You and your physician need to review any drug treatment options you are considering to assess the risks and benefits each offers. You may need to explore several treatment options to determine which drug is right for you. You may respond better to one drug than another or have side effects on one and not another. (Any side effects should be reported to your doctor immediately.)
The FDA approved categories of medication used for the treatment and/or prevention of osteoporosis are:
- Estrogens and estrogen-related compounds
- Synthetic Parathyroid Hormone
In general, estrogen is an effective agent for the prevention of post-menopausal bone loss. However, new guidelines developed in 2003 by the FDA advise doctors to consider alternative treatments. These changes were prompted by studies indicating that women who take estrogen or estrogen with progestin products after menopause are at higher risk for other conditions, including cardiovascular disease and breast cancer. Because of this, estrogen-containing products should only be considered for women at significant risk of osteoporosis.
Women who don't want to take estrogen because of a family or personal history of breast cancer may want to explore this newer form of estrogen known as SERM (selective estrogen receptor modulator). This compound has many of the benefits of estrogen but fewer of the side effects. Brand names include Evista (raloxifene hydrochloride).
These medicines have revolutionized the way doctors care for patients with osteoporosis by helping to reverse the effects of osteoporosis. The vast majority of people tolerate bisphosphonates very well and have reaped enormous benefits. Bisphosphonates may be especially beneficial for people who require long-term steroid treatment for diseases such as asthma or arthritis. There are several medications on the market with daily, weekly and monthly options for dosing. Brand names include Actonel® (risedronate), Boniva® (ibandronate sodium), and Fosamax® (alendronate)
Calcitonin is a naturally occurring hormone produced in our bodies to block bone loss. The synthetic versionhas the fewest side effects of any of the osteoporosis medications, but is not as effective as estrogens and bisphosphonates in preventing further bone loss. Calcitonin is usually used to treat people with osteoporosis who are at high risk of fracture and cannot take bisphosphonates. Some physicians have reported that calcitonin may decrease bone pain associated with osteoporotic fractures and vertebral compression fractures. It is sprayed into the nose were it is very quickly absorbed into the blood stream. Patients with bones that are being destroyed quickly seem to do the best with this drug. Brand names include Miacalcin®, Calcimar® and Fortical®.
Synthetic Parathyroid Hormone
This treatment option became available to women in November 2002 and is the first treatment that stimulates new bone growth to increase bone mass. It is a manufactured form of the naturally occurring hormone parathyroid, which works in the body to regulate the metabolism of calcium and phosphate in bones. The treatment is given in daily injections and is approved for postmenopausal women who are at high risk for bone fractures. Because it's possible that women treated with Forteo could have increased risk for developing osteosarcoma, a rare but serious cancer of the bone, doctors are advised to discuss this risk with their patients and be sure that it's the best treatment. Women who are prescribed Forteo receive an FDA-approved medication guide that explains the benefits and risks and gives other advice about how to use the treatment properly. The brand name is Fortéo® (teriparatide).