MedicineNet.com
About Us | Privacy Policy | Site Map
November 22, 2009
MedicineNet home Picture Slideshows Diseases and conditions Symptoms and signs Procedures and tests Medications Health and Living Picture Image Collection MedTerms medical dictionary
Font Size
A
A
A

Osteoporosis (cont.)

Medications that prevent bone loss and breakdown

Currently, the most effective medications for osteoporosis that are approved by the FDA are anti-resorptive agents, which prevent bone breakdown. The bone is a living dynamic structure; it is constantly being removed (resorbed) and rebuilt. This process is an essential part of maintaining the normal calcium level in the blood and serves to repair tiny cracks in the bones that occur with normal daily activity. Osteoporosis results over time when the rate of bone resorption exceeds that of bone rebuilding. Anti-resorptive medications inhibit bone removal (resorption), thus tipping the balance in favor of bone rebuilding and increasing bone density. Menopausal estrogen hormone therapy is one example of an anti-resorptive agent. Others include alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), ibandronate (Boniva), calcitonin (Calcimar), and the recently approved zoledronate (Reclast).

Bisphosphates

Bisphosphonates decrease the risk of hip fracture, wrist fracture, and spine fracture in postmenopausal women osteoporosis.

To reduce side effects and to enhance absorption of the medicine, all bisphosphonates taken by mouth (orally) should be taken in the morning, on an empty stomach, thirty minutes before breakfast, and with at least 8 ounces (240 ml) of water (not juice). Taking the pill sitting or standing minimizes the chances of the pill being lodged in the esophagus. Patients should also remain upright for at least 30 minutes after taking the pill to avoid reflux of the pill into the esophagus. Newer intravenous bisphosphonates, such as ibandronate (Boniva) and zoledronate (Reclast) avoid these potential gastrointestinal problems.

Food, calcium, iron supplements, vitamins with minerals, or antacids containing calcium, magnesium, or aluminum can reduce the absorption of oral bisphosphonates, thereby resulting in loss of effectiveness. Therefore, oral bisphosphonates should be taken with plain water only in the morning before breakfast. Also, no food or drink should be taken for at least 30 minutes afterwards.

Alendronate (Fosamax)

Alendronate (Fosamax) is a biphosphonate anti-resorptive medication. Alendronate is approved for the prevention and treatment of postmenopausal osteoporosis as well as for osteoporosis that is caused by cortisone-related medications (glucocorticoid-induced osteoporosis). Alendronate has been shown to increase bone density and reduce fractures in the spine, hips, and arms. Alendronate is taken by mouth once-a-week to prevent and treat postmenopausal osteoporosis. Alendronate is the first osteoporosis medication also approved for increasing bone density in men with osteoporosis, either in a daily or a weekly dose schedule.

Alendronate is generally well tolerated with few side effects. One side effect of alendronate is irritation of the esophagus (the food pipe connecting the mouth to the stomach). Inflammation of the esophagus (esophagitis) and ulcers of the esophagus have been reported infrequently with alendronate use. For more, please read the Fosamax drug information article.

Risedronate (Actonel)

Risedronate (Actonel) is another bisphosphonate anti-resorptive medication. Like alendronate, this drug it is approved for the prevention and treatment of postmenopausal osteoporosis as well as for osteoporosis that is caused by cortisone-related medications (glucocorticoid-induced osteoporosis). Risedronate is chemically different from alendronate and has less likelihood of causing esophagus irritation. Risedronate is also more potent in preventing the resorption of bone than alendronate. For more, please read the Actonel drug information article.

Ibandronate (Boniva)

Ibandronate (Boniva) is an oral bisphosphonate for prevention and treatment of postmenopausal osteoporosis. It is available in both daily and monthly oral formulas as well as intravenously every three months. For more, please read the Boniva drug information article.

Zoledronate (Reclast)

Zoledronate (Reclast) is a unique yearly intravenous bisphosphonate anti-resorptive medication. This formulation seems to have very good bone strengthening ability by increasing bone density as well as significant fracture prevention both for spinal bone and bones away from the spine. Its convenience as given only once a year are obvious. As with all bisphosphonates, patients taking zoledronate (Reclast) must be loaded with adequate calcium and vitamin D prior to and after taking the medication for optimal results. Generally patients are given acetaminophen the day of the infusion and for several days afterward to prevent occasional minor muscle and joint aching. The infusion lasts approximately 20-30 minutes.

Selective estrogen receptor modulators (SERMs)

Raloxifene (Evista)

Raloxifene (Evista) belongs to a class of drugs called selective estrogen receptor modulators (SERMs). SERMs work like estrogen in some tissues but as an anti-estrogen in other tissues. The SERMs are developed to reap the benefits of estrogen while avoiding the potential side effects of estrogen. Thus, raloxifene can act like estrogen on bone, but as an anti-estrogen on the lining of the uterus.

The first SERM to reach the market was tamoxifen, which blocks the stimulative effect of estrogen on breast tissue. Tamoxifen has proven valuable in women who have had cancer in one breast in preventing cancer in the second breast. Raloxifene is the second SERM to be approved by the FDA. Raloxifene has been approved for the prevention and treatment of osteoporosis in postmenopausal women. In a three year study involving some 600 postmenopausal women, raloxifene was found to increase bone density and lower LDL cholesterol, while having no stimulative effect on the uterine lining (which means that it is unlikely to cause uterine cancer).

Because of its anti-estrogen effects, the most common side effects with raloxifene are hot flashes . Conversely, because of its estrogenic effects, raloxifene increases the risk of blood clots, including deep vein thrombosis (DVT) and pulmonary embolism (blood clots in the lung). The greatest increase in risk occurs during the first 4 months of use. Patients taking raloxifene should avoid prolonged periods of immobility during travel, when blood clots are more prone to occur. The risk of deep vein thrombosis with raloxifene is probably comparable to that of estrogen, about 2 to 3 times higher than the usual low occurrence rate. Raloxifene decreases the risk of spine fractures in postmenopausal women with osteoporosis, but the benefit in decreasing hip fracture risk is not yet known. (The only agents that are definitely proven to decrease hip fracture risk are bisphosphonates.) For more, please read the Evista drug information article.

Calcitonin (Calcimar, Miacalcin)

Calcitonin (Calcimar, Miacalcin) is a hormone that has been approved by the FDA in the United States for treating osteoporosis. Calcitonins come from several animal species, but salmon calcitonin is the one most widely used. Calcitonin can be administered as a shot under the skin (subcutaneously) or into the muscle (intramuscularly), or inhaled nasally (intranasally). Intranasal calcitonin is the most convenient of the three methods.

Calcitonin has been shown to prevent bone loss in postmenopausal women. In women with established osteoporosis, calcitonin has been shown to increase bone density and strength in the spine only.

Calcitonin is not as effective in increasing bone density and strengthening bone as estrogen and the other anti-resorptive agents. In addition, it is not as effective in reducing spine fracture risk, and has not been proven effective in reducing hip fracture risk. Therefore, calcitonin is not the first choice of treatment in women with established osteoporosis. Nevertheless, calcitonin is a helpful alternative osteoporosis treatment for patients who cannot tolerate other medications.

Common side effects of either injected or nasal spray calcitonin are nausea and flushing. Patients using Miacalcin Nasal Spray can develop nasal irritations, a runny nose, or nosebleeds. Injectable calcitonin can cause local skin redness at the site of injection, skin rash, and flushing. For more, please read the Calcitonin drug information article.

Teriparatide (Forteo)

Teriparatide (Forteo) is a synthetic version of the human hormone, parathyroid hormone, which helps to regulate calcium metabolism. It promotes the growth of new bone, while the other osteoporosis medications improve bone density by inhibiting bone resorption. Teriparatide (Forteo) is self-injected into the skin. Because long-term safety is not yet established, it is only FDA-approved for 24 months of use. It reduces spine fractures in women with known osteoporosis, but reduction of hip fracture risk is currently unproven. For more, please read the Forteo drug information article.



Next: Choosing an osteoporosis medication »

Osteoporosis - Symptoms at Onset of Disease

The MedicineNet physician editors ask:

The symptoms of osteoporosis can vary greatly from patient to patient. What were your symptoms at the onset of your disease?

Comment submissions for this question have ended. Patient Discussions FAQs
See 22 Viewer Comments

View Comments


Printer-Friendly Format  |  Email to a Friend


Suggested Reading by Our Doctors
MedicineNet Doctors
  • medroxyprogesterone, Provera, Depo-Provera, Depo-Sub Q Provera 104 - Explains the medication medroxyprogesterone (Provera, Cycrin, Depo-Provera, Deop-Sub Q Provera 104), a drug used used to treat abnormal uterine bleeding, contraception, and for treating endometrial or renal cancer.
  • Bone Density Scan - Get information on bone density scan for osteoporosis and osteopenia risk. Learn about bone mineral density, how the screening is done and get an explanation of test results.
  • Lower Back Pain - Get information on causes of lower back pain (arthritis, pregnancy, herniated disc, sciatica, spinal stenosis, endometriosis, ovarian cysts), includes back pain treatment and diagnosis.

Latest Medical News


Healthy Bones

Get tips and advances in treatment.


Are you Depressed? Take the Quiz

Your Guide to Symptoms & Signs: Pinpoint Your Pain












Health categories:

Slideshows | Diseases & Conditions | Symptoms & Signs | Procedures & Tests | Medications | Health & Living | News & Views | Medical Dictionary

Popular health centers:

Allergies | Arthritis | Cancer | Diabetes | Digestion | Healthy Kids | Heart | Men's Health | Mental Health | Women's Health | More...

Publications:

ePublications (PDFs) | XML News via RSS | Audio Podcasts | Email Newsletters

MedicineNet.com:

About Us | Privacy Policy | Site Map | WebMD® | Medscape® | eMedicine® | eMedicineHealth® | RxList®

This website is certified by Health On the Net Foundation. Click to verify. This site complies to the HONcode standard for trustworthy health information:
verify here.

©1996-2009 MedicineNet, Inc. All rights reserved. Notices and Legal Disclaimer.
MedicineNet does not provide medical advice, diagnosis or treatment. See additional information.