Medications for Osteoporosis

Estrogen Replacement Therapy (ERT)

Common brand names include:

• Premarin
• Ogen
• Estrace
• Estraderm
• Estratab

Estrogen replacement therapy (ERT) has been used for both the prevention and treatment of osteoporosis. ERT has been shown to reduce bone loss, increase bone density in the spine and hip, and reduce the risk of spine and hip fractures in postmenopausal women. ERT is available as a pill or skin patch.

Although ERT may cut the risk of osteoporosis in half, it’s important to note that recent research shows a strong association between longer-term ERT or HRT use and a significantly increased risk of invasive breast cancer]]> , ]]>strokes]]> , ]]>heart attacks]]> , and blood clots. Be sure to discuss all of the health risks and benefits of hormone therapy with your doctor to determine if it is right for you.

]]> Estrogen and Progestin HRT (Combined HRT)

Common brand names include:

• Activella
• Femhrt
• Ortho-Prefest
• Premphase
• Prempro

Combined HRT has been used for both the prevention and treatment of osteoporosis. Combined HRT has been shown to reduce bone loss, increase bone density in the spine and hip, and reduce the risk of spine and hip fractures in postmenopausal women. Combined HRT is available as a pill.

Although combined HRT may cut the risk of osteoporosis in half, it’s important to note that recent research shows a strong association between longer-term ERT or HRT use and a significantly increased risk of invasive breast cancer, strokes, heart attacks, and blood clots. Be sure to discuss all of the health risks and benefits of hormone therapy with your doctor to determine if it is right for you.

Bisphosphonates

The three main bisphosphonates approved for the use and treatment of osteoporosis are:

• Alendronate]]> sodium (Fosamax)
• ]]>Risedronate]]> sodium (Actonel)
• ]]>Ibandronate]]> (Boniva)

Other bisphosphonates include ]]>pamidronate]]> (Aredia) and ]]>etidronate]]> (Didronel).

Among postmenopausal women with osteoporosis, bisphosphonates can provide the following health benefits:

• Reduced bone loss
• Increased bone density in the spine and hip
• Reduced risk of spine and hip fractures

A bisphosphonate should be taken on an empty stomach. Therefore, it is recommended that you take it first thing in the morning with a full glass of water, at least 30 minutes before eating, drinking, or taking other medicines. To minimize side effects, remain in an upright position for at least 30 minutes after taking this medication.

Raloxifene (Evista)

Raloxifene]]> is one of a class of drugs called Selective Estrogen Receptor Modulators (SERMs). It helps prevent bone loss at the spine, hip, and total body and may increase bone mass. In some studies, after three years of use, raloxifene reduced the risk of spine fractures by about 50%. New evidence also suggests Raloxifene lowers risk of breast cancer. Raloxifene is available as a pill and should be taken once a day, with or without meals.

Side effects include hot flashes and other potentially more serious complications. Recent evidence from a randomized placebo-controlled trial of more than 10,000 post-menopausal women with pre-existing cardiovascular disease (or those at increased risk for cardiovascular disease) suggests that while Raloxifene reduces the risk of breast cancer and spine fracture, it increases risk of fatal stroke and deep vein thrombosis.

Calcitonin (Miacalcin)

Calcitonin]]> is a naturally occurring hormone that slows bone loss, increases bone density, and reduces the risk of spinal fractures. It may also help reduce or relieve the pain of bone fractures. Calcitonin is approved by FDA for women who are at least five years past menopause. It is available as an injection or a nasal spray.

Possible side effects associated with the injected form of calcitonin include:

• Allergic reaction
• Flushing of the face and hands
• Urinary frequency
• Nausea
• Skin rash

Nasal calcitonin may cause a runny nose.

Denosumab (Prolia)

Denosumab, given as an injection, is a type of monoclonal antibody. The medicine works by targeting cells called osteoclasts, which break down bone. Denosumab is intended for postmenopausal women who have osteoporosis and are at a high risk for fractures]]>.

Common side effects include:

• Back pain
• Pain in the extremities
• Pain in muscles, tendons, ligaments, and bones
• High cholesterol levels
• Bladder infections