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Treatment of Osteoporosis (cont.)

Osteoporosis Medications

Medications are available to treat bone loss in those diagnosed with osteoporosis or osteopenia. A goal of treatment is to prevent the development of osteoporosis (if decreased bone mass or other risk factors exist) and to prevent further bone loss (especially if osteoporosis has already been diagnosed). Preserving or increasing bone mass and density decreases the risk of broken bones (osteoporotic fractures) and disability. Many treatments available today have been shown to work quickly (within one year), and they may reduce the risk of fracture by up to 50%. The choice of treatment should fit a person's specific medical needs and lifestyle. A doctor can help determine what treatment choice will work.

There are two main types of drugs: antiresorptive drugs that slow the progression of bone loss and bone-building agents that help increase bone mass. Antiresorptive drugs are already widely available. Bone-building drugs are being developed by researchers and are just becoming available.

Antiresorptive Drugs
Drug Type Action Drugs
Bisphosphonates Inhibit the body from breaking down bone (a process called resorption)

Act directly on the bone structure, reducing the rate of bone loss
Alendronate (Fosamax)

Risedronate (Actonel)

Ibandronate (Boniva)

Zoledronate (Reclast annual infusion)
Selective estrogen receptor modulators (called SERMS or estrogen analogs) Mimic estrogens in some tissues and antiestrogens in others; cause the body to retain the bone it has by working like estrogen, but without some unwanted side effects Raloxifene (Evista, postmenopause)

Bazedoxifene (in development)

Lasofoxifene (in development)
Hormone replacement therapy (HRT) Prevents osteoporosis when taken during and after menopause by replacing the sex hormones (for example, estrogen, progesterone) that the body stops producing during menopause Many formulations exist that contain estrogen or a combination of estrogen and progesterone such as Cenestin, Premarin, Prempro, etc., for oral use; also available as topical patches, such as Alora, Esclim, Estraderm, and Vivelle
Non-sex hormone Suppresses resorption of bone by inhibiting osteoclasts, a type of cell that "digests" bone to release calcium and phosphorus into the blood Calcitonin (Miacalcin Nasal Spray), not very effective for postmenopause prevention; also can relieve bone pain due to osteoporosis-induced fracture.
RANK Ligand inhibitor Suppresses resorption of bone by blocking RANK ligand osteoclast formation, function and survival Denosumab (Prolia) injections every six months

Bone-Forming Drugs
Drug Type Action Drugs
Parathyroid hormone (PTH) Stimulates new bone formation in both the spine and hip and reduces the risk of fractures of the spine (vertebral fractures) and nonvertebral fractures in postmenopausal women (effects on nonvertebral fractures in men unknown) Teriparatide (Forteo), used for advanced osteoporosis; administered by daily injection; common adverse effect includes a sudden decrease in blood pressure (may cause fainting or dizziness)
Strontium ranelate Decreases breakdown of bone and increases bone formation Strontium ranelate (Protos), investigational oral product in Europe, Australia, and Japan
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