Osteoporosis
How is it treated?
Although osteoporosis has no cure, several types of medications are available to reduce the rate of bone loss, increase bone density, and reduce the number of fractures. In general, they work in two main ways: they lessen bone break down (anti-resorptive agents) or they stimulate the formation of new bone (anabolic agents). Experts recommend that these medications be taken continuously in order to gain their full benefits. Generally, bone loss resumes if the medications are stopped.
Most of the medications used to treat osteoporosis are also used to help prevent it. They include:
- Calcium and Vitamin D
- Hormone Replacement Therapy (Estrogens and/or Progestins)
- Calcitonin
- Bisphosphonates
- Selective Estrogen Receptor Modulators (SERMs)
- Recombinant DNA Parathyroid Hormone
While calcium, vitamin D, and exercise are important first steps for maintaining healthy bone at any age, they may not completely stop bone loss. Unless specific reasons exist not to take calcium and vitamin D, both are necessary for all individuals whether or not they take other medications for osteoporosis. According to the United States Surgeon General, calcium intake should be 1,200 mg to 1,500 mg (1.2 to 1.5 grams) per day through diet, supplements or a combination of both. Click on the "Helping Yourself" button at the top of this page to learn more about calcium-rich foods. If not enough calcium is obtained from foods, additional amounts can be taken as supplements. Calcium carbonate and calcium citrate are the preferred forms, because the body absorbs more calcium from them.
Often, calcium alone is not enough to improve bone density. Supplementing with vitamin D has been shown to help maintain bone strength and increase calcium absorption into bones. A daily intake of 400-800 IU of vitamin D for those people found to be deficient is recommended by the osteoporosis guidelines published in 2003.
Learn more about calcium and vitamin D by clicking on the link below.
Hormone replacement therapy (HRT) ? using drugs to restore estrogen and/or progesterone levels that decrease after menopause ? is approved for prevention and treatment of osteoporosis in women. However, long-term use of HRT may be associated with an increased risk of breast cancer, heart disease, or stroke according to the Women?s Health Initiative trial. Although millions of women have used HRT, the American Heart Association (AHA) now recommends that HRT not be used for the prevention or treatment of heart disease. Alternatives to the use of HRT should be discussed with a doctor.
Calcitonin is a hormone that the human body makes in the thyroid gland. It slows the break down of bone. Supplemental calcitonin (Miacalcin, Fortical) comes as an injection or a nasal spray that is approved for the treatment of osteoporosis in men and women. Calcitonin supplements may be obtained from natural sources (usually salmon) or they may be made synthetically. Although generally considered to be safe, supplemental calcitonin may not be as effective as other treatments for osteoporosis. However, evidence from some studies shows that it may help to control pain associated with osteoporosis.
Bisphosphonates are a group of drugs that attach to minerals, primarily calcium, in bone. They work by decreasing the effects of osteoclasts, so less bone is broken down and bone density does not decline as rapidly. Certain bisphosphonates, such as alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva), are approved by the FDA for the prevention and treatment of osteoporosis for both men and women. Bisphosphonates are available in tablet and injectable form and--depending on the particular medication--are administered in various dosing regimens including daily, weekly, twice monthly, monthly and every three months. Zoledronic acid (Reclast) is the newest bisphosphonate and is approved only for the treatment of osteoporosis in postmenopausal women. Zoledronic acid differs from the other available bisphosphonates because it is available as an injection given only once per year.
Raloxifene(Evista) is an oral medication that is approved for the prevention and treatment of osteoporosis in women who are past menopause and who are not taking hormone replacement therapy. Raloxifene is a member of the class of drugs called selective estrogen receptor modulators (SERMs) which attach to the sites on cells where estrogen usually attaches. This results in a decrease in bone break-down and an increase in BMD. SERMs act like estrogen in some parts of the body (such as in the bones) without causing a general estrogen effect. Some early data suggests that SERMs may decrease the risk of breast cancer as well.
Teriparatide (Forteo) is the first drug in the newest drug class for treatment of osteoporosis in men and women who are particularly likely to experience fractures. This includes individuals who have previously suffered a fracture due to osteoporosis, individuals with multiple risk factors for fractures, and those who have failed or cannot tolerate other osteoporosis treatments. Approved by the FDA in 2002, teriparatide is human parathyroid hormone (PTH) created by recombinant DNA technology. PTH is a natural human hormone that controls calcium levels in the body. Teriparatide acts like natural PTH to increase bone formation. Because the increased activity of osteoblasts builds bone up faster than osteoclast activity can break bone down, bone density may actually increase. Available only as a daily injection, teriparatide is awkward to use. It is also very expensive compared to other drugs that treat osteoporosis.
What else might help?
Bed rest or inactivity can result in rapid bone loss. According to a recent study in the Journal of Women?s Health, regular exercise may actually increase bone density in the spine as well as increase muscle mass. Potentially beneficial types of exercise include aerobics, weight lifting, and resistance training. While these activities have been shown to increase bone density, no information is available on the reduction of fractures. Consult with your personal health care provider before beginning any exercise program.
To learn more about the drugs used to prevent and/or treat osteoporosis, click on the links below.
Drug classes used to treat Osteoporosis Bisphosphonates Estrogens Hormone--Parathyroid Progestins Recombinant DNA Parathyroid Hormone Selective Estrogen Receptor Modulators
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How is it treated?
