 AddThis Social Bookmark Button
BisphosphonatesBisphosphonates have been shown to have a significant effect in the prevention and treatment of osteoporosis. Bisphosphonates are non-hormonal drugs that bind to bone to protect against tissue breakdown. Agency for Healthcare Research and Quality, found that bisphosphonates-alendronate, etidronate, ibandronate, risedronate and zoledronic acid-plus calcitonin, parathyroid hormone, estrogen and raloxifene prevent spinal fractures. Evidence also showed that alendronate, risedronate and zoledronic acid, as well as estrogen and parathyroid hormones, prevent hip and other non-spinal fractures. Direct comparisons, however, have not shown bisphosphonates to be superior to other therapies in preventing bone fractures. No single bisphosphonate has been proven most effective in that class. Zoledronic Acid (Aclasta) - is a bisphosphonate in the form of a once yearly infusion.
Side Effects can include:- Pain with swallowing
- Upper gastrointestinal problems
- Indigestion
- More rarely:
- Jaw osteonecrosis
- Fracture of the femur (thigh bone) occurring rarely in patients on the bisphosphonate, alendronate (Fosamax)
It is important to take these medications as recommended, with a glass of water, and stay upright for 30 minutes after taking the medication to avoid the rare complications of ulcers and erosions of the oesophagus.
Strontium RanelateStrontium ranelate is a treatment to prevent fractures in post-menopausal women who have osteoporosis. It increases the formation of bone and decreases bone resorption. It halves the rate of spinal fractures and reduces other fractures by 16% and hip fractures by 19%. It is a taken once a day, as a powder mixed with water. It is recommended to be taken at bed-time, at least 2 hours after food, calcium-containing products or antacids.
Side Effects can include: - Nausea
- Diarrhea
- Headache
- Skin irritation
More rarely: - Blood clot in the vein (thrombosis) if you experience pain or swelling in the legs or unusual or sudden shortness of breath, see your doctor immediately.
- Drug hypersensitivity syndrome - which causes a fever and/or rash and can affect other organs. See your doctor immediately if a fever and/or rash occurs whilst taking this medication.
Hormone Replacement Therapy (HRT)
Hormone replacement therapy can help prevent bone loss and reduce the risk of fractures in post-menopausal women. It is not solely recommended for the management and treatment of Osteoporosis, due to HRT being associated with a small relative increase in the incidence of breast cancer, heart attack and stroke.
HRT is usually prescribed for the short-term relief of menopausal symptoms (up to 5 years), for women under the age of 60, and may have a role in preventing bone mineral density loss in women who have these symptoms. It can also be used for men with low levels of testosterone (hypogonadism), as hormone treatment also increases bone density.
Side Effects can Include: - Increased risk of Breast Cancer
- Increased risk of Heart attack
- Increased risk of Stroke
Selective Estrogen Receptor Modulators (SERMs)
Raloxifene (trade name: Evista) are part of a class of drugs that work in a similar way to, or opposite to estrogen, depending on which organ the drug is targeting. When bone is targeted, it acts like estrogen which reduces bone loss. Raloxifene halves the incidence of vertebral fractures, but has not been shown to reduce the risk of hip non-vertebral fractures.
Raloxifene can worsen the symptoms of menopause, and is not recommended for women experiencing menopause. Raloxifene has presented a reduction of the risk of invasive breast cancer in post-menopausal women on long term therapy (greater than 5 years) without increasing the risk of endometrial cancer.
Side Effects can Include: - Increased risk of clots and fatal stroke.
- Increased risk of venous thrombosis (clotting), similar to that seen with HT, so if you are immobilised for a prolonged period your doctor will probably not advise this treatment for you.
Teriparatide (Forteo)
Parathyroid hormone (teriparatide) stimulates bone formation and increases bone density and strength. The bone density of the spine has been shown to increase by up to 10% in some people and in studies of postmenopausal women with prior spinal fractures, has shown a reduction in the incidence of spinal (65%) and non-spinal (55%) fractures. Forteo is available in Australia for people with established osteoporosis who have had fractures when other drugs are considered unsuitable. It is currently not listed on the PBS (Pharmaceutical Benefits Scheme).
Side Effects can Include: It is important to talk to your doctor about any treatment you may be prescribed. You should also continue taking the medication as long as your doctor advises, so you get the full benefit of your treatment.
|
Osteoporosis Management 
