grains of sand are knocked out by the water. The stone becomes grainy, then porous; if you wait long enough, you could pick it up and crush it in your hand. That is essentially what is happening when a person is developing osteoporosis, as bones grow older and more cells (osteocytes) are dying than are being replaced. The bone becomes grainy, loses density and strength, and whereas it could withstand tremendous strain and pressure in the past, it could now break under even slight stress.

What can cause osteoporosis?

Several factors contribute to osteoporosis development, and the main ones are:
  • Aging
  • Hormonal changes, specifically the decline in estrogen levels in menopausal women and testosterone in men.
  • Chronic diseases such as rheumatoid arthritis
  • Medications such as prolonged use of steroids
  • Lifestyle choices like prolonged and heavy smoking
  • Dietary deficiencies, especially Vitamin D and calcium.

Can osteoporosis be treated?

Several treatment options are available for anyone who is developing osteoporosis and should be discussed with a healthcare provider. These include medications that reduce the rate of osteocyte breakdown, others that accelerate the rate of new cell formation, and finally, one that can work when all others fail. Bisphosphonates slow down bone resorption by reducing osteoclast activity. Examples include Fosamax and Actonel oral meds. One medication that accelerates the bone-building process by stimulating new cell formation is Prolia. It is an injection that has to be self-administered and can only be used for a maximum of two years. You can read more about how Prolia works in our in-depth study here. In cases where none of the other available treatments are working satisfactorily, doctors can now prescribe Evenity, which uses romosozumab, another bone-building drug that has the same effect as Prolia but works differently. Evenity is administered in a doctor’s rooms in 12 injections over one year. Romosozumab is intended to treat severe osteoporosis in postmenopausal women at high risk of bone fractures. Romosozomb binds to a protein called sclerostin and blocks its action, leading to increased bone formation. In this way, it helps build new bone and prevents further breakdown of existing bone. This action strengthens the bones and reduces the risk of fractures. These drugs are typically reserved for people with very low bone density, those who have had fractures, or whose osteoporosis is caused by steroid medication.

Why you should buy Evenity and Prolia from IsraelPharm

As these drugs are still only available in the brand version from the original developers, they are expensive if you source them from a US retail pharmacy. But from IsraelPharm, you can get the same drug, from the same manufacturer, at a significant saving. Take a look at the following table, and see the price difference.  
Name Packaging US Price IsraelPharm price
Evenity 2 syringes 105 mg/1.17 mL $2350 $725
Prolia 1 syringe 60mg/mL $1670 $480


What steps can I take to slow down osteoporosis?

Both women and men should take steps to prevent osteoporosis. Make sure that you:
  • Have a healthy and varied diet with enough calcium-rich foods. The RDI (recommended daily intake) for calcium is 1,000 mg per day for most people who are susceptible to osteoporosis
  • Eat fresh fruit, vegetables, and whole grains
  • Get enough vitamin D through exposure to sunlight and food sources such as fatty fish, liver, and cheese
  • Avoid or strictly limit smoking, alcohol consumption and caffeine.

Who is more likely to develop osteoporosis?

The National Osteoporosis Foundation has reported that about fifty percent of women over the age of 50 who are developing osteoporosis will experience an osteoporosis-related fracture. The Mayo Clinic advises that women with osteoporosis may also experience frequent fractures, particularly in the hip, spine, and wrist. It is mostly common in women after menopause but can also appear at young ages in the presence of risk factors for osteoporosis.

How serious is osteoporosis?

The World Health Organization ranks osteoporosis as second only to cardiovascular diseases as a global health issue.

How long does it take for Evenity to start working?

The drug’s duration is only one year, and it is active for all of that time; plus, it is expected to work for at least one year after the end of treatment. During the use of the drug and for a year afterward, you must be monitored by an endocrinologist.

What are the possible side-effects of Evenity?

Romosozumab may increase the risk of heart attack, stroke, and death due to various heart and blood vessel problems. As a result, doctors generally do not prescribe Evenity in the first year after a heart attack or stroke.  A Product Information leaflet comes with the medicine. Please read it carefully, and discuss any questions or issues with your doctor or pharmacist.
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