Newer Osteoporosis Treatments Build Stronger Bones
Recent drugs help maintain or increase bone density and also prevent fractures.
Other Options to Stop Bone Loss
For those patients, another option is Evista (raloxifene), one of a class of drugs known as selective estrogen receptor modulators, or SERMs, designed to offer some of the benefits of estrogens without their potential drawbacks (such as increased breast cancer risk).
"It's hard to compare the data directly, but while it's effective in maintaining bone density, I tend to think it's not quite as effective as the bisphosphonates," says Recker.
But if a patient has difficulty taking bisphosphonates because of gastrointestinal problems --perhaps if she's only at risk for osteoporosis, a condition known as osteopenia -- Evista may be a good option. "I tend to use it in younger women, in their 50s or early 60s, who have osteopenia and show markers of increased bone resorption," says Holick. "They may not need to increase bone density, but rather just keep what they've got."
One other option: hormone replacement therapy, or HRT. This isn't generally used as a front-line osteoporosis therapy these days, though. Rather, its bone-density benefits are often an add-on benefit for women who take HRT to cope with menopausal symptoms. HRTs are used much less in recent years, and always with caution, because of research showing that they can increase the risk of blood clots (so can Evista), heart attack and stroke, and breast cancer.
Fortical and Miacalcin contain the active ingredient calcitonin, which is a naturally occurring hormone that inhibits bone loss. It is available as a nasal spray or injection. Undesirable side effects include nausea and skin rashes.
Prolia is a treatment approved for the treatment of osteoporosis in postmenopausal women who are at high risk for fracture. Prolia is a so-called monoclonal antibody -- a fully human, lab-produced antibody that inactivates the body's bone-breakdown mechanism. It's the first "biologic therapy" to be approved for osteoporosis treatment. It is given by injection twice a year. The most common side effects seen in patients taking Prolia are back pain, pain in the extremities, muscle and bone pain, high cholesterol levels, and urinary bladder infections.
The drug also appears to lower calcium levels. Patients with low blood calcium levels should not take Prolia until the condition is corrected.
What if you could not only slow the breakdown of old bone, but actually stimulate the body to build more new bone? That's what Forteo does. Approved by the FDA in December 2002, Forteo is the first in a new class of drugs called parathyroid hormones. They treat osteoporosis by stimulating bone-forming cells called osteoblasts.
It's an exciting drug, says Holick. "It has a dramatic effect on bone, increasing bone mineral density in the spine by as much as 13% in 18 months and reducing the risk of fracture by as much as 90%."