Medicines Used For Osteoporosis

The first line treatment for osteoporosis is a class of drugs known as bisphosphonates. Bisphosphonates inhibit the action of osteoclasts, the cells that destroy bone. The bisphosphonates that are approved for the treatment of osteoporosis and low bone density are alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), and zoledronic acid (Reclast). Alendronate and risedronate are oral medications. Ibandronate is available orally or as an injection while zoledronic acid is an injection-only medication. The most notorious side effect of oral bisphosphonates are that they can cause problems for the esophagus and the stomach. In fact, patients are cautioned not to lie back for thirty minutes after taking the oral bisphosphonates so that the drug does not go back up the esophagus.

Bisphosphonates are used for both prevention and treatment of osteoporosis in women, whether the disease occurs as a consequence of menopause or long term steroid use. Alendronate and risedronate have been approved to treat osteoporosis in men but the others may be used "off label."

Selective estrogen receptor modulators or SERMs are drugs that can either stimulate or block the effects of estrogen, depending on the location of the estrogen receptor in the body. In bone, SERMs work like estrogen, by increasing the density of bone. The FDA has approved the selective estrogen receptor modulator, raloxifene (Evista), for the treatment of postmenopausal osteoporosis. The medication has been shown to increase bone density and decrease the incidence of spine fractures. Because it can affect estrogen receptors, this class of drugs is not used in premenopausal women. Scientists suspect SERMs increase the risk of blood clots, although evidence is unclear.

In addition to being a hormone, calcitonin can be given as a medication. Presciption calcitonin is available as an injection or a nasal spray. It is not a first line osteoporosis treatment because it has only been shown to reduce the risk of fractures in the spine but not in other bones. Also, calcitonin takes an average of five years to show a clinical benefit. Side effects of calcitonin include nausea, vomiting, and dry mouth. It can also cause a decrease in calcium in the bloodstream.

Parathyroid hormone is another naturally occurring hormone that is involved in how bone is formed and maintained. Teriparatide (Forteo) is an osteoporosis medication that is related to parathyroid hormone. This drug is available as a once a day injection. Teriparatide (Forteo) is approved for postmenopausal women and men for the treatment of osteoporosis. It can increase bone mass density and reduce the risk of fractures however it needs to be used for an average of 18 months to achieve optimal results.

In a sense, teriparatide works in a manner opposite to that of the bisphosphonates; it increases bone formation while bisphosphonates decrease bone resorption to the blood stream. Scientists had the idea that using them together would work better than either one alone. However, several trials found that a regimen of teriparatide plus alendonate did no better than teriparatide alone.

Teriparatide is very expensive and requires refrigeration, making it more difficult to deal with than bisphophonates. Teriparatide is now recognized as the preferred treatment for glucocorticoid-induced osteoporosis.

A new osteoporosis medication is denosumab, a monoclonal antibody that binds to the RANKL receptor. This medicine is sold under the names Prolia and Xgeva. This antibody binds to a receptor in cells that develop into osteoclasts, and prevents that development. With fewer osteoclasts, the natural bone desorption is slowed. Denosumab. In 2011 the FDA expanded the list of indications for denosumab, allowing it to be used for bone loss associated with breast cancer and prostate cancer treatment.

Drug Class	Generic Name	Brand Name	Dose/Route	Side Effects
Bisphosphonate	Alendronate	Fosamax	Treatment: 70 mg orally each week OR 10 mg orally each day Prevention: 35 mg orally each week OR 5 mg orally each day	GI effects, Heartburn
	Risedronate	Actonel	Treatment or prevention in women: 5 mg orally each day OR 35 mg orally each week OR 150 mg orally each month Treatment in men: 35 mg orally each week	GI effects, Heartburn
	Ibandronate	Boniva	150 mg orally each month OR 2.5 mg orally each day OR 3 mg intravenously every three months	GI effects orally, Muscle aches, Rarely a kidney reaction
	Zoledronic acid	Reclast	5 mg intravenously once a year	When taken with some other treatments may cause bone loss in the jaw
SERMs	Raloxifene	Evista	60 mg orally each day	May increase the risk for blood clots, may lead to liver problems
Calcitonin	Calcitonin	Miacalcin, Calcimar, Cibacalcin	One puff once a day in alternating nostrils OR One injection every other day	Nasal administration can cause irritation in the nose, Low blood calcium
Parathyroid Hormone	Teriparatide	Forteo	20 microgram injection each day	Dizziness, leg cramps, high blood calcium

 

People at risk can also prevent the development of low bone density through vitamin D and calcium supplementation. Vitamin D works as a hormone in the digestive system; it helps the calcium in the diet be absorbed into the bloodstream, and eventually into bone. The amount of calcium and vitamin D that people should get on a daily basis depends on their age and risk factors for osteoporosis. Consensus guidelines are for women who have not yet reached menopause, men younger than 50, and those without osteoporosis risk factors should receive a total of 1000 mg (1 gram) of calcium and between 400 and 800 IU (International Units) of vitamin D daily. In men older than 50, postmenopausal women, or anyone with osteoporosis risk factors, the recommended daily intake of calcium is 1,500 mg and 1,000 IU of Vitamin D.

Sources for Material on this Page Ohio State University, National Osteoporosis Foundation, Creighton University