Newer Osteoporosis Treatments Build Stronger Bones

No matter which osteoporosis drug your doctor chooses for you, it's helpful to know as much as possible about how the disease has affected you. One way to tell is to ask about your "markers."

What a difference a decade makes. In 1995, Fosamax, the first medication in a class of drugs called bisphosphonates, came on the market.

Bisphosphonates affect what's called the bone remodeling cycle, which involves bone resorption (the dissolving of existing bone tissue) and formation (the filling of the resulting small cavities with new bone tissue). Usually, these two parts of the cycle are balanced, but when resorption outpaces formation, you eventually have osteoporosis.

By slowing or stopping the bone-resorbing portion of the remodeling cycle, bisphosphonates allow new bone formation to catch up with bone resorption. Fosamax and a slightly newer drug, Actonel (risedronate) both increase bone density and help prevent fractures.

Increasing Bone Density

"Over three years on Fosamax, you can expect a 6% to 8% increase in spinal bone density and a 4% to 6% increase in hip bone density," says Michael Holick, MD, PhD, a professor of medicine, physiology, and biophysics at Boston University Medical Center. "And the bisphosphonates have been found to reduce spinal fracture by as much as 60% over three years, and hip fractures by as much as 50%."

Recently completed studies show that these effects continue with long-term use. "You see the most dramatic effect in the first three to five years on the medications, but we continue to see a smaller but significant increase in bone density for up to 10 years," Holick says. "More important, if you stop taking the drugs, you begin to lose bone at the same rate you would have before."

In addition to Fosamax and Actonel, the FDA recently approved another bisphosphonate, Boniva. Some studies show that Boniva, taken once monthly instead of once daily or weekly, improves bone density. -->

But bisphosphonates do have some limitations. For one thing, the regimen for taking them effectively is very intense. Since as little as 1% of the drug is actually absorbed by your body - the rest is excreted -- you have to make sure to make the most of every dose. With drugs like Fosamax and Actonel, this means taking it first thing in the morning once a week -- and then not ingesting anything else for half an hour to an hour.

"You have to stay upright for 30 to 60 minutes, and if you even brush your teeth, drink coffee, or juice, or take a nasal spray or mouthwash, it can affect the absorption rate," says Robert Recker, MD, MACP, professor of medicine and director of the Osteoporosis Research Center at Creighton University School of Medicine in Omaha, Neb. "You take the pill with 8 ounces of water, and then nothing more for up to an hour. I was surprised at how many people find that very difficult."

In a small percentage of patients, bisphosphonates can also cause some gastrointestinal problems. "Some people do have GI complaints," says Holick. "It's a very small number, but a few people just can't tolerate it."