Bisphosphonates include a group of medications that act by destroying the osteoclasts. The result is a significant decrease in bone turnover and bone loss. These medications have been proven thus far to be the most effective in fracture reduction. Studies have documented a 40-50 percent reduction in vertebral fractures and a 20-40 percent reduction in other fractures including hip. These bisphosphonates include Fosamax (alendronate), Actonel (risedronate), and Boniva (ibandronate). Therapies include daily, weekly, and monthly regimens. Side effects can include gastrointestinal problems such as ulcers and abdominal pain. In addition there is a rare occurrence of jaw bone death. Discontinuation of this medication can result in increased bone turnover and a decrease in bone density.
Selective estrogen receptor modulators (SERMS) exert estrogen like effects on selective tissue while avoiding some of the undesired effects of estrogen. Evista (raloxifene) is the SERM that has been studied for osteoporosis. It acts by decreasing bone turnover and has been proven to decrease the risk of vertebral fractures by 34-50 percent.
The side effects include hot flashes and an increased risk of thromboembolic events such as blood clots. The potential benefit is that it has demonstrated effectiveness in breast cancer prevention and may soon be approved for this use. Raloxifene probably should be used in osteoporosis prevention and would not be the first choice for the treatment of osteoporosis, except maybe of the spine.
Calcitonin inhibits osteoclast activity thereby preventing bone resorption. It was available only in an injectable form however the nasal spray Fortical has recently come on the market. In those with a diagnosis of osteoporosis it has been shown to decrease the risk of spine fractures by 33 percent.
No medication is completely free of risk or side effects. You can work closely with your health care provider to choose the one that is right for you. (Bella)
