Newer Osteoporosis Treatments Build Stronger Bones
Recent drugs help maintain or increase bone density and also prevent fractures.
Increasing Bone Density continued...
"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."
Reclast is also a bisphosphonate. However, this treatment is given intravenously, so it bypasses the gastrointestinal tract. Treatment is given once a year.
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.