There are several options available to prevent or treat osteoporosis. The treatment choice for one individual may be very different from person to person. There is not necessarily a right or wrong treatment choice, but a treatment that best suits the individual's needs.
The following groups of medications may be used to help treat or prevent osteoporosis:
- Bisphosphonates
- Selective Estrogen Receptor Modulators (SERMs)
- Denosumab
- Parathyroid Hormone Analogues
- Hormone Replacement Therapy
- Romosozumab
Bisphosphonates
Bisphosphonates are very effective in preventing and treating osteoporosis. Some examples of bisphosphonates that are used to treat and prevent osteoporosis are alendronate, risedronate and etidronate. Bisphosphonates are usually given in a tablet and are either taken daily or in a cycle. Occasionally, bisphosphonates can also be given intravenously to treat osteoporosis. Your physician can discuss the potential benefits of this therapy.
Since bisphosphonates are very poorly absorbed into the bloodstream from the stomach, it is very important that these medications be taken on an empty stomach with a full glass of water. They should not be taken with food, milk, antacids or calcium supplements. It is usually recommended they be taken 30 to 60 minutes before the morning meal. If taken before bedtime, the medication may wash back up into the esophagus (the tube connecting the mouth and stomach) during sleep. Some bisphosphonates have been known to cause severe heartburn or esophagitis (inflammation of the esophagus) and this can be worse if the medication is taken prior to lying down to go to bed. Risedronate and alendronate may be taken once daily or once weekly. Etidronate is taken in cycles with 14 days of active medication and 76 days of calcium supplements.
Selective estrogen receptor modulators (SERMs)
SERMs are also very effective for the prevention and treatment of osteoporosis. Currently, raloxifene is the only SERM available in Canada for osteoporosis. Raloxifene also decreases the risk of some types of breast cancer. Common side effects include leg cramps and hot flushes. It causes a slight increase in the risk of deep vein thrombosis (DVT or blood clots in the legs) and pulmonary embolism (blood clots that break off and lodge in the lungs). Raloxifene is taken as a single dose at any time of day.
Denosumab
Denosumab is the first biologic agent approved for the osteoporosis treatment. It is a human monoclonal antibody that prevents RANKL-RANK, inhibiting the cells (osteoclasts) that break down bone tissue. It is administered as an injection under the skin by a trained health care provider twice a year. Common side effects include pain in your muscles, back, legs or arms; dryness; and itching. It can also decrease your blood calcium levels.
Parathyroid Hormone Analogues
Teriparatide is a parathyroid hormone analogue that works by activating the bone-building cells (osteoblasts). It is recommended for postmenopausal women with severe osteoporosis, especially those who are at high risk of fracture or have not had success with other options. It is administered as an injection under the skin (usually into the thigh or abdominal wall) once daily. Common side effects include dizziness, leg cramps and nausea. Teriparatide should not be taken for longer than 2 years (24 months).
Hormone replacement therapy
In women, hormone replacement therapy (HRT) is effective for the prevention and treatment of osteoporosis. It can slow bone loss, increase bone density, and reduce the risk of broken bones. However, HRT increases the risk of heart disease, stroke, breast cancer, and blood clots in the lungs. For this reason, HRT is no longer a treatment of first choice for osteoporosis. However, it may be an option for women in the early stages of menopause who are already planning to take HRT to relieve menopause symptoms.
Hormone replacement therapy consists of the use of estrogen, either alone or in combination with the hormone progesterone. A number of estrogen preparations are available, including pills, skin patches, gels, and vaginal rings.
Romosozumab
Romosozumab belongs to a drug class called sclerostin inhibitors. It works by both increasing bone formation and decreasing bone resorption. It reduces the risk of fractures at the spine, hip and other areas for women with postmenopausal osteoporosis. Romosozumab is administered as two injections under the skin, by a trained health care provider, monthly for one year (a total of 12 doses). Common side effects include joint pain and headaches. While most side effects are similar compared to the other medications used to treat osteoporosis, romosozumab has been shown to slightly increase the risk of cardiovascular events.
Other ways to fight osteoporosis
Want to decrease your risk of osteoporosis? Here are some simple steps:
- Get active! Specifically, do more weight-bearing exercise, such as running, walking, or aerobics. This can help build up bone thickness and strength. Check with your doctor before starting a new exercise program.
- Quit smoking.
- Reduce your intake of caffeine-containing drinks such as coffee and tea, salt and alcohol.
- Make sure that you get enough calcium and vitamin D in your diet. This can help prevent osteoporosis. Calcium and vitamin D can also be used in combination with other treatments in people who already have osteoporosis.
How much calcium and vitamin D is enough?
Osteoporosis Canada recommends a daily intake of 1,000 mg of Calcium and 400 to 1,000 IU of Vitamin D for men and women aged 19 to 50 years, and for pregnant or breastfeeding women of any age.
A daily intake of 1,200 mg of Calcium and 800 to 2,000 IU of Vitamin D is recommended for both men and women over the age of 50.
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