There are a number of approved drugs in the United States. The commonest ones are called bisphosphonates and the brand names of these drugs are Fosomax, Actonel and Boniva.They are all slightly different in slightly different ways. They are similar, but they are all slightly different in terms of when you should use one verses the other.But they are all taken by mouth. Boniva can be take 4 times a year by injection.We have a fourth drug, called Reclast, which differs from the others in that it's given by vein once a year. Different drugs for different folks within this class.Bisphosphonates given by mouth primarily cause, in a small percentage of people, some indigestion type symptoms.The newer ways we give these drugs, once weekly, once monthly, seem to be associated with far less upper GI trouble.And so far, these drugs, the oldest of which is Fosomax, which was approved in 1995, seem to be remarkably well tolerated and very safe at bone in the overwhelming majority of people who take them.There's also a drug called Evista. Evista is a selected estrogen receptor modulator, big word, or SERM.SERMs work uh again to deal with some of the things that happen when you lose estrogen, but it's a different class of drugs.And one of the interesting things about Evista is that there are some studies that have shown that it also reduces the risk of breast cancer,and perhaps someday it will be used for that purpose as well.Evista can cause hot flashes and in susceptible patients can cause an increased risk, a small increased risk, of blood clots in the veins,which is something that estrogen also does. So you wouldn't use Evista if you have a history of such clots, but for most people, it appears to be very well tolerated.There's a nasal spray called calcitonin, an intranasal calcitonin which is called Miacalcin nasal spray. And that is another agent which is sometimes used.Miacalcin nasal spray, which I have to say, many of us believe is not quite as good a drug, we think it may be second tier, can cause nasal irritation, headaches and so on.Nothing horrible, but you know can be very annoying occasionally, you know, nose bleeds.For people who are at very high risk for fractures, for various reasons, there's a different kind of drug called Forteo. This other drug actually stimulates the formation of new bone.It's a daily injection. It's a little more, well, it's a lot more expensive right now, so it's not used in everybody by any means,but it's used in people at very high risk because it actually builds bone.