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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.
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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).
 Click here to learn more about
hormone replacement therapy (HRT).
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
Click here for more information Fosamax, courtesy of Merck and Company, Inc.
Click here for more information on Actonel, courtesy Proctor and Gamble.
Evista (raloxifene)
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.
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.
Common side effects of Evista may include:
- hot flashes
- leg cramps
- swelling of the legs and feet
- flu-like symptoms
- joint pain
- sweating
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.
Click here for more
information on Evista, courtesy of Eli Lilly and Company.
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 have severe kidney
disease. Fosamax is available in once daily or once weekly regimens.
Click here for more
information on Fosamax, courtesy of Merck and Company, Inc.
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
Click
here for more information on Miacalcin, courtesy of Novartis.
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
Click here to learn more about
percutaneous vertebroplasty.
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.
Click here to learn
more about clinical trials.
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.
In addition to treatment with vitamins
and drugs, women who have osteoporosis may need to make lifestyle changes. The National
Osteoporosis Foundation recommends the following guidelines to avoid bone fractures:
- Wear sturdy, low-heeled, soft-soled
shoes; avoid floppy slippers and sandals.
- Ask your doctor whether any medications
you are taking can cause dizziness, light-headedness, or loss of balance. If so, ask how
these effects can be minimized.
- Minimize clutter throughout the house.
- Secure all rugs; avoid using small throw
rugs that can slip and slide.
- Remove all loose wires and electrical
cords that can cause tripping.
- Make sure treads and handrails are
installed on staircases and remain secure.
- Keep halls, stairs, and entries well
lighted.
- Use nightlights in the bedroom and bath.
- In the bathroom, use grab bars and
non-skid tape in the shower or tub.
- In the kitchen, use nonskid rubber mats
near the sink and stove.
- Avoid using slippery waxes; watch out
for wet floors; clean up spills immediately.
- When driving, wear seat belts and adjust
seat properly.
Click here for specific information on
minimizing the risk of hip fractures.
Updated: April 7, 2008
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