Catching a Break: An Overview of Helpful Medications Used to Treat Osteoporosis

Osteoporosis is a painful disease affecting approximately 44 million Americans, over half of whom are female (68%).[1] While both preventable and treatable, Osteoporosis nonetheless remains a major public health threat throughout the United States and abroad. The NIH Osteoporosis & Related Bone Diseases National Resource Center estimates that "one out of every two women and one in four men over age 50 will have an Osteoporosis-related fracture in their lifetime."

The Center classifies Osteoporosis as "a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures of the hip, spine, and wrist."[2] The disease can lead to loss of height, painful and debilitating fractures, and subsequently, a major decline in physical and mental health. Many patients with Osteoporosis experience considerable pain and even lose the ability to care for themselves. The disease is diagnosed through a bone density test; a simple, painless procedure that can be performed in about 10 minute's time.

Risk factors for Osteoporosis include gender (chances of developing the disease are greater in females, particularly those who are postmenopausal); advanced age; small, thin-boned body type; family history of Osteoporosis or fractures; and ethnicity. Caucasian and Asian women are at the highest risk, while African-American and Latino women have a lower, yet still significant risk. Certain other factors and lifestyle behaviors can also increase the risks, including anorexia, lack of calcium and Vitamin D intake, use of glucocorticoids (Steroids) and anticonvulsants, lack of nutrition, alcohol consumption and smoking, and a lack of physical activity.

There are currently several medications available for the prevention and treatment of Osteoporosis in both men and women. These medications are intended to reduce bone loss and increase lumbar and hip bone density, thereby reducing the risk of fractures. Such therapies include:

Bisphosphonates:

Bisphosphonates inhibit the characteristic reabsorption of bone, without preventing the formation of new bone. Actonel and Fosamax are FDA-approved Bisphosphonates used in the prevention and treatment of Osteoporosis in post-menopausal women. Side effects reported by users include abdominal pain, nausea and acidic stomach. Those with allergies to Bisphosphonates or who have hypocalcemia, abnormalities of the esophagus, decreased kidney function or aspiration risks should not take Bisphosphonates.

Selective Estrogen Receptor Modulators (SERMs):

SERMs are highly potent anti-inflammatory agents which mimic the action of estrogen where it's wanted, such as in the cardiovascular and skeletal systems, but avoid estrogenic action where it's not; such as in the breast and uterine tissue. SERMs have been shown in studies to prevent bone loss in the spine, hip and total body. Raloxifene is an FDA approved SERM used in the prevention and treatment of Osteoporosis. Raloxifene has the potential to cause hot flushes and blood clots at a risk comparable to that of estrogen replacement therapy (ERT). Those who have known allergies to SERMs, are pregnant or breastfeeding, or who have a history of venous thrombosis are not candidates for Raloxifene therapy.

Estrogen Replacement Therapy (ERT):

Estrogen replacement therapy can protect the bones during the time of rapid bone loss immediately following menopause. Estrogen can also be effective later in life in preventing hip fractures. ERT is not without significant risk. For example, the Women's Health Initiative Study reported increased risks of heart attack, stroke, invasive breast cancer, pulmonary embolism, blood clots in the legs, breast tenderness, weight gain, fluid retention, gall bladder disease and vaginal bleeding in their study participants. Those with known allergies to estrogen, who have a history of estrogen dependent cancers, are pregnant, have a history of venous thrombosis, or who are experiencing unusual vaginal bleeding are not candidates for estrogen replacement therapy. Be sure to discuss the pros and cons of ERT with a qualified physician before embarking on estrogen replacement therapy.

Calcium & Vitamin D Supplements:

Calcium is an over-the-counter treatment for both men and women. Calcium and Vitamin D are essential to reduce bone loss and can also enhance the efficacy of other Osteoporosis medications. Popular examples of this widely available supplement include Viactiv, OsCal, Citracal and CalCitrate. Daily oral intake of 1000-1200 mg of calcium is recommended to decrease Osteoporosis risk. Those patients with allergies to calcium or Vitamin D or who have elevated calcium concentrations in their blood should not use these supplements. Certain food and medications can interact with calcium supplements, including spinach, rhubarb, whole-grain bran cereals, Tetracycline and Thiazide diuretics, so be sure to check with a qualified physician when embarking on Calcium therapy. Side effects include constipation and contribution to kidney stone formation in those individuals who have had stones in the past.

Calcitonins:

Calcitonins such as Calcimar and Miacalcin are injection and nasal spray formulations used in both men and women suffering from Osteoporosis. Calcitonins slow bone loss, increases spinal bone density and relieve pain associated with bone fractures. Calcitonin is a hormone produced by the thyroid gland that inhibits bone removal while promoting bone formation. These drugs are typically used for just a short time and are given in conjunction with calcium and Vitamin D supplements to enhance efficacy. These drugs can be genetically engineered from human calcitonin or derived from salmon. Side effects include such symptoms such as [nasal administration]: runny nose, crusting, nosebleed, back and/or joint pain and headache. Hot flushes, nausea, allergic reactions and respiratory tract irritation have been reported in both the nasal and injectible dosages. Those who are allergic to salmon Calcitonin should not use Calcitonins, and these drugs have not been studied in pregnant or nursing mothers.

Parathyroid Hormone Derivatives (PTHDs): PTHDs such as Forteo are genetically engineered Parathyroid Hormones, used to regulate calcium in the blood and stimulate bone formation. Persons with known allergies to PTHDs, those with an increased risk of osteosarcoma, Paget's disease, unexplained alkaline phosphatase elevations, or prior skeletal radiation should not use Parathyroid Hormone Derivatives. Reported side effects include increased uric acid levels in the blood, low blood pressure, nausea, vomiting, constipation and unusual fatigue.

On the Horizon:

According to the Cleveland Clinic[3], potential therapies under investigation include new forms of Bisphosphonates, Sodium Fluoride, additional SERMs, Parathyroid Hormone and Vitamin D metabolites.

For extensive information on medical therapies used to treat Osteoporosis, see EMedicine's "Understanding Osteoporosis Medications" presentation online at: http://www.emedicinehealth.com/articles/45766-5.asp

National Osteoporosis Foundation
http://www.nof.org �

National Osteoporosis Society
http://www.nos.org.uk �

Medline: Osteoporosis
http://www.nlm.nih.gov/medlineplus/osteoporosis.html

DID YOU KNOW…?

…Osteoporosis causes 1.5 million fractures annually and costs an estimated national expenditure of $14 billion each year. - NIH Osteoporosis & Related Bone Diseases National Resource Center

References:

[1, 2] The National Institutes of Health Osteoporosis & Related Bone Diseases National Resource Center. "Osteoporosis Overview." Web: http://www.osteo.org/newfile.asp? doc=osteo&doctitle=Osteoporosis+Overview&doctype=HTML+Fact+Sheet [3] Cleveland Clinic. "Osteoporosis: New Bone Builders and Protectors." Web: http://www.clevelandclinic.org/health/health-info/docs/1500/1591.asp?index=6691