Prevention of Osteoporosis (cont.)
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Medication for Osteoporosis Prevention
Currently, bisphosphonates, such as alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), and zoledronate (Reclast) are approved by the U.S. Food and Drug Administration (FDA) for the prevention and treatment of postmenopausal osteoporosis in women. As men age, they are also susceptible to osteoporosis. Alendronate is approved to increase bone mass in men with age-related osteoporosis. Alendronate and risedronate are approved to treat men and women with steroid-induced osteoporosis. Adequate calcium and vitamin D intake is essential for bisphosphonates to be effective.
Raloxifene (Evista) is approved for the prevention of osteoporosis only in postmenopausal women who are not taking hormone replacement therapy. Teriparatide is approved for the treatment of the disease in postmenopausal women and men who are at high risk for fracture. Estrogen/hormone therapy (ET/HT) is approved for the prevention of postmenopausal osteoporosis, and calcitonin is approved for treatment. Both alendronate and risedronate are approved for use by men and women with glucocorticoid-induced osteoporosis. See Understanding Osteoporosis Medications for more information.
After menopause, bone strength and density decreases rapidly in women. Studies show that estrogen therapy/hormone therapy (ET/HT) reduces bone loss, increases bone density in both the spine and hip, and reduces the risk of broken bones (especially the hip and spine). Currently, ET/HT is approved to prevent osteoporosis from developing after menopause. This therapy is most commonly available in the form of a pill or skin patch. See Hormone Replacement and Osteoporosis for more information.
When estrogen therapy (ET) is taken alone, it increases a woman's risk of developing cancer in the uterus (cancer of the uterine lining, called endometrial cancer). Therefore, for women who have not had their uterus removed (have not had a hysterectomy), doctors prescribe an additional hormone, either natural progesterone or a synthetic similar substance called progestin. Progestin or progesterone in combination with estrogen is called hormone therapy (HT), and it reduces the risk of endometrial cancer in women who have not had a hysterectomy. A large study from the National Cancer Institute (NCI) has recently indicated that long-term use of ET (estrogen alone) may also be associated with an increase in the risk of ovarian cancer.
The Women's Health Initiative (WHI) study recently demonstrated that HT is associated with increases in the risk of breast cancer, ovarian cancer, stroke, and heart attack. No studies have determined whether ET (estrogen alone) is associated with an increase in the risk of breast cancer or whether it has an effect on cardiovascular events (like heart attack).
Doctors prescribe any estrogen therapy only for the shortest period of time possible. ET/HT used to prevent osteoporosis after menopause should only be considered for women with menopausal symptoms who at significant risk of developing osteoporosis, and other nonestrogen medications should be considered if osteoporosis is the primary concern.
Coburn Hobar, MD
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