Osteoporosis - medical treatment

Osteoporosis has no cure, but it is preventable, and there are treatments. Following are descriptions of the most common therapies available today — and some you may see in the future.

hormone therapy

Doctors sometimes prescribe estrogen to replace the hormones lost during menopause and slow the rate of bone loss. This therapy is called hormone replacement therapy (HRT). HRT can reduce the risk of spine, hip, and wrist fractures by up to 70 percent. It works best if taken during the five to ten years immediately following menopause, or in the case of surgical menopause, when the ovaries are removed. But HRT offers bone benefits to women even if they start taking it much later in life. Once the therapy is discontinued, however, bone loss resumes.

Experts do not know all the risks of long-term use of HRT. Women should discuss benefits, risks, and possible side effects of HRT with their doctors.

bone-saving drugs

A variety of drugs are available to slow bone loss or build up bone, but all require adequate calcium to work effectively.

alendronate (fosamax)

Alendronate prevents bone from being resorbed. The drug appears to build up a woman’s spine by 3 percent a year for three years. In five studies, involving 1,602 women, the drug was found to reduce fractures by nearly 30 percent. In particular, it can prevent three kinds of fractures: forearm fractures, hip fractures, and vertebral collapse (which leads to loss of height).

Typically, a woman will take one 10-milligram tablet daily, with plain water on an empty stomach. The worst side effect of the drug is that it can irritate the esophagus, but gastrointestinal upset can be lessened if you take the drug when you first gets up, at least 30 minutes before breakfast, and stay upright during that time.

The Food and Drug Administration (FDA) has approved the use of Alendronate for treating osteoporosis but not for preventing it. Studies to date have lasted only four years, and since the drug is actually bound into the bone, there’s some concern about its long-term safety. That’s why Alendronate is usually reserved for women who can’t take estrogen. For its benefits to last, Alendronate must be taken for life.

calcitonin

Calcitonin is a naturally occurring hormone that increases bone density in the spine by one and a half percent per year for two years. Studies have found no benefit to the hip or forearm after two years.

The drug comes in two forms: injection (Calcimar, Miacalcin) or nasal spray (Miacalcin). It’s a protein, so if it were taken orally, it would be digested before it could work. In its injectable form, calcitonin has been studied for more than a decade and has been found to have few side effects. (It leaves the body within a matter of hours.) A nasal spray, however, may irritate the nasal passages or inflame the sinuses if used for years. Calcitonin doesn?t build as much bone as Alendronate, but because it has a pain-killing effect, it’s a good post-fracture treatment. It is also a good alternative for women who don’t want to take hormone-replacement therapy or Alendronate. Both Alendronate and calcitonin must be taken for life to be beneficial.

raloxifene (evista)

This “designer estrogen,”otherwise known as a selective estrogen receptor modulator, was approved by the FDA in December, 1997, as an alternative to HRT. In a study of 13,000 women, raloxifene increased bone density by 1 to 2 percent, but did not stimulate the breast tissue, meaning it would not raise the risk of breast cancer. It also does not stimulate uterine tissue and would therefore not raise the risk of uterine cancer either. When the researchers examined how the drug affected cholesterol levels, they found that raloxifene lowered levels of total cholesterol and “bad” LDL cholesterol, but did not raise “good” HDL levels. (It does increase hot flashes at the start of treatment, though these tend to be mild.) Finally, the drug is taken orally once a day and doesn’t have to be timed to coincide with meals, as do some hormone-replacement medications.

simvastatin (zocor)

Simvastatin belongs to a class of drugs called statins. It is approved to treat hyperlipidemia and hypercholesterolemia — that is, to lower blood fats and reduce the risk of heart disease and cardiovascular events in high-risk patients. Statins block the liver’s synthesis of cholesterol by blocking a pathway involved in the process.

A study in Bone from the University of Siena, Italy reported that 30 postmenopausal hypercholesterolemic women were treated with simvastatin for 12 months and 30 normocholesterolemic postmenopausal women provided control data. The difference between the two groups was significant for bone mineral density at the spine and hip, with the treated women showing increases at both sites, and a positive effect shown for simvastatin.

An article in Pharmacoepidemiological Drug Safety reported on a study from Brigham and Women’s Hospital in Boston that examined the relationship between statin use and bone density among postmenopausal women. They did a survey of postmenopausal women who had bone densitometry and agreed to a telephone interview about their OP risk factors, use of hormone replacement therapy, and osteoporosis medications and statin exposure. Of 339 women studied, 162 were current or past users of statins. Statin users has significantly higher body mass index and rates of thiazide use and were more likely to abstain from alcohol. Researchers found that statin use was associated with significantly higher bone mineral density at the hip compared to non-users.

working with your doctor

Print out the decision chart and take it with you to your doctor’s appointment. The chart can help you determine your risk for osteoporosis, as well as help you and your doctor get a handle on the benefits and risks of HRT for you. After reviewing it together, ask your doctor the following questions:

• What do you think is my long-term osteoporosis risk, based on my personal and family medical histories?
• If I am at high risk, what therapy do you recommend — and why?
• Is the therapy to halt bone loss, or to rebuild bone?
• When should I begin treatment? before menopause? after menopause?
• How long will I have to be on it?
• What is the best outcome I can expect?
• What are the possible side effects of treatment?
• Are there any side effects that warrant immediate attention?

Be sure to let your doctor know all of the prescription drugs you’re taking, as well as any nutritional supplements or herbs.

DRUGS USED TO TREAT OSTEOPOROSIS

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