Preventing osteoporosis by maintaining a health diet rich in calcium and vitamin D and exercising regularly can help many women avoid the serious effects of osteoporosis. Women who have low bone mineral density or osteoporosis may also benefit from taking hormone replacement therapy or other drug therapies. This section describes treatments for osteoporosis.
Hormone Replacement Therapy
Hormone replacement therapy (HRT) is synthetic estrogen and/or progesterone (called progestin). HRT is designed to "replace" a woman's depleting hormone levels at menopause. HRT is commonly prescribed to help relieve menopausal symptoms, such as hot flashes and vaginal dryness. HRT is also used to help prevent osteoporosis. HRT is often effective against osteoporosis if taken during the first five years after menopause begins. HRT works against osteoporosis as long as the woman is taking estrogen; women lose protection once they have stopped taking HRT. It is estimated that HRT can lead to a 50% to 80% decrease in vertebral fractures and a 25% decrease in non-vertebral fractures with five years of use.
Side effects of HRT vary from woman to woman but common side effects include:
· Bloating · Nausea · Breast tenderness (usually during the first three to four months of treatment) · Vaginal bleeding · Fluid retention · Weight gain · Depression
Possible increase in migraine headaches Estrogen has also been linked to an increased risk of endometrial cancer (cancer of the lining of the uterus). Women who have not had hysterectomies (removal of the uterus) should take HRT regimens with progestin to offset the increased risk of endometrial cancer associated with estrogen. There is no increased risk of endometrial cancer if progestin is also used.
There is emerging evidence that hormone replacement therapy can slightly increase the risk of breast cancer. All women who are considering HRT should discuss the benefits and risks with their physician to determine whether HRT is an appropriate option. In many cases, the benefits of taking HRT outweigh the potential risks. Women with a family or personal history of breast cancer, or other factors, and those who do not wish to take HRT may want to consider non-hormonal treatments for osteoporosis (see below).
Bisphosphonates - Fosamax (alendronate) and Actonel (risedronate sodium)
The drugs, Fosamax (generic name, alendronate) and Actonel (generic name, risedronate sodium), belongs to a group of drugs called bisphosphonates. They are commonly used to prevent and treat osteoporosis in post-menopausal women. Fosamax and Actonel are not estrogens and do not carry the associated risks or benefits of estrogen (see the hormone replacement therapy section above).
Studies show that after three years of use, Fosamax can reduce the risk of hip fractures in patients with a history of vertebral fracture by 51%. Actonel can reverse bone loss and help reduce the risk of bone fractures by halting further loss of bone and increasing bone mass. Actonel is not an estrogen and does not carry the associated risks or benefits of estrogen Recent research shows that Fosamax may be combined with hormone replacement therapy (HRT), and in fact, when used in combination, patients may receive increased protection from fractures. However, HRT does carry some risks (see the hormone replacement therapy section above). Also, the long-term use of combination Fosamax and HRT has not been assessed.
Fosamax and Actonel should be taken first thing in the morning in an upright position (sitting or standing) with six to eight ounces of plain water. Patients should not eat or drink anything besides plain water with the medicines, and they should not lie down within 30 minutes of taking the medicines. Calcium, vitamin D, or other supplements should be taken at a separate time.
Side effects of bisphosponates include:
· Abdominal or musculoskeletal pain · Nausea · Heartburn · Irritation of the esophagus
Evista (generic name, raloxifene) belongs to a group of drugs called SERMs (selective estrogen-receptor modulators) and is prescribed to help prevent and treat osteoporosis. Evista helps build new bone and reduces the risk of fractures. In several studies, Evista has reduced the risk of bone fractures by 50%. Most post-menopausal women who take Evista are prescribed one pill a day (60 milligrams). Physicians recommend that women take calcium and vitamin D supplements in addition to Evista to further reduce the risk of fractures.
As with every drug, Evista has a range of possible side effects, both positive and negative. One positive effect of Evista is that is has been shown to reduce LDL ("bad") cholesterol and total cholesterol levels, which can decrease a woman’s risk of heart disease. Studies are also investigating whether Evista may also help prevent breast cancer in women at high risk for the disease.
Common side effects of Evista may include:
· Hot flashes · Leg cramps · Flu-like symptoms · Nausea · Headache
Evista can also increase the risk of deep vein thrombosis (blood clots in the deep veins of the leg) and pulmonary embolism (blood clots in the lungs). Women who have a history of blood clots should not take Evista.
Fosamax (generic name, alendronate) belongs to a group of drugs called bisphosphonates and is commonly used to prevent and treat osteoporosis in post-menopausal women. Fosamax has been shown to strengthen bones and reduce hip and spinal fractures. Studies show that after three years of use, Fosamax can reduce the risk of hip fractures in patients with a history of vertebral fracture by 51%. Recent research shows that Fosamax may be combined with hormone replacement therapy (HRT), and in fact, when used in combination, patients may receive increased protection from fractures. However, the long-term use of combination Fosamax and HRT has not been assessed.
Side effects of Fosamax may include:
· Abdominal pain · Nausea · Indigestion · Constipation and diarrhea · Muscle or joint pain · Headache
In addition, some patients who take Fosamax develop severe digestive reactions including irritation, inflammation or ulceration of the esophagus. These reactions can cause chest pain, heartburn or difficulty or pain upon swallowing. The risk of severe esophageal adverse reactions appears to be greater in patients who lie down immediately after taking Fosamax and/or those who fail to take Fosamax with a full glass of water. Patients should not take Fosamax if they have certain disorders of the esophagus, they cannot stand or sit upright for at least 30 minutes, they have low levels of calcium in their blood, or they
Miacalcin (generic name, calcitonin) is used to treat post-menopausal osteoporosis in women who have low bone mass but cannot take estrogen (hormone replacement therapy). The drug is usually recommended to women who been post-menopausal for at least five years. Miacalcin comes in the form of a nasal spray (not an inhaler) that enters the bloodstream quickly to help strengthen bone and prevent bone loss.
Side effects of Miacalcin may include:
· Nasal symptoms (runny nose, crusting, nosebleed) · Back and/or joint pain · Headache
Percutaneous vertebroplasty (PV) is a new treatment that involves injecting a special liquid cement into fractured vertebral sections. It is being performed at select centers across the U.S. PV is used to fill holes or fractures in the spinal column left from osteoporosis, a degenerative bone disease. PV helps rebuild the collapsed spine and relieves pain and pressure. In a recent study, 29 of 30 patients experienced significant pain relief immediately after the procedure and 80% of the patients reported lasting pain relief.
Before the procedure, patients are given a mild sedative. To perform the minimally invasive operation, a surgeon places a needle through the skin into the area of the spine needing treatment. X-ray fluoroscopy is used to help guide the needle. Once the needle is positioned properly, a special liquid cement (called polymethylmethacrylate) is injected into the spinal fracture. Once injected, the liquid cement takes approximately 20 minutes to harden. When it hardens, it becomes a permanent spinal reinforcement. In many cases, a second needle puncture is needed to fill the other side of the vertebra.
Possible side effects of PV include:
· Bleeding · Another fracture · Pain or weakness · Infection · Paralysis
In addition to the therapies outlined in this article, researchers are currently investigating a variety of other medicines to treat and prevent osteoporosis. These investigational methods include:
· New forms of bisphosphonates · Sodium fluoride · Additional selective estrogen receptor modulators (similar to Evista) · Parathyroid hormone · Vitamin D metabolites
Several clinical trials are currently underway to investigate these new treatments. Patients with osteoporosis should ask their physicians about new methods to treat the disease.
Monitoring the Treatment of Osteoporosis with Bone Densitometry
Many physicians use bone densitometry to monitor patients with osteoporosis. While effects of treatments may begin soon after therapy is begun, evidence of a response to hormone replacement therapy or other drug treatments may not be accurately detected using DEXA bone densitometry right away. For this reason, osteoporosis patients usually have bone scans at one to two year intervals to monitor treatment responses. Patients at high risk of rapid bone loss (for example, patients on steroid therapy) may receive bone densitometry more frequently. Natural bone loss (not drug related) almost never occurs so rapidly as to require densitometry tests more frequently than at one to two year intervals.