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Osteoporosis Medications & Treatment Options

If you have osteoporosis, your doctor will work with you create a total treatment program that will include the various lifestyle, diet, and exercise options discussed above. Your doctor, if appropriate, may also recommend prescription medications to you to help prevent and/or stop bone loss.
testing

Osteoporosis Medication

Example of medications approved for the treatment and prevention of osteoporosis are listed below. As always, talk to your doctor about whether any of these medications are right for you.

  • Bisphosphonates – This is a class of drugs that decrease the activity of bone dissolving cells. The drugs thus can slow down bone loss, reduce the risk of bone fractures, and potentially increase bone density. Bisphosphonates have been shown to be effective in the spine, hip, and wrist. Specific drugs in this class include Alendronate (Fosamax), risedronate (Actonel), & ibandronate (Boniva). Alendronate and risedronate can be taken daily or weekly by both men and women, but alendronate is only available as a monthy dose for women. General side effects include heartburn, nausea, and stomach pain. In certain instances, bisphosphonates can cause serious digestive problems if not taken properly. On rare occasion, some patients experience muscle, bone, or joint pain while taking these medications.
  • Miacalcin (Calcitonin) – This drug is approved for use by women who are at least 5 years past full menopause. Calcitonin is a thyroidal hormone that effects bone metabolism and calcium regulation. It is generally administered as a nasal spray or through injection. Calcitonin is known to reduce bone loss in the spine and reduce the risk of spinal fractures. Like Raloxifene, it has not been shown to be effective in treating other parts of the body. There are no known serious side effects.
  • Evista (Raloxifene) – This drug is for approved for use by post menopausal women only. Raloxifene is a non-hormonal drug belonging to the SERM drug class (Selective Estrogen Receptor Modulators). They are also know as “designer estrogens.” Drugs in this class have evoke effects on the skeleton in a manner similar to estrogen, but they somehow block the effects of estrogen in the uterus and breast. This drug class may thus be used for people who are at risk for at breast or uterine cancer. While Raloxifene has been shown to slow bone loss and reduce fracture risks in the spine, it has not been shown to be effective on hip fractures. Typical side effects may include hot flashes and an increased risk of blood clots.
  • Hormone Replacement Therapy (HRT) – Estrogen therapy is approved for the use in treating menopause and osteoporosis, however recent studies have shown an increase in the risk of serious health conditions such as breast cancer, strokes, and heart attacks. Thus, hormone therapy is indicated only for women who are at significant risk due to osteoporosis and after all non hormonal options have been considered first. Estrogen has been shown effective in reducing bone loss and increasing bone density in the hip and spine. Estrogen is most commonly administered via a pill or skin patch. Side effects may include nausea, bloating, tenderness of the breast, and hypertension. Read more about HRT and menopause.
  • Forteo (Parathyroid Hormone or Teriparatide) – This hormone is indicated for the treatment of post menopausal women and men who are at high risk for a fracture. Parathyroid hormone helps new bone form, increases bone density, and helps decrease the risk of a serious fracture in multiple areas of the skeleton. This hormone is administered through a daily injection.
  • Prozac (Fluoxetine)– Recent studies by researches at the Forsyth Institute of Boston have shown that treatment with the drug Prozac resulted in a 60% increase in bone mass in adult mice. Prozac is currently approved for treating depression and belongs to a class of drugs called SSRIs (selective serotonin reuptake inhibitors). Previous research discovered that serotonin receptors were commonly expressed on the surface of bone cells. In the study, scientists showed tha Prozac reacted with these receptors on the surface of bone cells and was able to both reverse overall bone loss triggered by inflammation, as well as spurring on the formation of new bone under normal circumstances.

Medications for Osteoporosis Prevention and Treatment

Types

Brand
Names

FDA Approval

Forms of
Administration

Other Considerations

Possible Side Effects

alendronate

Fosamax

Fosamax approved for preventing and treating osteoporosis in postmenopausal women. Fosamax approved for treating glucocorticoid-induced osteoporosis in women and men and for treating osteoporosis in men.

Fosamax available as pill in daily and weekly doses.

Oral medication should be taken on an empty stomach with a full glass of water first thing in the morning. After taking the medication, remain in an upright position and do not eat or drink for at least 30 minutes.

May include abdominal or musculoskeletal pain, nausea, heartburn, irritation of the esophagus, and rarely osteonecrosis of the jaw.

alendronate plus vitamin D

Fosamax Plus D

Fosamax Plus D approved for treating osteoporosis in postmenopausal women and in men.

Fosamax Plus D available in weekly dose.

Oral medication should be taken on an empty stomach with a full glass of water first thing in the morning. After taking the medication, remain in an upright position and do not eat or drink for at least 30 minutes.

May include abdominal or musculoskeletal pain, nausea, heartburn, irritation of the esophagus, and rarely osteonecrosis of the jaw.

ibandronate

Boniva

Boniva approved for preventing and treating osteoporosis in postmenopausal women.

Boniva available as pill in monthly dose and as an intravenous injection administered once every 3 months.

Oral medication should be taken on an empty stomach with a full glass of water first thing in the morning. After taking the medication, remain in an upright position and do not eat or drink for at least 30 minutes.

May include abdominal or musculoskeletal pain, nausea, heartburn, irritation of the esophagus, and rarely osteonecrosis of the jaw.

risedronate

Actonel

Actonel approved for preventing and treating osteoporosis in postmenopausal women. Actonel approved for preventing and treating glucocorticoid-induced osteoporosis in women and men.

Actonel available as pill in daily and weekly doses.

Oral medication should be taken on an empty stomach with a full glass of water first thing in the morning. After taking the medication, remain in an upright position and do not eat or drink for at least 30 minutes.

May include abdominal or musculoskeletal pain, nausea, heartburn, irritation of the esophagus, and rarely osteonecrosis of the jaw.

risedronate with calcium

Actonel with Calcium

Actonel with Calcium approved for the prevention and treatment of osteoporosis in postmenopausal women.

Actonel with Calcium available in weekly dose.

Oral medication should be taken on an empty stomach with a full glass of water first thing in the morning. After taking the medication, remain in an upright position and do not eat or drink for at least 30 minutes.

May include abdominal or musculoskeletal pain, nausea, heartburn, irritation of the esophagus, and rarely osteonecrosis of the jaw.

salmon calcitonin

Miacalcin

Approved for treating osteoporosis in postmenopausal women

Daily nasal spray or injection

Approved for use in women at least 5 years beyond menopause

Use of nasal spray may result in runny, irritated nose. Injectable form may cause flushing of the face and hands, frequent urination, nausea, and skin rash.

estrogen therapy

Including:
 Climara
 Estrace
 Estraderm
 Estratab
 Ogen
 Ortho-Est
 Premarin
 Vivelle

Approved for preventing osteoporosis in postmenopausal women

Pill and skin patch forms

Estrogen taken without progesterone increases the risk of uterine cancer. ET should be considered only for women at significant risk of postmenopausal osteoporosis and only after nonestrogen medications have been considered.

May increase risk of blood clots in the veins, stroke, heart attack, and breast and ovarian cancer. Also, vaginal bleeding, breast tenderness, mood disturbances, and gallbladder disease.

hormone therapy

Including:
 Activella
 Femhrt
 Ortho-
    Prefest
 Premphase
 Prempro

Approved for preventing osteoporosis in postmenopausal women

Pill and skin patch forms

HT should be considered only for women at significant risk of postmenopausal osteoporosis and only after nonestrogen medications have been considered.

May increase risk of blood clots in the veins, stroke, heart attack, and breast and ovarian cancer. Also, vaginal bleeding, breast tenderness, mood disturbances, and gallbladder disease.

teriparatide

Forteo

Approved for treating osteoporosis in postmenopausal women and men at high risk for fracture

Daily injection

Approved for use for up to 24 months

May include nausea, dizziness, and cramps

raloxifene

Evista

Approved for preventing and treating osteoporosis in postmenopausal women

Pill in daily dose

May have a protective effect against breast cancer

May include hot flashes and blood clots in the veins

Source: NIH

pills

 

Osteoporosis Surgery

In severe cases, your doctor may recommend surgery to correct the effects of osteoporosis on your weakened body. It's important to note that the surgical procedures listed below only address the symptoms and results of osteoporosis and are not a cure to the condition itself.

Kyphoplasty Surgery

Kyphosplasty is a surgical procedure used to treat painful progressive vertebral body collapse and fractures (VCFs). This condition is usually a result of osteoporosis of the vertebrae, but certain forms of cancer are also known to cause similar problems.

Osteoporosis weakens the vertebrae of the spine and causes it to weaken, collapse, and form a progressively worsening hunched back. This is generally accompanied by server pain.

Kyphoplasty is a minimally invasive surgery. A surgeon creates two small incisions (usually < 3mm) and inserts a tube into the center of the vertebrae. A balloon is then inserted via this tube and is inflated. The inflation of the balloon pushes the bone back to a normal shape and height. After the balloon is extracted, the a special bone cement is inserted into the remaining cavity to strengthen and augment the bone.

Vertebroplasty

Vertebroplasty is a minimally invasive procedure used to strengthen vertebrae that have been weakened due to osteoporosis or cancer. It is most commonly used to treat pain from a compression fracture. In this procedure, a hollow needle (trocar) is inserted into the vertebrae, and a special bone cement is then injected. The cement stabilizes and strengthens the fractured bone, thus alleviating the compression fracture pain.

 

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