Treatments for Osteoporosis

Treatment list for Osteoporosis: The list of treatments mentioned in various sources for Osteoporosis includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

• Calcium supplements
• Vitamin D supplements - aids calcium absorption.
• Treatments for menopausal women
  • Estrogen replacement therapy
  • Calcitonin (Miacalcin®)
  • Bisphosphonates
    • Alendronate (Fosamax®)
    • Risedronate (Actonel®)
  • Raloxifene (Evista®) - a selective estrogen receptor modulator (SERM)
  • Fluoride
• Prevention of fractures
  • Care when lifting
  • Care when bending
  • Avoiding falls - see prevention of falls
• See also treatment of fractures

Treatment of Osteoporosis: medical news summaries: The following medical news items are relevant to treatment of Osteoporosis:

• Adherence rates for osteoporosis treatment regimens is very poor
• Antidepressant use by children can cause bone weakness during adulthood
• Calcium supplementation during puberty may reduce risk of osteoporosis later in life
• Ceasing hormone replacement therapy may increase osteoporosis risk in women
• Comparison trial shows Fosamax to be a winner for osteoporosis treatment
• Crohn’s patients suffering from bone loss benefit most from only calcium and vitamin D therapy
• Depo-Provera users need to evaluate the risk of bone mass loss with the benefits
• Depression drugs may affect bone formation in children
• Hospital over prescribe steroids for cold patients
• HRT may help men with prostate cancer without the negative side effects
• Inhaled steroids may increase risk of osteoporosis
• Intranasal steroid therapy doesn’t stunt children’s growth
• It’s not enough to take calcium supplements to ward off osteoporosis
• Lactoferrin helps prevent bone loss as well as promoting bone growth
• New Dietary Guidelines support numerous research results
• New osteoporosis drug may prevent many fractures
• Osteoporosis drug had preventative effect against breast cancer
• Osteoporosis drug may reduce knee damage from osteoarthritis
• Osteoporosis is a serious disease often undiagnosed
• Osteoporosis rates expected to increase with reduced useage of HRT
• Osteoporosis risk defined for degenerative disease treatment being developed
• Prostate cancer victims need more focus on osteoporosis prevention
• Steroid drugs used to treat nephritic syndrome do not affect bone mass
• Testicle removal to treat prostate cancer may increase osteoporosis risk
• Thyroid disorder underdiagnosed and misdiagnosed
• Vitamin D essential for more than just bone health
• Women needlessly scared off using HRT
• Young women are also prone to bone thinning disease
• You’re never too young to have osteoporosis

Treatments of Osteoporosis discussion: Under FDA guidelines, drugs to treat osteoporosis must be shown to preserve or increase bone masses and maintains bone quality to reduce the risk of fractures. Before 1996, the only choices were the hormones, estrogen, and indictable calcitonin, as well as the use of calcium supplements. But there have been recent advances in treatment. Three medications have recently been approved by the FD One agent, called a bisphosphonate, slows down the rate of bone loss. One common bisphosphonate os alendronate, marketed by the brand name Fosamax. The second agent is an inhaled form of calcitonin. A third treatment called raloxifene, a selective estrogen receptor modulator (SERM), has many estrogen-like properties. Studies have shown that this agent can decrease bone loss but not quite as much as estrogen. A woman and her doctor need to carefully weigh the risks and benefits of these treatment options. ¹

Lifestyle changes and medical treatment are part of a total program to prevent future fractures. A diet rich in calcium, daily exercise, and drug therapy are treatment options. Good posture and prevention of falls are important in reducing the chance of being injured.

Under FDA guidelines, drugs to treat osteoporosis must be shown to preserve or increase bone mass and maintain bone quality in order to reduce the risk of fractures. The following drugs are approved by the FDA for the treatment or prevention of osteoporosis:

• Estrogen – Estrogen Replacement Therapy (ERT) is approved for both prevention and treatment of osteoporosis. It reduces bone loss, increases bone density in the spine and hip, and reduces the risk of fractures in postmenopausal women. Doctors prescribe ERT in combination with the hormone progestin (called hormone replacement therapy or HRT) to reduce the risk of developing cancer in the lining of the uterus. HRT has shown to be effective at reducing the symptoms of menopause and having beneficial effects on both the skeleton and heart.

• Alendronate (Fosamax®) – This drug belongs to a class of drugs called biophosphonates and is approved for both prevention and treatment of osteoporosis. It is used to treat bone loss from the long-term use of osteoporosis-causing medications and is used for osteoporosis in men. In postmenopausal women, it has shown to be effective at reducing bone loss, increasing bone density in the spine and hip, and reducing the risk of spine and hip fractures.

• Risedronate (Actonel®) – Like Alendronate, this drug also is a biophosphonate and is approved for both prevention and treatment of osteoporosis, for bone loss from the long-term use of osteoporosis-causing medications, and for osteoporosis in men. It has been shown to slow bone loss, increase bone density, and reduce the risk of spine and non-spine fractures.

• Calcitonin (Miacalcin®) - Calcitonin is a naturally occurring hormone involved in calcium regulation and bone metabolism. Calcitonin can be injected or taken as a nasal spray. In women who are at least five years beyond menopause, it slows bone loss and increases spinal bone density. Women report that it also eases pain associated with bone fractures.

• Raloxifene (Evista®) – This drug is a selective estrogen receptor modulator (SERM) that has many estrogen-like properties. It is approved for prevention and treatment of osteoporosis and can prevent bone loss at the spine, hip, and other areas of the body. Studies have shown that it can decrease the rate of vertebral fractures by 30-50%.

Other treatments are being studied. They include new biophosphonates and SERMs, Vitamin D metabolites, parathyroid hormone, and sodium fluoride. A woman and her doctor need to carefully weigh the risks and benefits of these treatment options. ²

Treatment of osteoporosis aims to stop bone loss and rebuild bone. Along with making lifestyle changes, there are several medication choices. Some will slow your rate of bone loss, and others will actually rebuild bone. These are:

• Estrogen. Doctors sometimes prescribe estrogen to replace the hormones lost during menopause, to slow the rate of bone loss, and to increase bone mass in the spine and hip. When estrogen alone is used, this treatment is called estrogen replacement therapy (ERT). Post-menopausal women who still have a uterus and who choose to take estrogen should receive hormone replacement therapy (HRT), taking both estrogen and progestin. ERT or HRT may also protect against heart disease. Experts do not know all the risks of long-term use of these hormones. Each woman should discuss possible benefits, risks, and side effects of ERT or HRT with her doctor.
• Raloxifene. This new drug is approved to prevent osteoporosis. It is known as a SERM (selective estrogen receptor modulator). Like estrogen, this SERM prevents bone loss, but may cause blood clots in some women. Unlike estrogen, it may cause hot flashes, but should not increase your chance of developing cancer of the endometrium (the lining of the uterus or womb).
• Alendronate and risedronate. These medicines are bisphosphonates, drugs that slow the breakdown of bone and may even increase bone density. They can lessen your chance of breaks in the spine and hip. Side effects may include nausea, heartburn, and pain in your stomach, muscles, or bones. These drugs must be taken in a certain way—when you first get up, before you have eaten, and with a full glass of water. You should not lie down or eat for at least one-half hour after taking the drug.
• Calcitonin. This is a naturally occurring hormone that increases bone mass in the spine and may lessen the pain of fractures there. It comes in two forms—injection or nasal spray. The injection may cause an allergic reaction and has some unpleasant side effects. The only side effect of the nasal spray form is a runny nose in some people. It is most useful for women who are 5 years past menopause.
• In the future. Other SERMs and bisphosphonates are being studied as improved treatments for osteoporosis. Also promising as possible therapies are sodium fluoride, parathyroid hormone (PTH), and some forms of vitamin D.

If the scan shows osteoporosis, treatment, with the exception of estrogen and raloxifene, is similar to that suggested for older women. This includes getting enough calcium and vitamin D, doing weight-bearing exercise, not smoking, and limiting alcohol. The only drugs available for men are alendronate, risedronate, and calcitonin. Some men with low levels of testosterone may find testosterone supplements helpful.³

Footnotes:
1. excerpt from Aging - Women Getting Older: NWHIC
2. excerpt from Osteoporosis: NWHIC
3. excerpt from Osteoporosis - Age Page - Health Information: NIA

Last revision: June 5, 2003

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