When it's time to choose an osteoporosis medicine, you have lots of options. In the past 10 years, science has come a long way in helping women treat their bone problems.
First step: Make sure you're getting adequate calcium and vitamin D, advises Eve Scopelitis, MD, an internist with Ochsner Medical Center in New Orleans. "Vitamin D is now being recognized as a key player in osteoporosis. Even though patients are taking calcium plus D, they may not be getting enough D. They may need prescription vitamin D -- it's that important.
A bone density scan can detect thinning bones at an early stage. If you already have osteoporosis, bone scans can also tell you how fast the disease is progressing.
But an abnormal bone scan can create as many questions as it answers. Who should get a bone density scan, and what do the results mean? If your bone density is below normal, what can you expect, and what should you do?
In fact, even when you start taking osteoporosis medicine, it's critical to keep getting these supplements, says Holly Thacker, MD, director of the Women's Health Center at The Cleveland Clinic. "A postmenopausal woman needs 1,500 milligrams calcium daily, plus 1,000 units of vitamin D. Some need prescription-strength vitamin D [Calcitriol]. This deficiency is a serious problem."
Also critical: Do weight-bearing exercise, don't smoke, and if you drink alcohol, drink moderately.
Second step: Talk to your doctor about getting a bone resorption marker test -- a blood or urine test, advises Mary Ruppe, MD, an endocrinologist with the University of Texas Health Science Center in Houston.
Bone resportion is bone loss -- and the test will tell you whether your osteoporosis medicine is having an effect on bone loss, she explains. "The first test is your baseline. Get it before you start the medication. Then get it checked after you've taken the drug for a few months to see the change." Insurance typically covers two tests the first year.
Now let's weigh the advantages and disadvantages of six main types of osteoporosis medicine.
Bisphosphonates are the mainstays of osteoporosis medicines today. "They're the workhorses of osteoporosis treatment," says Bobo Tanner, MD, director of the Osteoporosis Clinic at Vanderbilt University in Nashville, Tenn. "They offer an enormous number of options for patients."
Fosomax was the first FDA-approved osteoporosis medicine 10 years ago, followed by Actonel three years later. Boniva, and Reclast are the most recent FDA approvals.
What They Do: All these drugs have been shown to increase bone density -- and Fosamax and Actonel lower the risk of spine and hips fractures. Actonel has been shown to work quickly, reducing fracture risk within the first six months, Thacker reports.
"Boniva has not yet been shown to reduce hip fractures, and that's a concern," she adds.
Reclast or Zometa increase bone mineral density and have been shown to reduce spine fractures and hip fractures -- with the reduced spine fracture risk sustained over three years. According to the manufacturer, Reclast also reduces fractures of the wrist, arm, leg, and rib. Reclast has been shown to reduce mortality in people who have already had hip fractures, Thacker tells WebMD.