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All about osteoporosis maintaining bone health types of osteoporosis causes of osteoporosis osteoporosis risk factors risk factors for primary osteoporosis risk factors for secondary osteoporosis consequences of osteoporosis symptoms of osteoporosis diagnosis of osteoporosis osteoporosis treatments osteoporosis medications treatment for osteoporosis in men treatment for osteoporosis in women osteoporosis lifestyle therapy osteoporosis exercises osteoporosis diet prevention of osteoporosis osteoporosis and calcium osteoporosis and magnesium osteoporosis and vitamin D

What osteoporosis medications are available?

Major drug therapies now exist for treating osteoporosis. Most drugs currently used for osteoporosis are antiresorptives which are used to slow the rate of bone remodeling but cannot rebuild bone. Such agents include bisphosphonates, hormone replacement therapy, SERMs, and calcitonin. Agents that rebuild bone are known as anabolics. Injections of

parathyroid hormone increase bone mass and are proving to be very effective. Fluoride is one of the few bone-building agents, but it has limitations

Bisphosphonates

The bisphosphonates (alendronate and risedronate) are useful in preventing and treating all types of osteoporosis. The bisphosphonates inhibit osteoclast activity, increase bone mass, and are among the primary drugs against osteoporosis in postmenopausal women and in people taking corticosteroids or hormonal agents that suppress estrogen. They are proving to reduce the risk of both spinal and hip fractures, including in women who have had prior bone breaks. A bisphosphonate must be swallowed with a full glass of water (6 to 8 ounces) on arising for the day, and no other food, drink, or drug should be consumed for the next 30 minutes. Because bisphosphonates can irritate the lining of the esophagus, the person must not lie down after taking a dose for at least 30 minutes, and then must not lie down until after something has been eaten.

Alendronate (Fosamax): This medication is used to treat osteoporosis and to prevent bone loss in women. In clinical trials, alendronate has been shown to reduce the risk of new spinal and hip fractures by 50%. Gastrointestinal problems, such as nausea, acid reflux symptoms, and constipation, are the most common side effect. You must take this medication first thing in the morning with a large glass of water and not lie down or eat for 30 minutes. Some women find this restriction difficult. This medication is taken daily or once a week.

Risedronate (Actonel): This medication is used for the treatment and prevention of osteoporosis. Gastrointestinal upset is the most common side effect. Women with severe kidney impairment should avoid this drug. Results from a recent study showed that daily risedronate use can lead to a significant reduction in new vertebral fractures (62%) and multiple new vertebral fractures (90%) in postmenopausal women with osteoporosis, compared with a similar group who did not take this medication.

Etidronate (Didronel) can prevent early bone loss in menopausal women, help prevent fractures, and protect against bone loss in patients receiving high doses of corticosteroids. This drug has been approved by the FDA for treatment in Paget disease, another bone condition. Doctors have been using this drug successfully in clinical trials to treat women with osteoporosis.

Ibandronate (BONIVA): This drug is the most recently FDA-approved bisphosphonate and is used to prevent or treat osteoporosis in postmenopausal women. Boniva is indicated for the treatment and prevention of osteoporosis in postmenopausal women. In postmenopausal women with osteoporosis, Boniva increases bone mineral density and reduces the incidence of vertebral fractures. Boniva also may be considered for postmenopausal women who are at risk of developing osteoporosis and for whom the desired clinical outcome is to maintain bone mass and reduce the risk of vertebral fracture.

Estrogen

Hormone replacement therapy (HRT) contains estrogen with or without progesterone and is available in many brands and forms. HRT increases bone density. It also appears to improve balance and protects against falling. For newly menopausal women, estrogen replacement is one way to prevent bone loss. Estrogen can slow or stop bone loss. And, if estrogen treatment begins at menopause, it can reduce the risk of hip fracture up to 50%. It may be taken orally or as a transdermal (skin) patch (for example, Vivelle, Climara, Estraderm, Esclim, Alora). Many women participate in HRT when they undergo menopause, to alleviate symptoms such as hot flashes, but hormones have other important roles as well. They protect women against heart disease, the number one killer of women in the United States, and they help to relieve and prevent osteoporosis. HRT increases a woman's supply of estrogen, which helps build new bone, while preventing further bone loss.

Selective estrogen-receptor modulator (SERM)

For women who are unable to take estrogen or choose not to, selective estrogen receptor modulators (SERMs) such as raloxifene (Evista) offer an alternative. Selective estrogen-receptor modulator (SERM) have been designed with the goal of producing the same benefits that estrogen has on the bones and cholesterol levels without increasing the risk for hormone-related cancers. Some studies have been performed with SERMs in men, but benefits to date are not strong. Raloxifene (Evista) is the first SERM to be approved for preventing spinal fractures. The effects of raloxifene on bone and cholesterol levels are comparable to those of estrogen replacement. There appears to be no estrogen stimulation of the breasts or uterine lining, which reduces the risk profile of hormone replacement. Tamoxifen (Nolvadex), commonly used in the treatment of certain breast cancers, also inhibits bone breakdown and preserves bone mass. Tibolone (Livial) is showing promise in Europe for improving bone mineral density, most effectively in the lower spine. It has minimal side effects and patient compliance in clinical trials has been high.

Other designer hormones

Calcitonin (Miacalcin): Calcitonin is a hormone (extracted from salmon) that slows bone loss and may increase bone density. Produced by the thyroid gland, natural calcitonin regulates calcium levels by inhibiting the osteoclastic activity, the breakdown of bone. Calcitonin may be an alternative for patients who cannot take a bisphosphonate or SERM. It also appears to help relieve bone pain associated with established osteoporosis and fracture. The main side effects of calcitonin are nasal irritation from the spray form, and nausea from the injectable form.

Teriparatide (Forteo): Teriparatide contains a portion of human parathyroid hormone. It primarily regulates calcium and phosphate metabolism in bones, which promotes new bone formation and leads to increased bone density. This drug is given as a daily injection. Although high persistent levels of parathyroid hormone can cause osteoporosis, daily injections of low and intermittent doses of this hormone actually stimulate bone production. Unlike most treatments for osteoporosis, including bisphosphonates, the benefits may persist even after the injections have been stopped.

More information on osteoporosis

What is osteoporosis? - Osteoporosis is a thinning and weakening of the bones, usually associated with the aging process. Osteoporosis is a disease, often with no detectable symptoms.
Building and maintaining skeletal health - Factors involved in building and maintaining skeletal health are adequate nutrition and body weight, exposure to sex hormones at puberty, and physical activity.
What types of osteoporosis are there? - Osteoporosis can be classified in various ways based on diagnostic categories, etiology. Osteoporosis can be classified as either primary osteoporosis or secondary osteoporosis.
What causes osteoporosis? - Osteoporosis is related to the loss of bone mass that occurs as part of the natural process of aging. Osteoporosis results when there is excess bone loss without adequate replacement.
What are the risk factors for osteoporosis? - Many disorders are associated with increased risk of osteoporosis. Osteoporosis is far more prevalent in women after menopause due to the loss of the hormone estrogen.
What're the risk factors for primary osteoporosis? - Risk factors for primary osteoporosis include age, gender, race, figure type, lifestyle, diet, and lack of sunlight.
What're the risk factors for secondary osteoporosis? - Risk factors for secondary osteoporosis include genetic disorders, hypogonadal states, endocrine disorders,hematologic disorders, nutritional deficiencies, drugs.
What are the consequences of osteoporosis? - Consequences due to osteoporosis are increased risk of fracture with minor trauma, frequency of traumatic events from lifting and bending impact.
What are the symptoms of osteoporosis? - Patients with uncomplicated osteoporosis may be asymptomatic or may have pain in the bones or muscles, particularly of the back. Osteoporosis becomes apparent in dramatic fashion.
How is osteoporosis diagnosed? - The diagnosis of osteoporosis is usually made by your doctor using a combination of a complete medical history and physical examination.
What're the treatments for osteoporosis? - Treatment for osteoporosis includes eating a diet rich in calcium and vitamin D, getting regular exercise, and taking medication to reduce bone loss and increase bone thickness.
What osteoporosis medications (drugs) are available? - Medications (drugs) to cure osteoporosis include bisphosphanates (Fosamax), calcitonin (Miacalcin), raloxifene, estrogen, and selective estrogen receptor modulators (SERMs).
How to treat osteoporosis in men? - Alendronate and teriparatide have been approved to treat osteoporosis in men. Calcitonin may work in men, treatment with testosterone appears to increase bone density.
How to treat osteoporosis in women? - The non-hormonal bisphosphonate drugs, alendronate and risedronate prevent and treat postmenopausal osteoporosis. Raloxifene is approved for preventing and treating osteoporosis.
What lifestyle changes can help osteoporosis? - Alcohol consumption should also be kept within safe limits. Supplements of calcium plus vitamin D may help maintain bone density. Limiting sodium and avoiding junk food.
What osteoporosis exercises are suggested? - Exercise is very important for slowing the progression of osteoporosis. Taking regular exercise is the single most important action improve the strength of their bones.
What osteoporosis diet is suggested? - A good calcium intake is essential throughout life for healthy bones. Vitamin D helps the absorption of calcium from the intestines. Reducing salt may be useful for osteoporosis patients.
What can be done to prevent osteoporosis? - For prevention and treatment of osteoporosis, patients should be encouraged to stop smoking, limit alcohol consumption and perform weight-bearing exercise.
Osteoporosis and calcium - Calcium could alter the physical-chemical properties of the bone mineral. The daily recommended dietary calcium intake varies by age, sex, and menopausal status.
Osteoporosis and magnesium - Magnesium supplementation is as important as calcium supplementation in the treatment and prevention of osteoporosis.
Osteoporosis and vitamin D - Vitamin D is necessary for the absorption of calcium in the stomach and gastrointestinal tract and is the essential companion to calcium in maintaining strong bones to prevent osteoporosis.
Bone, joint, & muscle disorders

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