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Osteoporosis Medications: How They Work

From the latest medications to daily supplements -- what's your osteoporosis medication doing for you?

Osteoporosis Medication Can Restore Balance continued...

Bisphosphonates enter the bones, binding to areas of bone undergoing resorption. When osteoclasts try to dissolve bone coated with the drug, it disrupts the osteoclasts' function. The result? Less bone gets resorbed, and the bone has a better chance to rebuild.

"Bisphosphonates are the most effective medicines we have to treat osteoporosis," says Mary Rhee, MD, MS, an endocrinologist and assistant professor of medicine at Emory University in Atlanta. The key health benefits: increased bone density and reduced risk of fracture.

Calcitonin

Calcitonin is a hormone made in the thyroid gland. In animals, calcitonin binds to osteoclasts, preventing bone resorption. The drug preparation of calcitonin is usually made from salmon calcitonin, which is more potent than human calcitonin.

Taken as a medicine, calcitonin slows bone loss, increases bone density, and may relieve bone pain. It is most often used as additional therapy, or when someone cannot tolerate a bisphosphonate. The key health benefit: Reducing the risk of spinal fractures. 

Raloxifene

Raloxifene is a selective estrogen receptor modulator, or SERM, originally used to treat breast cancer. Now, it’s also approved to prevent and treat osteoporosis. Raloxifene binds to estrogen receptors throughout the body to produce some estrogen-like effects. One effect is prevention of bone resorption.

Doctors typically use raloxifene in addition to other osteoporosis medications, not by itself. Because raloxifene may also reduce the risk of breast cancer, it may be a good medicine for someone with osteoporosis who is also at high risk for breast cancer.

The key health benefit: Increased bone mass and reducing the risk of spinal fractures.  

Calcitriol 

Calcitriol is prescription-strength vitamin D. Since vitamin D is essential for bone health, calcitriol might be expected to help.

In treating or preventing osteoporosis, calcitriol has shown promise in some studies, but not in others. Also, this drug requires periodic monitoring of calcium levels. Most experts do not recommend calcitriol as a first-line treatment for osteoporosis.

Teriparatide

Teriparatide is a prepared form of human parathyroid hormone. This hormone has a tricky effect. Constant high levels of parathyroid hormone cause bone resorption and loss. But intermittent doses of teriparatide cause bone formation.

Teriparatide is the only medicine today proven to stimulate bone growth. It's also proven to prevent fractures. Teriparatide has two main drawbacks: it's extremely expensive, and it must be given as an injection.

Also, when teriparatide is given to women already taking bisphosphonates, bone growth is less than when it's given to a woman as a first-line medicine. "It's nice to have a drug that actually builds bone," says Baker. "But the cost issues [with teriparatide] still need to be worked out."   The key health benefit: bone grown and reduced risk of fractures.

Vitamin D and Calcium 

You won't see million dollar ad campaigns for these low-tech osteoporosis medicines. But don't let that fool you: osteoporosis experts say vitamin D and calcium are key to preventing and managing osteoporosis.

Every postmenopausal woman should take 1,200 milligrams of calcium a day, according to the National Osteoporosis Foundation. For women or men with osteoporosis, the need is even greater. As Baker puts it, "trying to build bone without adequate calcium and vitamin D is like trying to build a brick wall without the mortar."

Many women have low vitamin D levels but don't know it, according to Rhee. Since vitamin D in normal doses is cheap and risk-free, a good option for most postmenopausal women is to take a combined vitamin D and calcium supplement every day.

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