Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
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.
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.
Inhibit the body from breaking down bone (a process called resorption)
Act directly on the bone structure, reducing the rate of bone loss
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
Prempro, etc., for oral use; also available as topical patches, such as
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
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)
Decreases breakdown of bone and increases bone formation
Strontium ranelate (Protos), investigational oral product in Europe, Australia, and Japan