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Whether you have risk factors for developing osteoporosis or youve been diagnosed, you may wonder what the best avenues are for strengthening your bones. While theres no cure for this bone-thinning condition, with the right meds, you can see improvement and slash your risk of fractures.
Osteoporosis means porous bones. In short: Its a condition that occurs when you lose more bone mass than your body can make. Think of your bones as a bank account: You spend the first couple of decades of your life socking away bone (money) for retirement. When you reach age 30 or so, youll hit your peak bone massthe highest bone mass youll have in your lifetime. When youre a kid, a calcium-rich diet, exercise, and general good health yield healthy bone development.
If you skimped on any of the above (say, due to a childhood illness), your peak bone mass might be on the low side. Once you reach that retirement age (over 50), youll need to make some withdrawals; this is when you start losing bone mass naturally and bone formation slows.
If you didnt have a great peak bone mass to start with, you could get into trouble, leaving bones thin, brittle, and vulnerable to breaks. Certain risk factorssuch as being a postmenopausal woman or having a family history of osteoporosiscan also mean youll lose bone at a faster-than-normal rate.
The end goal of all osteoporosis treatments is to stabilize your bone densitymeaning, prevent you from losing additional bonerather than achieve a complete cure. These meds are designed to slow your bone loss, and in some cases, help make new bones, so yours are less vulnerable to fracture (breaking).
Thats important because fractures arent just painful they can be debilitating, leading to loss of mobility and independence, financial strain, and even death. The mortality rate a year after a hip fracture is about 22 percent. Yet, osteoporosis causes a staggering number of bone breaks a year: 1.5 million to be exact, according to research in the Journal of the American Medical Association.
To answer that, lets start with what actually constitutes osteoporosis. The condition is often diagnosed when you have a bone density scan, a test that measures your bone mineral density (BMD).
The most common BMD test is a dual-energy X-ray absorptiometry or bone densitometry referred to as a DXA or DEXA scan. It checks the mineral levels in your bones, comparing your level to that of a 30-year-old of the same gender. The idea is to see how far your bone density has deviated since then. Heres how to read your results, known as a T-score:
If youve suffered a fracture, your doctor will likely do a bone density scan to see if osteoporosis is at play. The scan is also routinely given to women starting at age 65 (at risk women can start at 60) and to men starting at 70 years old.
Your doctor will also determine how likely you are to fracture a major bone within the next 10 years via a Fracture Risk Assessment Tool (FRAX). If you have osteopenia and a low risk of fracture, you probably wont be treated with an osteoporosis drug. Instead, the recommendation is to make lifestyle changes to improve, or at least stabilize, your bone density. What kinds of tweaks are we talking about? These may include:
However, if youre diagnosed with osteopenia and have a high risk of fracture, your physician may start you on osteoporosis meds to slow down your bone loss before it becomes osteoporosis. Medications arent always a given though. A person who is diagnosed relatively young with no history of fractures and is otherwise healthy may not need meds just yet.
A few drug classes for osteoporosis that work in different ways to prevent fracture and a treatment plan may include one of the following types of drugs:
This family of meds give your natural bone production a chance to play catch-up by slowing or stopping resorption, when bones break down and release minerals such as calcium into your blood. They home in on and inhibit osteoclasts, the cells that do the breaking down. Antiresorptive drugs include:
Youve probably heard of Fosamax or Boniva (or the Boniva generic ibandronate). Theyre part of this drug class the most commonly prescribed for osteoporosis. Bisphosphonates work by slowing down those osteoclasts, giving your osteoblasts (the bone-building cells) a chance to get ahead. Examples include:
Most drugs come with some risk of side effects, and bisphosphonates are no exception. The most common side effects of bisphosphonates are:
There is a side effect from Fosamax called osteonecrosis of the jaw (loss of blood supply to this bone). Its a risk with all bisphosphonates, but its rare and usually seen in people receiving high doses of the meds during cancer treatments. Another less common side effect is atypical femoral fracture; (yes, an osteoporosis med can actually cause a bone break). Long-term use is linked to breaks in the upper thigh area. Zoledronic acid side effects can also include flu-like symptoms, but theyre temporary.
To reduce the risk of the more serious side effects, current osteoporosis treatment guidelines for bisphosphonates call for reassessing a patients fracture risk after three to five years. If your risk of fracture is low-to-moderate after treatment, you may be able to take a break from the drugs; those who are still high risk can remain on bisphosphonates for up to 10 years.
These injections work by neutralizing RANKL, a protein thats necessary for osteoclasts to do their job breaking down bone. Theyre given via injection every six months, depending on the brand, for up to 10 years. Example include:
RANKL injections can also lead to atypical fractures, and that risk is even greater if you suddenly stop treatment. A study in the journal Osteoporosis International found a five percent increase in multiple vertebral fractures after halting the osteoporosis treatment injection.
HRT cuts down on fragility fractures by 20 to 35 percent, studies have shown, but because of its potential health risks (pulmonary embolism, cardiovascular issues, and breast cancer are just a few), its considered a last resort treatment for osteoporosis alone and is reserved for women who are experiencing both menopause symptoms and osteoporosis. Side effects can include:
HRT is approved for women in the form of daily oral tablets and transdermal patches that are applied daily or weekly.
SERMs arent hormones, so they dont carry the same risks as traditional HRT, but this class of drugs does act similar to estrogen in the body by reducing menopause systems and fortifying your bones and preventing fracture, particularly in the spine.
Its a good option for women who are dealing with both menopause symptoms and osteoporosis, but have a high risk of breast cancer that eliminates HRT as an option. SERMs are taken as a daily tablet. One example is Evista (raloxifene), a daily oral tablet approved for women. Evitas most common side effects are:
This type of drug, like Duavee (conjugated estrogens/bazedoxifene) combines estrogen with a SERM to help with severe menopause symptoms such as hot flashes and boost bone mineral density. Research has shown it can increase both spine and hip density after 12 months. Its a daily tablet thats taken orally. Side effects can include:
Because TSEC contains estrogen, it carries some of the risks of HRT.
These are your bone builders. This osteoporosis drug class is designed to stimulate osteoblasts, the cells that beef up bone formation. Theyre typically reserved for more severe cases of osteoporosis where the risk of fracture is very high. Anabolics include:
The most common side effects of these osteoporosis treatment injections are:
The newest bone maker on the block, romosozumab-aqq, is an anti-sclerosin monoclonal antibody approved for postmenopausal women with high risk of fracture. It comes with a risk of cardiovascular issues, so if youve had a heart attack or a stroke within the past year, this is not an ideal drug. Teriparatide and abaloparatide are synthetic versions of parathyroid hormone, which regulates calcium, essential for strong bones.
While worries about side effects may give you pause about filling your prescription for osteoporosis meds, its important to remember this: The benefits of preventing a fracture (and all that comes with it) win out over the risks of taking these meds, according to guidelines from the Endocrine Society published in The Journal of Endocrinology & Metabolism.
Its not widely done, but theres evidence that pairing an antiresorptive with an anabolic agent may yield better results than giving one drug alone. One study in the Journal of Bone and Mineral Research showed combining the bisphosphonate zoledronic acid with the anabolic teriparatide boosted bone mineral density in the spine and hip more than either drug alone.
In an analysis of seven studies, research in the BMJ Open found that a combo of the two drug classes greatly improved bone mineral density of the hip and spine more quickly than an anabolic agent alone. Some doctors will also give an anabolic first (in severe cases) and prescribe a bisphosphonate to maintain your newly formed bone mass.
While bisphosphonates and anabolic agents are the most common osteoporosis medications, some drugs that are used to treat other conditions that can also have a positive effect on bone density.
Youve probably heard steroids are bad for bones. Its true; long-term use of corticosteroids (synthetic drugs that are similar to cortisol, a hormone your body produces) deteriorates bone mineral density, causing osteoporosis. But low doses of anabolic steroids (synthetic versions of the male hormone androgen) may have the opposite effect, stimulating bone growth and reducing osteoporosis pain from fractures, according to research in Clinical Calcium. However, theres limited data to know the long-term side effects of anabolic steroids.
This used to be a malaria medication. How can that possibly help your bones? Hydroxychloroquine is antirheumatic, meaning its used to treat rheumatoid arthritis (RA), lupus, Sjgen syndrome, etc. Researchers discovered those treated with Plaquenil had higher bone mineral density than those who werent. Its not FDA approved for osteoporosis and comes with a rare, but serious risk of eye damage in high doses. More common side effects include:
This is another type of bisphosphonate given via IV infusion that slows down bone loss, but its primarily used to treat bone damage from Pagets Disease (a chronic disease that causes deterioration of bone tissue) and certain types of cancer, as well as hypercalcemia (high levels of calcium in blood caused by calcium). Its an option for osteoporosis patients, but zoledronic acid has proved better for fracture prevention.
Right now, there are no natural supplements that experts recommend in lieu of FDA-approved osteoporosis drugs. If youve been searching the internet for that, youve probably come across info on strontium, a trace element, for osteoporosis.
There is some scientific basis on this one. A study found that postmenopausal women who took two grams of strontium ranelate every day for three years suffered 37 percent fewer spinal fractures compared to women taking a daily placebo pill.
Theres also a strontium ranelate-based drug (Protelos) approved in Europe, but not here in the US. (Its associated with some serious side effects such as pulmonary embolism and heart attacks.) So, should you take an over-the-counter version of the mineral, such as strontium citrate or strontium chloride, to strengthen your bones? Not so fast. These are not the same as strontium ranelate, and theres no evidence they work.
What about OTC estrogen pills? Phytoestrogens, plant-based versions of the hormone such as soy and flaxseed, have some limited data behind them to show that they may help slow bone loss. But physicians say not enough to replace your prescribed medication. Phytoestrogens in your diet may be better at preventing low bone density than treating osteoporosis.
No one drug stands out as the safest; all medications have side effects. Youll have to weigh the pros and cons of each with your physician to find the right fit for you. Typically, bisphosphonates are well tolerated and have been shown to be safe to take for up to 10 years, which is why theyre the first line of treatment for osteoporosis.
Theres no cure for osteoporosis, but you can strengthen bones and reduce the risk of fracture by taking medications and making lifestyle changes. These include: boosting your calcium and vitamin D intake, doing weight-bearing exercises at least three days a week, drinking less alcohol (no more than one to two drinks a day), and if youre a smoker, quitting.
No, osteoporosis drugs are not a lifelong commitment. You can take bisphosphonates for up to 10 years, but the latest osteoporosis guidelines suggest reassessing a patients bone density between three and five years, and, if possible, taking a break from the drugs. Bisphosphonates linger in your bones after you stop taking them, so you have some built-in protection. RANKL agents such as Prolia can be used up to 10 years, while anabolic agents can only be given for up to two years.
The risk of suffering a fracture is far greater than incurring some of the most serious side effects of medication. One in two women over age 50 will fracture a bone and fractures can be extremely painful and debilitating. Need more convincing? Consider this stat from a New York Times article: For every 100,000 women taking bisphosphonates, fewer than three will have osteonecrosis of the jaw, and only one will suffer an atypical femoral fracture. But 2,000 will have avoided an osteoporotic fracture.
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What Are Your Osteoporosis Medication Options? - HealthCentral.com
