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Medications

To prevent and manage osteoporosis

There are a number of medications available for the prevention and management of osteoporosis. If you have osteoporosis or low bone density, please discuss each of these medications carefully with your health care provider. All of these medications require adequate amounts of calcium and exercise to work best.

Bisphosphonates
Actonel® (risedronate), Boniva®, and Fosamax® (alendronate)

• Bisphosphonates can be used in the prevention and treatment of postmenopausal osteoporosis. They can also help prevent fractures of the spine, hip, and wrist in people with osteoporosis and prevent bone loss for men and women taking steroids. Fosamax® has also been approved by the FDA for the treatment of osteoporosis in men.
  
  
• Fosamax®, Boniva®, and Actonel® are available in daily and once weekly doses.
  
  
• Side effects of bisphosphonates may include muscle aches, joint aches, stomach upset or heartburn.
  
  NOTE: Bisphosphonates must be taken first thing in the morning on an empty stomach. When taking the pill, drink a full glass (8 oz.) of water. Do not use orange juice, coffee or any other beverage to take this medication. After taking the pill, do not have anything else to eat or drink for at least 30 minutes. In addition, remain sitting or standing up (do not lie down) for 30 minutes after taking the medication
  

Estrogen Replacement Therapy (ERT)
Hormone Replacement Therapy (HRT)
When estrogen is taken alone, it can increase a woman’s risk of developing cancer of the uterine lining (endometrial cancer). To eliminate this risk, physicians prescribe the hormone progestin in combination with estrogen (hormone replacement therapy or HRT) for those women who have an intact uterus. ERT/HRT relieves menopause symptoms and has been shown to have beneficial effects on both bone and heart health.

• Estrogen replacement therapy has been approved for the prevention of osteoporosis and the maintenance of bone mass for postmenopausal women. It has been shown to reduce bone loss and increase bone density in the hip and spine. Although specific drug trials have not shown that ERT/HRT can reduce the risk of hip and spinal fractures in women past menopause, certain statistical studies have shown this as a likely additional benefit.
  
  
• ERT is most commonly found in the form of a pill or skin patch, daily or weekly.
  
  
• Side effects may include nausea, bloating, breast tenderness and high blood pressure. Many side effects can be eliminated by working with your doctor to experiment with different levels of hormone. Ask your doctor about "low dose HRT."
  

Parathyroid Hormone (PTH)
Parathyroid hormone is currently under investigation as a new treatment for osteoporosis. Both in humans and in the laboratory, it has been shown to stimulate new bone growth and help prevent fractures. It is expected to obtain final FDA approval in the coming months, and will be released as Fortéo“.

Selective Estrogen Receptor Modulators (SERMs)
SERMs, often called designer estrogens, are a family of drugs made in a laboratory. They have some effects similar to estrogen on bone, cholesterol and other blood fats. SERMs decrease the effects of estrogen on certain tissues like the breast and uterus, and may be used with people who are at risk for developing these cancers. SERMs may also reduce the risk of breast cancer and lower your cholesterol. Research is currently being done to better understand these effects.

• One SERM, Evista® (raloxifene), has been approved for the prevention and treatment of osteoporosis. Evista® has been shown to help prevent bone loss in the hip and spine and decrease spine fractures.
  
  
• Evista® is available as a pill.
  

The side effects of SERMs may include hot flashes, leg cramps and blood clots. SERMs normally do not cause bloating, breast tenderness, or bleeding from the uterus. Even if you have a uterus, you do not need to take progesterone with a SERM.

Calcitonin
Calcitonin is a hormone normally found in the human body that helps with bone metabolism and calcium regulation.

• It can slow bone loss in the spine and increase spinal bone density and may also help reduce the risk of spinal fractures or help decrease the pain of these fractures. It has not been shown to prevent bone loss or fracture in other parts of the body.
  
  
• Calcitonin is given as a nasal spray or as an injection.
  
  
• Side effects may include a runny nose with the nasal spray or an allergic reaction or other effects with the injectable form.