Osteoporosis Myth: Once You Get Osteoporosis, No Treatment Helps
Reality: If diagnosed, osteoporosis can be treated with a variety of new osteoporosis medications that help to prevent bone loss and rebuild bone. These osteoporosis treatments can substantially reduce your risk of developing dangerous and potentially deadly bone fractures.
Antiresorptive medications affect the body's bone remodeling cycle by slowing or stopping the part of the process that involves breakdown of bone. This can both prevent the onset of osteoporosis and help treat the disease once it develops. These drugs include bisphosphonates, selective estrogen receptor modulators (SERMs), and estrogen therapy.
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?
Bisphosphonates include Actonel, Binosto, Boniva, Fosamax, and Zometa. Each of the bisphosphonates has been shown in clinical studies to reduce the risk of fracture from osteoporosis, although they are not all the same. Fosamax, for example, has been shown to reduce spine, hip, and wrist fractures, while Boniva has been shown to reduce spine fractures. Each drug has its advantages and disadvantages. Talk with your doctor about which might be best for you.
In addition, the FDA has approved another bisphosphonate, a drug known as Reclast, for the treatment of osteoporosis. Reclast is a once-yearly treatment, administered as a 15-minute IV injection.
These drugs are considered generally safe. However, a rare condition called osteonecrosis of the jaw has been linked to some bisphosphonates. This condition involves a wound that exposes bone and is difficult to heal, and can lead to infection. Most cases have occurred in people with cancer taking certain biphosphanates, and not in those with osteoporosis. Still, it is important to be aware of this condition and discuss it with both your doctor and dentist. A treatment plan and length of therapy needs to be discussed with you doctor as these guidelines are changing.
SERMs are designed to provide the beneficial effects of estrogen therapy, without the disadvantages that have been seen in some studies, such as increased risk of heart attack, breast cancer, and stroke. Only one SERM, Evista, has been approved for treating osteoporosis as of 2007, but others are currently in development. Evista has been shown to reduce the risk of spine fractures, but it's not yet known if it reduces fractures in other areas, such as the hip.
Estrogen therapy (alone or in combination with progestin or bazedoxifene) has been shown to decrease bone loss and reduce hip and spine fractures. It replaces the estrogen levels that drop drastically during menopause. Unfortunately, it has also been linked to an increased risk for heart attack, breast cancer, and stroke, so the FDA recommends that you consider other osteoporosis medications first.
Bone-forming medications are designed to do just what they say: instead of stopping the process of bone breakdown, they work to build more bone. There is currently only one bone-forming medication approved by the FDA: Forteo, a type of parathyroid hormone, which stimulates the laying down of new bone and improves bone density. In women, it's been shown to reduce spine and extremity fractures. (Forteo has not been studied as thoroughly in men.) The primary disadvantage of Forteo is that it must be injected daily.
In addition to these existing medications, scientists continue to research other new osteoporosis drugs.
There are many different options for treatment and prevention, both for people who already have osteoporosis and those who are at high risk. If one osteoporosis medication doesn't work well for you, it's likely that another will. Talk with your doctor about your choices and take an active role in protecting your bones.