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Newer Osteoporosis Treatments Build Stronger Bones

Recent drugs help maintain or increase bone density and also prevent fractures.

Rebuilding Bone continued...

So why isn't every woman with osteoporosis taking it? Cost, mostly. Forteo costs about $600 a month, and it also must be injected every day. For those reasons, it's generally only prescribed for patients with severe osteoporosis, or who have already had one or more fractures.

But that may not always be the case. Holick notes that research on less expensive, easier-to-deliver versions of this drug is already in the works. "There are a huge number of potential new treatments on the horizon, actually, a number of which are already in phase III trials," he says. "Now that we better understand the mechanism by which our bone cells work, we have a better idea of the strategies that can be used to stimulate bone cells to make new bone, or inhibit the removal of calcium."

Know Your Osteoporosis Test Markers

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."

When you're being treated for osteoporosis, your doctor orders a blood or urine test. This reveals several markers -- levels of different enzymes, proteins, and other substances circulating in the body -- that provide clues about your disease and the progress of your treatment. Some of the bone markers that your doctor may order include alkaline phosphates, bone specific alkaline phosphatase (BALP), and serum or urine NTX. These are used to help determine bone turnover.

Some of these measures include:

  • Bone-specific alkaline phosphatase (Bone ALP or BALP). This is an estimate of the rate of bone formation over your entire skeleton. Bone formation may sound like a good thing, but depending on the circumstances, too much can be bad. People with osteoporosis generally have BALP levels that are up to three times normal.
  • Osteocalcin. This is another marker of bone formation.
  • Urinary N-telopeptide of type I collagen, or uNTX. This is a marker of bone resorption, or loss of bone.
  • Vitamin D levels.Your doctor may also measure your vitamin D level because an adequate vitamin D level is essential to good bone health. Because of our diets and the lack of adequate sunshine, many people are lacking in vitamin D.

The problem, says Recker, is that none of these markers is particularly reliable. "The markers of bone resorption and bone formation are generally up in menopausal osteoporosis, but they don't behave with as much precision and truthfulness as we would like," he says. "We still don't understand the physiology associated with them very well."

That doesn't mean doctors don't still use them. It simply means that these markers alone can't indicate whether you have osteoporosis, or whether a treatment is working.

Still, Recker says, if you've been undergoing treatment for osteoporosis for a year and your BALP levels haven't fallen at all, it may indicate that you're not taking your medication as consistently as you should, or following the strict guidelines for how a bisphosphonate drug should be taken.

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Reviewed on July 16, 2010
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