Many Drug Choices for Patients with Osteoporosis
By Michael Lasalandra
Beth Israel Deaconess Medical Center Correspondent
Patients with osteoporosis or who have had a bone fracture now have a variety of medications available to them to help strengthen their bones and prevent future breaks.
"We are fortunate to have a number of choices that individuals at high risk for fractures can discuss with their doctors," said Mary L. Bouxsein, PhD, assistant professor in the Department of Orthopedic Surgery at the Harvard Medical School Center for Advanced Orthopedic Studies at Beth Israel Deaconess Medical Center.
A class of such drugs, called biphosphonates, has been around for years. These include such well-known drugs as Fosamax, Boniva and Actonel. They are prescribed to prevent and treat bone loss (osteoporosis), which causes bones to become thinner and break more easily. They inhibit the breakdown of bone.
- Fosamax was the first such drug, approved in 1996. It is a pill taken orally once a week.
- A newer drug, Actonel, is also taken in pill form once a week.
- Boniva is taken once a month, also in pill form.
- More recently, the FDA approved a newer formation of Actonel, called Atelvia, which is taken in pill form once a month, like Boniva.
- Another drug, Reclast, is also a biphosphonate, but is given by intravenous injection once a year. It requires sitting in the doctor's office for two hours.
Teriparatide is a recombinant form of parathyroid hormone. It is given daily by subcutaneous injection -- at home. It works differently than the other medications, as it promotes bone formation rather than just inhibiting bone breakdown.
Most recently, the FDA approved Prolia, a so-called monoclonal antibody -- a human, lab-produced antibody that inactivates the body's bone-breakdown mechanism. It is the first "biologic therapy" to be approved for osteoporosis treatment. It is given by subcutaneous injection, in the doctor's office, twice a year.
Discuss Options with Your Physician
Bouxsein said that large scale studies show all of these drugs are more effective at reducing fractures than simply taking calcium and vitamin D.
She said patients may choose one drug over another because of convenience, price or side effects.
"It is up to the individual to have a discussion with their physician about what is appropriate and going to work for their lifestyle," she said.
Some patients prefer the injectable drugs because they have a hard time remembering to take their pills, she noted.
The drugs are designed for patients who have osteoporosis diagnosed by a low bone mineral density test or who have suffered a previous fracture.
"They've already got weak bones," she said.
This may be as a result of age, estrogen deficiency due to menopause, poor nutrition in childhood, bad genetics or because they are taking medications, such as steroids, that are bad for the bones.
All of the drugs have been shown to increase bone density and reduce fracture risk. "And it's not too late to start therapies to prevent fractures even if the patient has already suffered a fracture," she said.
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Posted March 2011