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 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
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 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
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
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 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
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
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