Osteoporosis Medications

There are a few different types of medication that can be used to treat osteoporosis.

Bisphosphonates

This class of medications, which includes Alendronate (e.g., Fosamax), Ibandronate (e.g., Boniva) and Risedronate (e.g, Actonel), is used to prevent and treat osteoporosis in both women and men. Bisphosphonates work by slowing the rate of bone thinning, which can prevent the development of osteoporosis and reduce the risk of fracture in people who already have osteoporosis. They are taken orally.

Alendronate
The use of Alendronate (e.g. Fosamax) causes a shift of bone balance toward bone formation by inhibiting bone resorption and has been shown to increase bone mass. Alendronate is significantly more expensive than estrogen, but its ability to prevent fractures is very similar to estrogen.

Two studies about Alendronate include:

  • Lieberman et al — 10 mgs of Alendronate per day over a three-year period of time built bone mass in 96% of patients and decreased the risk of fracture significantly.
  • Fracture Interventional Trial by Black et al — with the use of Alendronate, there was a 47% decrease in new vertebral fractures, a 50% decrease in hip fractures, a 55% decrease in the risk of symptomatic vertebral fractures, a 48% decrease in wrist fractures, and a 28% decrease in the risk of all clinical fractures.
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Ibandronate
Approved for postmenopausal osteoporosis, Ibandronate (e.g., Boniva) is taken orally once per month. The use of Ibandronate reduces bone loss, increases bone density and reduces the risk of spine fractures.

Risedronate
Approved for postmenopausal osteoporosis and for glucocorticoid-induced osteoporosis (e.g., from long-term use of prednisone or cortisone), Risedronate (e.g., Actonel) is taken orally on a daily or weekly basis. The use of Risedronate reduces bone loss, increases bone density and reduces the risk of spine and non-spine fractures.

Calcitonin

Calcitonin (e.g. Miacalcin, Calcimar, Fortical) is a hormone that is produced naturally in the body, and it is now available as a prescription medication. It can be taken in injection form or intranasal (through a nose spray). This has been found to increase bone density mainly in the spine.

Calcitonin is indicated for patients who are approximately 5 years past menopause and have low bone mass, or with obvious osteoporosis, who choose not to or cannot take estrogen. Calcitonin has also been shown to be helpful for pain management with compression fractures. The effectiveness of Calcitonin tends to plateau approximately 18 years after menopause.

In the study of anti-resorptive agents over a two-year period, there was a comparison of placebo, estrogen, calcitonin and alendronate. Increases in bone density were noted with all agents, as follows:

  • Estrogen — 5%
  • Alendronate — 8%
  • Calcitonin — 2%

There was no residual protection from bone loss after stopping the estrogen and calcitonin, however, after stopping the Alendronate a positive bone balance was noted.

Raloxifene, a Selective Estrogen Receptor Modulator (SERM)

Brand name Evista, Raloxifene is part of the Selective Estrogen Receptor Modulators (SERMs) class of drugs developed to provide the benefits of estrogens without their disadvantages. Approved for postmenopausal osteoporosis, Raloxifene is taken orally once a day and is shown to increase bone mass and reduce the risk of spine fractures.

Estrogen therapy/hormone replacement therapy

Estrogen replacement therapy had been widely used to treat symptoms of menopause in post-menopausal women. To reduce a woman's risk of developing endometrial cancer, doctors often prescribe the hormone progestin in combination with estrogen for those women who have an intact uterus. This combination is called ET/HT (estrogen therapy/hormone replacement therapy). Because of its ability to decrease the risk of fractures in the hip and spine in postmenopausal women, estrogen replacement therapy and ET/HT has also been used in the treatment of osteoporosis.

However, recent studies show that a certain type of hormone replacement is associated with an increase in breast cancer, stroke and heart attack. As a result, the FDA now advises patients to consider other osteoporosis medications first and to use ET/HT conservatively (e.g., lowest possible dose, shortest time period) to manage symptoms of menopause.

Teriparatide

Teriparatide (e.g., brand name Fortéo) is the only approved treatment for osteoporosis that increases bone formation (rather than slowing bone loss) leading to increased bone mineral density. It is a man-made form of the naturally occurring parathyroid hormone which regulates calcium and phosphate metabolism in bones. Teriparatide is approved for use for up to 24 months as a self-administered daily injection in men with high fracture risk and in postmenopausal women. In men, studies show fracture reduction in the spine; in postmenopausal women, fracture reduction was shown in the spine, hip and other bones.

References:

  1. National Osteoporosis Foundation. www.nof.org. Accessed on May 19, 2006.
  2. The National Institutes of Health – Consensus Development Program: Optimal Calcium Intake. www.nih.gov. Accessed on June 14, 2006.
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