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Treatment of Osteoporosis (cont.)

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 1 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 2 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. See Understanding Osteoporosis Medications for more information.

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 (Zometa injection)
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 (eg, 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.

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