Osteporosis Treatments
What are the current treatments available for osteoporosis?
In general the following non pharmacologic measures are recommended:
- Over age 50, 1200 mg of calcium per day
- Vitamin D 400-800IU
- Regular weight bearing and muscle strengthening exercises (walking, jogging, dancing)
- Avoidance of tobacco use & alcohol abuse
- Preventing falls by avoiding certain medications, reducing clutter, handrails etc)
The following are FDA approved medications for osteoporosis:
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Estrogen
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Calcitonin
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Alendronate
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Risedronate
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PTH 1-34(teriparatide rDNA origin)
Estrogen replacement
- FDA approved for prevention of postmenopausal osteoporosis (PMO)
- Preserves/increases BMD (bone mineral density) in recently menopausal women (2-5 % at hip, 3-5% at spine in 3 yrs)
- Proven to reduce hip fractures
- Must consider Women’s Health Initiative study before considering long-term use
Raloxifene (Evista)
- Selective Estrogen Receptor Modifier (estrogen like effects in some parts of the body but unlike estrogen it does not affect uterine or breast tissue and may reduce the risk of breast cancer).
- Approved for prevention & treatment of postmenopausal osteoporosis (PMO)
- 2.4% increase in BMD at spine & hip
- Proven to reduce new vertebral fractures only
- Does not relieve hot flashes and has a small incidence of increase in blood clots
Alendronate (Fosamax)
- Belongs to a class of drugs called bisphosphonates
- Approved for prevention & treatment of PMO and steroid (such as prednisone) induced osteoporosis
- Helps to slow bone breakdown and studies show a 9% increase in spine BMD in 3 yrs, 6% at hip in 3 years
- Proven to reduce new vertebral & non vertebral (including hip) fractures
- May cause gastrointestinal upset or worsen reflux disease
Risedronate(Actonel)
- Another medicine from the bisphosphonate family—FDA approved for prevention and treatment of PMO & steroid induced osteoporosis
- Increases bone density by 5% within 3 years at spine, 3% at hip
- Proven to reduce both vertebral & non vertebral fractures
- Similar profile to alendronate but may be better tolerated in patients with mild reflux
Calcitonin nasal spray
- FDA approved for treatment of PMO in women 5yrs post menopause
- Minimal increases in BMD (1.2% over 5 years)
- Proven reduction in vertebral fractures only
- Has a possible analgesic effect in patients with compression fractures of the spine.
PTH 1-34(Forteo)
- It is a form of human parathyroid hormone that stimulates new bone formation and increases bone density
- Administered by daily injection
- 10% increase in spine BMD
- 65% decrease in new vertebral fractures
- Indicated for men & women with a high risk for fracture
- It should not be used in patients with Pagets disease, prior skeletal radiation, bony metastases, high calcium and in children & adolescents
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