Osteoporosis: Treatment & Therapy (1)
Not all people with osteoporosis will require treatment. The treatment of osteoporosis depends on a number of factors including age, sex, medical history, and if you have ever broken any bones. Considering these factors helps to decide if treatment is necessary and what the most appropriate treatment is.
There are many good treatments available for osteoporosis with advances in research being made all the time offering a wider choice of options. Most of these treatments are aimed at maintaining bone density by slowing down the rate that old bone is removed and thus maximizing bone strength.
1. Hormone replacement therapy (HRT)
Hormone replacement therapy is particularly useful for the prevention and treatment of osteoporosis in women who require it for control of menopausal symptoms, and also have other risk factors for osteoporosis, and in those women who have had an early menopause.
For those women who have had an early menopause, (before 45), HRT can be taken until the age of 50, which is the average age of menopause, when the risks and benefits of whether to continue should then be discussed.
HRT has been shown to maintain bone density and reduce the risk of fracture whilst taken, and is licensed for bone protection. This bone protection wears off once HRT is stopped.
2. Raloxifene
Raloxifene is a drug known as a Selective Estrogen Receptor Modulator (SERM). It mimics the action of on bones without increasing the risk of breast cancer which is associated with the long term use of HRT in and treatment of osteoporosis in post-menopausal women and has been shown to reduce the risk of fractures of the spine (vertebral fractures). It is most suitable for women can cause or worsen these.
3. Bisphosphonates
The bisphosphonates are a group of drugs which are non- hormonal. They work by affecting bone resorption which means that they slow down the action of the cells which break down old bone (osteoclasts), allowing the bone building cells to work more effectively in laying down estrogen on bone, although is non-hormonal, and selectively binds to estrogen receptors in the body.
By not having menopausal symptoms such as flushes as it but not so in tissues such as the breast where it has women over the age of 50. It is used for the prevention being selective in its action it acts like estrogen on bones anti-estrogen effect. It therefore has a protective effect new bone, thereby increasing bone density.
These type of drugs have been shown to very effective in the treatment of osteoporosis by increasing bone strength and reducing the risk of fracture.
There are currently 4 bisphosphonates drugs with more likely to be available in the future:
- Etidronate (Didronel PMO) – is a bisphosphonate drug which is taken in a 3 month cycle with a prescribed calcium supplement.
- Alendronate (Fosamax)
- Risedronate (Actonel)
- Ibandronate (Bon viva)
Alendronate, Risedronate and Ibandronate all have a similar mode of action.
Bisphosphonates Side effects
The bisphosphonate drugs are poorly absorbed from the bowel and can sometimes cause stomach problems such as indigestion, heartburn, or nausea although are generally very well tolerated. To maximise absorption and minimise side effects, they have to be taken first thing in the morning on an empty stomach with a full glass of plain tap water, with nothing else to eat and drink (including any other medications) until at least ½ hour afterwards.
It is also advisable to stay upright or wander about in this time and not to lie flat after taking the tablet. Alendronate and Risedronate are available as both daily and weekly preparations but most people now prefer to take the weekly tablet for convenience. Ibandronate is available as a monthly tablet, which some people prefer, or as an intravenous injection. The injection is usually prescribed in a specialist clinic.
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