Recently a patient asked me to review all osteoporosis medications for her to consider and choose from. We had already optimized her Calcium intake, 25-hydroxy Vitamin D level, Protein intake, Multiple Vitamins & Minerals, and Exercise program. These had all helped substantially, but not enough for her peace of mind. She feels that she needs osteoporosis medication too. Here they are:
All but one are Antiresorptives, all of which slow bone turnover. The biggest class are the Bisphosphonates. The Oral Bisphosphonates must be taken on an empty stomach, and can cause reflux disease (GERD). Atelvia is a new oral bisphosphonate, with enteric coating. Reclast is a bisphosphonate taken IV – therefore no reflux issues.
Prolia is a different class of antiresorptive, without GI or renal issues.
Very rarely Atypical Fractures of the Femur (AFF) and OsteoNecrosis of the Jaw (ONJ) are associated with the above medications, especially after more than 5 years continuous use. Routine Fractures (including occasional AFF and ONJ) are far more common in UNTREATED women and men.
Modern Hormone Replacement Therapy (HRT) restores bone turnover to its pre-menopausal state, but has possible problems with blood clots and breast cancer, especially in women over 70. Evista is a Human Estrogen analog that restores a pre-menopausal bone turnover state and also decreases Breast Cancer risk.
Some patients need an Anabolic medication to increase bone by stimulating the OsteoBlasts, the cells that make new bone, especially after multiple fractures. Forteo is the anabolic available in the USA. Forteo is a daily shot, like insulin, but for only 2 years. Forteo is used to treat ONJ and AFF.
If you need medication, read the links, evaluate and choose the one that best fits your situation. Take Control of your future bone health.
Jay Ginther, MD