Osteoporosis

Osteoporosis Medications: Before the Bone Breaks

Osteoporosis is a disease that causes the bones to lose mass, to deteriorate, and to become brittle. This means that bones also lose their strength, which increases the chance of breaks or fractures. Fractures caused by osteoporosis can be debilitating and reduce quality of life. They can result in pain, emotional distress, loss of independence, and an increased demand on resources.

While men can develop osteoporosis, 80 percent of osteoporosis patients in the United States are women. According to the National Institutes of Health, 10 million people already have the disease (2 million are men), and 34 million more have low bone mass, which is a major risk factor for osteoporosis. Although osteoporosis can strike at any age, it most often appears after menopause when women’s hormone levels decline. At least 1.5 million fractures occur each year because of osteoporosis, costing more than $14 billion. The most typical sites of fractures related to osteoporosis are the hip, spine, wrist, and ribs, although the disease can affect any bone in the body.

A Bone’s Life

Bones grow quickly and usually reach their full length by the late teens or early 20s. Bones continue to thicken and reach their thickest point between ages 25 and 35. In women, bone mass tends to slowly decline from the mid-30s to menopause. When a woman reaches menopause, bone loss happens much faster and bones become thin and weak. A woman may lose up to 20 percent of her bone mass in the five to seven years following menopause, according to NIH. One in two women and one in four men over age 50 will have an osteoporosis-related fracture in their lifetime. Most fractures are the result of falls.

Treatment Options

A complete osteoporosis treatment program includes focusing on proper nutrition, exercise, and safety issues to prevent falls that may result in fractures. In addition, your doctor may prescribe medications to slow or stop bone loss, increase bone strength, and reduce fracture risk.

Osteoporosis medications affect the bone remodeling cycle. Bone remodeling is made up of two stages: bone resorption (bone loss) and bone formation. These stages usually occur together to maintain a healthy bone. In osteoporosis, the cycle becomes imbalanced and bone loss occurs more rapidly than bone formation, resulting in a weakened bone.

Anti-Resorptive Medications
(Drugs that slow bone loss)

Bisphosphonates

Brand Name	Fosamax^® (alendronate sodium) Fosamax Plus D^reg; (alendronate sodium plus 2,800 IU vitamin D3)
Indication	Prevention and treatment of postmenopausal osteoporosis, treatment of glucocorticoid-induced osteoporosis in men and women, and treatment of osteoporosis in men
Dose	5mg per day or 35mg once a week (prevention) 10mg per day or 70mg once a week (treatment)

Brand Name	Boniva^® (ibandronate sodium)
Indication	Prevention and treatment of postmenopausal osteoporosis
Dose	2.5 mg per day or 150 mg once a month (prevention and treatment)

	Brand Name	Actonel^® (risedronate sodium) Actonel^® with Calcium (risedronate sodium plus 500mg calcium carbonate)
Indication	Prevention and treatment of postmenopausal osteoporosis, prevention and treatment of glucocorticoid-induced osteoporosis in men and women.
Dose	5mg per day or 35mg once a week (prevention and treatment)

Side Effects of Bisphosphonates

Nausea and vomiting
Heartburn
Irritation or pain of the esophagus
Difficulty swallowing
Constipation or diarrhea
Gas

How to Take Bisphosphonates

Must be taken first thing in the morning upon getting up for the day
Swallow with a full glass (6-8oz.) of plain water
Fosamax^® and Actonel^®: take at least 30 minutes before the first food or drink (other than water) intake of the day or before taking any oral medications. Patients must not lie down for at least 30 minutes after taking the medication.
Boniva^®: take at least 60 minutes before the first food or drink (other than water) intake of the day or before taking any oral medications. Patients must not lie down for at least 60 minutes after taking this medication.

Calcitonin

Brand Name	Miacalcin^® Nasal Spray Fortical^® Nasal Spray Miacalcin^® Injection Osteocalcin^® Injection Calcimar^® Injection Salmonine^® Injection
Indication	Prevention (all brands) and treatment (Fortical^®) of postmenopausal osteoporosis
Dose	Injection - 50 to 100 units per day given subcutaneously (SQ) or intramuscularly (IM) Nasal Spray - 200 units (1 spray) per day, alternating nostrils daily
Side Effects	Flushing of face and hands Nausea, vomiting, diarrhea Loss of appetite Nasal irritation Inflammation, swelling, pain, redness, and itching at injection site<
How to use Calcitonin	Keep unopened nasal spray bottles in refrigerator Activate nasal spray pump Once pump has been activated, store at room temperature Store nasal spray upright After 30 days, throw away any unused nasal spray Injections must be stored in the refrigerator at all times

Estrogens

Brand Name	Premarin^®Estrace^®Prempro^®Estraderm^®Estratab^® and others
Indication	Prevention of post-menopausal osteoporosis in women at significant risk.
Dose	1 injection (20mcg) per day given subcutaneously (SQ) in the thigh or abdomen
Side Effects	Spotting Headache Breast Pain Abdominal Pain