Osteoporosis Drug Therapy

Our Specialty Pharmacy offers pharmacy services to people with osteoporosis who need long-term teriparatide (Forteo) or other injection drug therapy. Our pharmacy staff can provide the medication for your condition after you return home from the clinic. Experienced pharmacy professionals work closely with your Mayo Clinic care team to develop a personalized medication management program at no additional cost. We coordinate all billing and claims on your behalf, relieving you of up-front costs and the headaches of completing insurance forms and filing claims.

About Osteoporosis
The Role of Medications in Treating Osteoporosis
Side Effects, Cautions and Special Requirements
Always Ask Your Pharmacist

About Osteoporosis

Osteoporosis, which means "porous bones," causes bones to become weak and so brittle that even mild stresses such as bending over, lifting a vacuum cleaner or coughing can cause a fracture. In most cases, bones weaken because of low levels of calcium, phosphorus and other minerals in the bones. Osteoporosis can also accompany endocrine disorders or result from excessive use of medications, such as corticosteroids.

In the United States, osteoporosis causes more than 1.5 million fractures every year, most involving the spine, hip or wrist. Although often considered a women's disease, osteoporosis also affects many men. About 8 million American women and 2 million American men have osteoporosis, and nearly 18 million more Americans may have low bone density. Even children are not immune.

It is never too late, or too early, to do something about osteoporosis. Everyone can take steps to keep their bones strong and healthy throughout life.

The Role of Medications in Treating Osteoporosis

A number of prescription drugs can help slow bone loss and may even increase bone density over time, including:

Bisphosphonates. This group of drugs can inhibit bone breakdown, preserve bone mass and even increase bone density in the spine and hip. Bisphosphonates may reduce the risk of hip and spine fractures by about 50 percent. Bisphosphonates may be especially beneficial for men, young adults and people with steroid-induced osteoporosis. They are also used to prevent osteoporosis in people who require long-term steroid treatment for diseases such as asthma or arthritis. Bisphosphonates include the oral medications alendronate (Fosamax) and risedronate (Actonel).

Raloxifene (Evista). This medication is taken orally and belongs to a class of drugs called selective estrogen receptor modulators (SERMs). Raloxifene mimics estrogen's beneficial effects on bone density in postmenopausal women, without some risks associated with estrogen, such as increased risk of uterine and, possibly, breast cancer.

Calcitonin (Miacalcin). This hormone produced by the thyroid gland reduces bone resorption and may slow bone loss. It may also prevent spine fractures, although it doesn't appear to protect against hip fractures. It is administered as a nasal spray and can cause nasal irritation. Calcitonin is usually used to treat people with osteoporosis who are at high risk of fracture and cannot take bisphosphonates.

Tamoxifen (Nolvadex). This synthetic hormone has been used to treat breast cancer for years. It is now also being given to certain high-risk women to help reduce their chances of developing breast cancer. Although tamoxifen blocks estrogen's effect on breast tissue, it has an estrogenlike effect on other cells in your body, including your bone cells. As a result, tamoxifen appears to reduce the risk of fractures, especially in women over age 50.

Teriparatide (Forteo). This medication is a manufactured form of the naturally occurring hormone parathyroid. It helps in forming new bone and increases bone strength. Teriparatide is used in both men and women who are at high risk for bone fractures. It is administered once daily as an under-the-skin (subcutaneous) injection, usually in the thigh or abdomen.

Side Effects, Cautions and Special Requirements

Side effects of bisphosphonates can include nausea, abdominal pain and irritation of the esophagus. If you cannot tolerate oral bisphosphonates, your doctor may recommend periodic intravenous infusions of bisphosphonate preparations.

Hot flashes are a common side effect of raloxifene. This drug should not be taken by anyone who has a history of blood clots. Raloxifene is only approved for women with osteoporosis.

Possible side effects of tamoxifen include hot flashes, stomach upset and vaginal dryness or discharge.

Teriparatide must be refrigerated. Most side effects of teriparatide are mild, including leg cramps, dizziness or rapid heartbeats after injection.

Always Ask Your Pharmacist

If you experience problems with your osteoporosis therapy, your pharmacist is a reliable source of information about osteoporosis management and can help you monitor your condition, maximize the benefits of your medications, limit side effects and identify drug-drug or drug-disease interactions. Your pharmacist will work closely with your doctor to create a safe and appropriate care plan.

Optimal control of osteoporosis requires the coordinated care of your health care team. Doctors, nurses and other caregivers must work closely with pharmacists and others to ensure therapy is safe and effective. Incomplete management of osteoporosis or another medical condition may lead to complications or limit the success of treatment.