Treating Osteoporosis: An introduction to available drugs.

Our bones are constantly being renovated throughout our lives. Bone turnover is a process regulated by two types of cells mainly the osteoclasts and the osteoblasts. Osteoclasts are responsible for breakdown while the latter deposit new bone. The rate at which bone is being removed increases after menopause. However, bone growth doesn’t always keep up with this increase. This can lead to bone loss, and eventually weakening of bones resulting in brittle and easily breakable bones, this condition is called osteoporosis.

Even though a person with osteoporosis has weakened bones fractures are not common and can easily be avoided by using available medication.

Bone density is the component when diagnosing osteoporosis it is measured by using dual-energy x-ray absorptiometry or a (DEXA) scan. The T-score obtained through the scan is a comparison of your bone density to that of a healthy woman aged 30 years.

Medication is prescribed if a person falls in one of the following categories:

  • A T-score below -2.5 indicated osteoporosis.
  • A history of hip (or vertebral) fractures caused by a low impact fall from a short distance i.e standing.
  • A T-score of -1.0 to -2.5 (called Osteopenia), indicates a high likelihood of a hip fracture or osteoporosis-related bone fracture within the next 10 years, according to a fracture calculator.

Treating osteoporosis: What should you do?

The first step to treating osteoporosis is to slow down bone breakdown and loss. The class of drugs preferred by doctors in case of a very low T-score is bisphosphonates.

  • Pills such as Fosamax (alendronate), Boniva (Ibandronate), and risedronate (Actonel, Atelvia) are prescribed daily, weekly, and monthly.
  • Injections of ibandronate (Boniva), once every three months
  • Intravenous infusions of zoledronic acid (Reclast), prescribed are once a year

An important factor to take into account is the site at which the bone loss is centered. All three of the drugs mentioned above have been proven effective in reducing spine fractures. However, alendronate or risedronate might be better choices than ibandronate for women who have had hip fractures in the past.

Your doctor may recommend that you receive an injection or an infusion of the drugs if you have any gastrointestinal issues such as reflux or can’t stand or sit straight for the required 30-60 minutes after you take an oral bisphosphonate. Both methods are equally effective.

You may have heard about the risks of bisphosphonate drugs, particularly fractures in the femur (thighbone) and osteonecrosis in the jaw. Although these side effects are real, they are more commonly associated with long-term usage in high doses and in people who take IV bisphosphonates as a cancer treatment.

Other options for drugs

These are some other options for postmenopausal women who don’t want to start with a bisphosphonate or have been on one for more than five years.

Raloxifene (Evista), a selective estrogen receptor modulator (SERM), is mainly known for its role in breast cancer prevention and treatment. However, it is also used to treat osteoporosis. It works by binding to estrogen receptors in the body to produce estrogen-like results, including a decrease in bone turnover. This drug is especially useful in preventing vertebral fractures in those who have osteoporosis of the spine. Hot flashes, muscle pain, and increased risk of deep-vein thrombosis (blood clots) are the major side effects.

Teriparatide (Forteo) and abaloparatide (Tymlos), these two drugs are synthetic forms of parathyroid hormones. They are used to increase bone density and strength. Mainly prescribed to those with very low bone density and a high risk of fractures as they can significantly reduce the chance of fracture. This treatment is usually limited to two years, and patients are then switched to bisphosphonates to maintain bone density.

Denosumab, also known as Prolia, is a monoclonal antibody that is administered twice a year. It prevents osteoclast formation in turn preventing bone breakdown. It is an alternative for those who cannot tolerate bisphosphonates. The therapy is lifetime as stopping use could cause bone-resorption to accelerate.

Romosozumab (Evenity), is another monoclonal, its use is indicated if the patient presents with a fragility fracture meaning severe osteoporosis. It is a sclerostin blocker. Dosage is two prefilled syringes used to administer the full amount of medication. Romosozumab use is only recommended for one year.

Calcitonin (Miacalcin Fortical) is an osteoporosis drug that has been around since 1980. Calcitonin is a hormone that binds with osteoclasts to prevent the loss of bone. Calcitonin, whether administered by nasal spray or injection, can reduce spinal fractures. However, it has not been proven to be effective in preventing other fractures. It is not recommended for first-line treatment for most women.

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