Medications to Treat Osteoporosis

Therapeutic Medications. Currently, estrogen, calcitonin, alendronate, raloxifene, and risedronate are approved by the U. S. Food and Drug Administration (FDA) for the treatment of postmenopausal osteoporosis. Estrogen, alendronate, risedronate, and raloxifene are approved for the prevention of the disease. Alendronate is approved for the treatment of osteoporosis in men. Alendronate and risedronate are approved for use by men and women with glucocorticoid-induced osteoporosis.

Estrogen. Estrogen replacement therapy (ERT) has been shown to reduce bone loss, increase bone density in both the spine and hip, and reduce the risk of hip and spinal fractures in postmenopausal women. ERT is administered most commonly in the form of a pill or skin patch and is effective even when started after age 70. When estrogen is taken alone, it can increase a woman's risk of developing cancer of the uterine lining (endometrial cancer). To eliminate this risk, physicians prescribe the hormone progestin in combination with estrogen (hormone replacement therapy or HRT) for those women who have not had a hysterectomy. ERT/HRT relieves menopause symptoms and has been shown to have beneficial effects on both the skeleton and heart.

Experts recommend ERT for women at high risk for osteoporosis. ERT is approved for both the prevention and treatment of osteoporosis. ERT is especially recommended for women whose ovaries were removed before age 50. Estrogen replacement should also be considered by women who have experienced natural menopause and have multiple osteoporosis risk factors, such as early menopause, family history of osteoporosis, or below normal bone mass for their age. As with all drugs, the decision to use estrogen should be made after discussing the benefits and risks and your own situation with your doctor.

Raloxifene. Raloxifene (brand name "Evista") is a drug that is approved for the prevention and treatment of osteoporosis. It is from a new class of drugs called Selective Estrogen Receptor Modulators (SERMs) that appear to prevent bone loss at the spine, hip, and total body. Raloxifene has been shown to have beneficial effects on bone mass and bone turnover and can reduce the incidence of vertebral fractures by 30-50%. While side-effects are not common with raloxifene, those reported include hot flashes and deep vein thrombosis, the latter of which is also associated with estrogen therapy. Additional research studies on raloxifene will be ongoing for several more years.

Alendronate. Alendronate (brand name "Fosamax") is a medication from the class of drugs called bisphosphonates. Like estrogen and raloxifene, alendronate is approved for both the prevention and treatment of osteoporosis. Alendronate is also used to treat the bone loss from glucocorticoid medications like prednisone or cortisone and is approved for the treatment of osteoporosis in men. In postmenopausal women with osteoporosis, the bisphosphonate alendronate reduces bone loss, increases bone density in both the spine and hip, and reduces the risk of both spine fractures and hip fractures. Side effects from alendronate are uncommon, but may include abdominal or musculoskeletal pain, nausea, heartburn, or irritation of the esophagus. The medication should be taken on an empty stomach and with a full glass of water first thing in the morning. After taking alendronate, it is important to wait in an upright position for at least one-half hour, or preferably one hour, before the first food, beverage, or medication of the day.

Calcitonin. Calcitonin is a naturally occurring non-sex hormone involved in calcium regulation and bone metabolism. In women who are at least 5 years beyond menopause, calcitonin slows bone loss, increases spinal bone density, and according to anecdotal reports, relieves the pain associated with bone fractures. Calcitonin reduces the risk of spinal fractures and may reduce hip fracture risk as well. Studies on fracture reduction are ongoing. Calcitonin is currently available as an injection or nasal spray. While it does not affect other organs or systems in the body, injectable calcitonin may cause an allergic reaction and unpleasant side effects including flushing of the face and hands, urinary frequency, nausea, and skin rash. The only side effect reported with nasal calcitonin is a runny nose.

Risedronate. Risedronate sodium (brand name Actonel®) is approved for the prevention and treatment of osteoporosis in postmenopausal women and for the prevention and treatment of glucocorticoid-induced osteoporosis in both men and women. Risedronate, a bisphosphonate, has been shown to slow or stop bone loss, increase bone mineral density and reduce the risk of spine and non-spine fractures. In clinical trials, side effects of risedronate were minimal to moderate and those that were reported occurred equally among people taking the medication and those taking a placebo. Risedronate should be taken with a glass of water at least 30 minutes before the first food or beverage of the day other than water. After taking risedronate, it is important to remain in an upright position and refrain from eating for at least 30 minutes.