Osteoporosis (cont.)
Choosing an osteoporosis medication
In choosing a medication for osteoporosis, a doctor will take into account
all aspects of a patient's medical history and the severity of the osteoporosis.
If a postmenopausal woman has other menopausal symptoms such as
hot flashes and
vaginal dryness, menopausal hormone therapy will be the proper choice for these
menopausal symptoms as well as for the prevention of osteoporosis. After the
menopause symptoms have passed, some other non-estrogen prescription
osteoporosis medication will be considered for the long-term.
If the prevention
and treatment of osteoporosis is the only issue under consideration, then
bisphosphonates such as alendronate, ibandronate, or risedronate are more
effective than menopausal hormone therapy in preventing osteoporotic fractures,
and less likely to be associated with substantial adverse effects. So far,
bisphosphonates are the most effective category or prescription medications for
treating postmenopausal osteoporosis.
A few specific serious esophageal conditions preclude the
use of oral bisphosphonates. These are called esophageal stricture or achalasia. Caution is often advised for people with dysphagia,
gastritis, duodenitis, or ulcers
who take oral bisphosphonates. Any worsening symptom should be reported immediately,
but the vast majority of people can tolerate bisphosphonates when the
prescribing directions are followed carefully. Fortunately, gastroesophageal
reflux disease (GERD) or heartburn, which are common,
are not
specific contraindications to the use of bisphosphonates. Prescribing directions
should be followed carefully. Moreover, intravenous bisphosphonates, such as zoledronate (Reclast) may be given to those with gastrointestinal side effects from oral bisphosphonates.
In patients with GERD or who have symptoms of
heartburn, risedronate may prove to cause less irritation to the esophagus than
alendronate, but now intravenous bisphosphonates, such as zoledronate (Reclast) may be preferred.
Calcitonin is a weaker anti-resorptive medication than estrogenic
bisphosphonates. It is reserved for those who cannot take or will not consider
taking the other medications. Raloxifene is also a weaker medication [in
improving bone density or preventing fractures) compared to estrogen or
bisphosphonates (alendronate (Fosamax), ibandronate (Boniva), and risedronate
(Actonel)]. Thus, in patients with moderate to severe osteoporosis, it is
advisable to use the more potent anti-resorptive medications. The safety and
effectiveness of more than three years of raloxifene use or more than 24 months of
teriparatide use, have not been well-researched.
Estrogen replacement and
raloxifene differ in their side effects and also in their effects on cholesterol
panels. For example, raloxifene does not raise the "good HDL cholesterol," but
estrogen replacement does. They both lower the "bad LDL cholesterol."
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