If you have already been diagnosed with osteoporosis or osteopenia, or your doctor feels that you should be on medication to prevent the development of osteoporosis, the goods news is that there are a variety of tested and FDA-approved medications for you to choose from. As recently as the early 1980s, estrogen was the only approved treatment for osteoporosis. Then, in 1985, calcitonin, a bone-preserving hormone, was approved, but the catch was that it had to be taken by injection. It was not until the mid-1990s that things really began to change. The first nonhormonal treatment for osteoporosis, alendronate (Fosamax), was approved by the FDA in 1995, and a few years later raloxifene (Evista) received government approval. Patients today have many more medication choices than ever before, and several promising studies that may provide newer and even more effective treatment. I'll talk about some of this research at the end of this chapter, but for now I'd like to discuss some of the medical options currently available and help you determine which may work the best for you. Just remember, though, that even if you are on a special medication to prevent the advancement of osteoporosis, it is still vitally important to get enough calcium and vitamin D into your diet, through foods or supplements, and to follow a regular exercise program.
The medications were going to discuss can be extremely important to high-risk patients, but they do not replace natures natural cures-exercise, calcium, and vitamin D. They simply help them out.
The drugs now available for treating osteoporosis fall into four categories: 1) bisphosphonates (alendronate and risedronate sodium); 2) selective estrogen receptor modulators (raloxifene hydrochloride), referred to as SERMs; 3) calcitonin; and 4) estrogens, which we will discuss, although since the findings of the WHI study, I usually don't recommend estrogens to my patients; and 5) parathyroid hormones. These osteoporosis drugs have been shown to reduce bone loss-in some cases, promote bone growth-cut down on the risk of fractures, and sometimes even ease the pain caused by fractures.
Deciding which drug is best for you will depend on several things, including your gender, age, risk factors, and whether you already have osteoporosis (and how severe it is), or whether you are just trying to prevent the disease. But before starting any drug, consult your doctor. I'll give you a quick breakdown of the pros and cons of each drug before going into a more complete discussion. Let's start with the most popular bisphosphonates: alendronate and risedronate sodium.
Bisphosphonates work only on the bone and do not affect the heart, breast, or uterus or other parts of the body. Do not take Fosamax with tea, coffee, juice, or mineral water. Use only eight ounces of natural water, and be sure not to eat or drink anything else for thirty minutes after taking the drug, because this can interfere with the absorption and effectiveness of the drug. If you can wait an hour after taking the drug before eating or drinking anything else, that's even better. Taking nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, along with Fosamax can irritate the stomach or intestine, so let your doctor know about it.
Do not take Fosamax if you are pregnant or nursing. It may pose a risk to the fetus. This drug is primarily for postmenopausal women, as well as some high-risk men who are being treated for osteoporosis that has resulted from long-term use of steroid medications such as cortisone and prednisone. Fosamax was the first nonhormonal treatment for osteoporosis. Clinical studies have shown that alendronate prevents bone loss and reduces the risk of all osteoporosis-related fractures, including fractures of the spine and hip in people with osteoporosis.
Who Should Take Fosamax?
This is the drug I most often prescribe for my high-risk patients. It also has been shown to help prevent bone loss in those who decide to go off hormone therapy. A 1999 Spanish study of 144 women who went off HRT showed that after one year, those taking alendronate maintained bone density in their hips and increased bone density in their spines by 2.3%. The women taking the placebo lost 1.4% bone density in their hips and 3.2% in their spines.
This is a newer bisphosphonate. It is much like Fosamax and should be taken just the same way-on an empty stomach, with eight ounces of water. You should remain in an upright position for at least a half hour after taking it, and eat and drink nothing else during that half hour. Research has shown that risedronate sodium can:
Although risedronate appears to have a profile similar to that of alendronate, there is some evidence that risedronate may have lower gastrointestinal (G.I.) irritation. A dose of 5 mg risedronate provides only 80% of the hip protection of the 10-mg dose of alendronate, yet the cost is about the same.
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