Ask the Harvard Health

ASK THE HARVARD HEALTH EXPERTS

HOWARD LEWINE, M.D., PREMIUM HEALTH NEWS SERVICE

Q: I AM A 62-YEAR-OLD WOMAN WITH OSTEOPOROSIS. I SEE ADVERTISEMENTS FOR SEVERAL DIFFERENT TREATMENTS. HOW DOES ONE CHOOSE?

A: First, make getting enough calcium and vitamin D a daily priority. Calcium rich foods include dairy products, sardines, salmon, green leafy vegetables and calcium-fortified foods and beverages. Your doctor may also prescribe a calcium supplement.

You should have a blood test to be sure your vitamin D level is adequate. Even if it is, a daily vitamin D supplement of 1,000 IU per day is good insurance.

In addition, you want to stay physically active, with daily scheduled exercise times. For example, do moderate-intensity aerobics 5 days per week and resistance training on the other two days. Limit alcohol consumption, and if you smoke, it’s time to quit. Throughout our lives, our bones undergo constant turnover. Cells called osteoclasts break down and remove old bone, and then cells called osteoblasts lay down new bone. After menopause, the rate of bone breakdown speeds up.

To slow bone breakdown, many doctors first turn to bisphosphonates. There are several bisphosphonates to choose from:

• Pills, such as alendronate (Fosamax), ibandronate (Boniva), or risedronate (Actonel, Atelvia), taken daily, weekly, or monthly • Intravenous (IV) infusion of ibandronate (Boniva), given once every three months • IV infusion of zoledronic acid (Reclast), given once a year.

Your doctor will also consider where your bone loss is centered. Alendronate, risedronate, and ibandronate have all been shown effective for reducing spine fractures. For women with a history of hip or non-spinal fractures, alendronate or risedronate may be preferred.

If you have gastrointestinal problems like reflux, or if you can’t sit or stand upright for the full 30 to 60 minutes required after taking an oral bisphosphonate, your doctor may recommend one of the intravenous bisphosphonates.

Most women take these drugs for about five years. The good news is that the bone-protective benefits continue even after you stop taking bisphosphonates.

For postmenopausal women who aren’t starting with a bisphosphonate, or those who’ve already been on one for five years, here are a few other options.

Raloxifene (Evista) is an oral selective estrogen receptor modulator (SERM) that works by binding with estrogen receptors around the body to produce estrogen-like effects, one of which is to decrease bone turnover.

Teriparatide (Forteo) and abaloparatide (Tymlos) are synthetic versions of parathyroid hormone that increases bone density and strength. Women on teriparatide or abaloparatide need to give themselves a daily injection.

Denosumab (Prolia) is a monoclonal antibody given as a twice-yearly IV infusion. It prevents bonedissolving osteoclast cells from forming.

Romosozumab (Evenity) is another monoclonal available for women with very severe osteoporosis. It acts by blocking sclerostin, a protein that inhibits bone formation. The medication is injected once a month using two separate prefilled syringes for a full dose.

Q: I AM IN MY 70S. I KEEP HEARING ABOUT THE IMPORTANCE OF A STRONG CORE. WHAT ARE SOME EASY EXERCISES I CAN DO?

A: Your core is the stable part of your body that’s more than just your abdominal muscles, it also involves your hips, back and even your shoulders. A strong core helps make everyday movements more efficient and safer — like whenever you reach, carry, walk, bend, or twist.

Core strength is crucial for fall prevention. Our bodies constantly have to adapt not only to different surfaces, but different weighted loads. Adequate core stability and strength can prepare you to better react to these changes and keep you from losing your balance and stumbling.

Some floor exercises like the plank and superman poses are great for engaging your core muscles. A plank pose is where you hold a push-up position — with straight arms or resting on your forearms. You might only be able to hold it for 15 seconds at first, but over time you will increase the duration of the plank.

With superman, you lie face down with arms extended overhead, and you lift legs, shoulders, and arms off the floor simultaneously and hold for two to three seconds.

Another type of core workout involves walk-andcarry exercises, also known as “loaded carries.” You hold weights, such as dumbbells or kettlebells, while walking. Carrying a heavy object while you walk engages much of your entire core musculature. Loaded carries can improve everyday movements like holding and carrying groceries, moving furniture, or rising out of bed.

Here are three easy-to-do loaded carries to try.

Farmer’s carry. Stand tall and hold either a dumbbell or kettlebell in each hand. (Begin with a moderate weight, like the amount you use to do biceps curls.)

Keep your arms down at your sides. Engage your core muscles by taking in a deep belly breath and then blowing it out while you tighten your abs. Walk for a minute. (You mimic a farmer carrying pails of milk, hence the name.) Continue to breathe throughout the carry, maintain proper posture, and try to keep the tension in your abs as you move. Rest for 30 seconds, and repeat until you’ve completed two or three sets.

Cross-body carry. This is performed like the farmer’s carry, except you keep one arm straight overhead with the other hand down at your side as you walk. After you have completed your walk, rest for 30 seconds, switch hand positions, and repeat. This completes one set. Do two or three sets.

Suitcase carry. This is also done like the farmer’s carry, except you hold a weight in only one hand while your other hand is free. After you have completed your walk, rest for 30 seconds, switch the weight to the other hand, and repeat the walk to finish one set. Do two or three sets.

Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.

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