Conventional treatment for osteoporosis
Osteoporosis drugs can slow or even reverse the disease's progression and help prevent bone fractures.
A diagnosis of osteoporosis can be frightening. You may wonder if you won't be able to keep up with daily activities or if you will have to live with broken bones or changes in your appearance.
Rest assured that it's never too late to do something about bone health. It's never too late to stop osteoporosis in its tracks. Treatment can slow or even reverse its progression. The goal is to maintain good bone health to ensure a low risk of fracture.
Healthy behaviors, such as getting enough calcium and vitamin D and being physically active, are key components of any plan to prevent or treat osteoporosis. But these measures alone might not completely offset bone loss due to aging.
This is where medications to improve bone health come into play. In recent decades, the development of these drugs has helped transform osteoporosis into a treatable condition.
Your doctor can prescribe a medication to prevent or treat osteoporosis if:
- You've been diagnosed with osteoporosis
- You have low bone density (osteopenia), are postmenopausal or have other risk factors for osteoporosis
- You experience continued bone loss or a fracture, even though you're physically active and get enough calcium and vitamin D
You and your health care professional now have a variety of options to choose from in order to provide the most effective drug to fit your individual needs. Here's a look at the options.
These are the most widely prescribed osteoporosis medications. Bisphosphonates inhibit bone breakdown, preserve bone mass and increase bone density in the spine and hip.
Bisphosphonates can be taken in pill form daily, weekly or monthly. Or you can have an injection once every few months or once a year, depending on the drug. Bisphosphates include:
- Alendronate (Fosamax)
- Risedronate (Actonel, Atelvia)
- Ibandronate (Boniva)
- Zoledronic acid (Reclast, Zometa)
The most common side effects of oral bisphosphonates are heartburn and abdominal pain caused by irritation to the esophagus or stomach. Intravenous medications don't cause gastrointestinal upset.
Bisphosphonates have also been linked to two rare but serious problems — osteonecrosis of the jaw and an unusual type of fracture in the upper thigh bone (atypical femoral fracture). Osteonecrosis of the jaw develops when the jawbone fails to heal after a minor injury, such as getting a tooth pulled. The bone is exposed and begins to weaken and die, causing pain and potential infection. The risk of serious side effects is very low, and for most people the benefit of treatment outweighs the risk.
Bisphosphonates are more effective when taken with adequate amounts of calcium and vitamin D. People who are typically prescribed a bisphosphonate drug are more likely to be deficient in vitamin D. It's important to have calcium and vitamin D levels assessed before starting treatment.
This drug chemically modifies the body's parathyroid hormone (PTH). PTH plays a critical role in the bone remodeling cycle and in maintaining the calcium balance in your bloodstream.
The medication teriparatide (Forteo) builds new bone. It has been approved to treat women and men with severe forms of osteoporosis, including those who are at high risk of fractures or who haven't responded well to other forms of treatment. It's taken by daily self-injection.
In animal studies, a small increase in cancerous bone tumors has occurred with large doses of teriparatide. Humans aren't thought to have the same risk. But because the long-term effectiveness and safety of the drug aren't known, treatment generally does not continue for more than two years. After two years of treatment with teriparatide, another osteoporosis drug is usually prescribed to maintain the new bone growth.
Denosumab (Prolia) is used to treat osteoporosis in postmenopausal women who have an increased risk of fracture, as well as women or men who cannot take or did not respond to other osteoporosis drugs.
This drug works by slowing the bone-breakdown process. It's delivered by injection every six months. Common side effects include skin irritation, back pain, and other bone, muscle or joint pain. People who receive denosumab should also take calcium and vitamin D supplements to offset lowered calcium levels.
Raloxifene (Evista) 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 of the risks associated with estrogen.
The drug slows bone loss and prevents spinal fractures, but it's not as effective as other osteoporosis drugs for preventing hip fractures. Raloxifene is taken as a tablet once each day. The most common side effect is hot flashes. The drug also increases the risk of blood clots.
Calcitonin is a hormone produced in the thyroid gland. A synthetic form of calcitonin (Miacalcin) is approved to treat, but not prevent, postmenopausal osteoporosis. Like the bisphosphonates and raloxifene, calcitonin works by slowing bone breakdown. It's most commonly given as a nasal spray, but can also be given as an injection.
This drug is safer but less effective than other osteoporosis medications. For that reason, it's considered to be one of the last treatment options. Side effects of the injectable form include nausea, irritation at the injection site, increased urination, and flushing of the face and hands. The only side effects of the nasal spray are nasal irritation and headache.
Getting the most from treatment
If your health care professional prescribes an osteoporosis drug, then the key is to take it as recommended. To get the most from your medication it's also important to exercise regularly and get enough calcium and vitamin D.
July 02, 2019
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