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  • Signs and symptoms of osteoporosis
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    One of the most often prescribed medical treatments for osteoporosis are the oral bisphosphonates. These drugs are manufactured to have the same structure of pyrophosphate.

    Bisphosphonate Work by Acting in the Bone Remodeling System

    Pyrophosphate occurs naturally in the body and is an inhibitor of bone resorption in the bone remodeling system. The bisphosphonate drug compounds include alendronate sodium, risedronate sodium, ibandronate sodium, etidronate and clodronate.

    As bisphosphonates are antiresorptive agents they act by decreasing the number of osteoclasts — the cells that are responsible for bone resorption — but do not affect the function of the osteoblasts — cells that create new bone. This leads to an increase in the rate of bone creation, and in turn an increase in the overall mineral density of bone.

    Bisphosphonates are delivered to the surface of the bone by use of a pro-drug. Once at the bone surface bisphosphonates are able to bind to the hydroxyapatite crystals of the bone and decrease the growth and activity of osteoclasts; this leads to the inhibition of bone reabsorption.
    Following inhibition of the resorption process two things can happen to the pyrophosphate analogs.

    1. They are removed by renal mechanisms
    2. They remain in the bone matrix and act upon further bone remodeling processes.

    The latter case is responsible for giving the bisphosphonate drugs such a long life span in the body.

    Fosamax Osteoporosis Treatment - the Bisphosphonate Alendronate Sodium

    There are many bisphosphonates that have been approved by the FDA for use in America, and are also used in Europe. One of these is Fosamax; this is alendronate sodium and is manufactured by Merck. It acts by mimicking the natural occurring pyrophosphates that are involved in the inhibition of bone resorption.

    Fosamax Helps to Prevent and Treat Osteoporosis

    Fosamax is an FDA approved form of alendronate that shown to reduce osteoporosis fractures in hips, the spine and wrists by half, when used over a three-year period in people who have already suffered a spine fracture. In people who have no history of spine fractures the decrease in spine fractures that occurs over a three-year period in comparison to people not taking osteoporosis treatments is 48%.

    Fosamax is usually taken at a dose of 5 mg per day (35mg weekly) if used for the prevention of osteoporosis fractures. When Fosamax is used to treat osteoporosis fractures then it is usually taken at a dose of 10mg per day (70mg weekly), along with a supplement of vitamin D.

    Fosamax is usually taken orally and the tablet form needs to be taken with a glass of water; if taken alendronate sodium as a solution then it should also be washed down with a little water. It is best to take the treatment in the morning, and it should never be taken before retiring to sleep. Additionally it is important that people who take the treatment remain in an upright position and refrain from taking food for 30 minutes or preferably longer following taking Fosamax. Although Fosamax can be taken by people who have a mild renal insufficiency, it should not be taken by people who have severe renal insufficiency.

    Research Carried out on Fosamax - Alendronate Sodium

    Research carried out on postmenstrual women that looked at the effect of alendronate sodium on the incidence of bone fractures has shown positive results. The women were given a supplement of calcium and vitamin D, and either alendronate sodium or a placebo. It was found that there was an increase in bone mineral density and a reduction in rates of total fractures by about 14% in comparison to the control group.

    The use of alendronate sodium led to a reduction of neck fractures by around 36% in women with osteoporosis, and a reduction of 44% seen when accessing vertebral fractures. If patients did not have osteoporosis, and hence had a fairly healthy bone mineral density, then no significant reduction was seen when taken Fosamax in comparison with the placebo.

    Alendronate sodium use can help to increase bone mineral density in osteoporosis sufferers (people with a Bone Density Test t-score of -2.5 or less) and lead to a reduction in the risk of fractures in osteopenia and osteoporosis sufferers with a BMD T-score of -2 or less.

    However there are many known side effects when taking bisphosphonates such as Fosamax, these are discussed in other sections of the osteoporosis advice site.

    Actonel Osteoporosis Treatment - the Bisphosphonate Risedronate Sodium

    Bisphosphonates work by mimicking the action of pyrophosphates, which are active in the inhibition of bone resorption in the bone modeling system. They belong to the class of antiresorptive agents, and some of the common bisphosphonate osteoporosis drugs include Fosamax, Actonel and Boniva. We now take a look at the bisphosphonate risedronate sodium; this drug is manufactured by Proctor & Gamble under the name of Actonel.

    The Use of Actonel to Prevent and Treat Osteoporotic Fractures

    Research carried out over a three-year period revealed that by taking risedronate spine fractures could be reduced by 49%, and non-spine fractures reduced by 36% in people who had already suffered spinal fractures.

    The recommended dose, for both the prevention and treatment of fractures, is 5mg per day (35mg per week). The drug is absorbed rapidly by the system in about an hour in the gastric intestine. One of the advantages of Actonel over Fosamax is that people can take it that have renal insufficiency.

    Research Carried Out on Actonel - Risedronate Sodium

    Research has also been carried out into the efficiency of Actonel (risedronate) in the USA. Patients were given either a daily dose of 5mg of risedronate; or a placebo. It was found that the incidence of vertebral fractures that could be identified by radiographic methods was reduced by 44% in the people who took the risedronate sodium. The rates of non-vertebaral fractures was reduced by 39%.

    The use of Risedronate sodium in this research resulted in a significant increase in bone mineral density, especially in the lumbar spine (5.4%), femoral trochanter (3.3%) and femoral neck (1.6%).

    As with all bisphosphonates there are many known side effects when taking Actonel.

    Boniva Osteoporosis Treatment - the Bisphosphonate Ibandronate

    There are many ways in which osteoporosis can be treated; natural methods include increasing calcium and vitamin D intake and performing weight bearing exercises such as walking and dancing. However for people who have risk factors such as previous fractures, smoke, or have other known osteoporosis risks it may be necessary to additionally take drugs aimed at combating osteoporosis.

    One of the biggest group of medicines taken to prevent osteoporotic fractures are bisphosphonates. These act by mimicking pyrophosphate, a natural compound found in the body, that is involved in the bone remodeling system. One of the newest bisphosphonates licensed is ibandronate, this is released under the trade name of Boniva and manufactured by Roche.

    The Use of Boniva to Prevent and Treat Osteoporosis

    Boniva is taken orally. It is usually took either as a once monthly tablet of 150mg or as a daily 2.5mg dose. It is thought that ibandronate bisphosphonate is able to reduce the risk of fractures by as much as 50%.

    Boniva (ibandronate) is absorbed into the gastrointestinal tract, and it has been found that taking Boniva at the same time as food (specifically breakfast) can reduce the absorption of the drug by as much as 90%.
    Once absorbed by the body, Boniva (like Fosamax and Actonel) is not systematically metabolized by the body, and as much as 60% is not taken up by the bones, but is extracted by the renal system. The use of Boniva is not recommended for people who have intense renal insufficiency.

    Aredia and Zometa Osteoporosis Treatment — The Intravenous Delivery of Bisphosphonates

    If you have been diagnosed with osteoporosis it may be necessary for you to take osteoporosis pharmaceuticals such as bisphosphonates to combat the condition, these are usually taken orally under the common names of Fosamax, Boniva and Actonel. However, many people have problems taking these osteoporosis bisphosphonate drugs orally, and this may lead to problems with the esophagus. It may therefore be necessary to take intravenous osteoporosis treatment. There are two main intravenous treatments that used to combat the condition: these go under the names of Zometa and Aredia.

    Zoledronic Acid - Zometa

    Zoledronic acid is manufactured by Novartis and released under the name of Zometa. It is taken as a single dose of 4mg. Zometa has been demonstrated to increase the bone mineral density of, and to suppress bone resorption in, postmenopausal women. It was originally created for use in people with multiple myeloma and malignant hypercalcemia, and has recently been assessed by the FDA for the treatment of osteoporosis.

    Pamidronate - Aredia

    Pamidronate is manufactured by Novartis as the drug Aredia. It is usually taken at an initial dose of 90 mg, and followed up by supplemental 30 mg doses every three months. Although used to treat osteoporosis, it is used 'off label' and if it is truly able to reduce the risk of osteoporosis fractures is unproven.

    References

    Cummings et al (1998). Effect of alendronate risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. 2077 to 2082.
    Harris et al (1999). Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial: Vertebral Efficacy With Risedronate Therapy (VERT) Study Group: 1344 to1352. Mayes (2007) Review of post menopausal osteoporosis pharmacology. Nutr. Clin. Prac. 22:3: 276 to 285
    Ibandronate (Boniva) - package pamphlet
    Mauck and Clarke (2006). Diagnosis, screening, prevention, and of osteoporosis. Clin Proc. :662 to 672
    Mayes (2007) Review of post menopausal osteoporosis pharmacology. Nutr. Clin. Prac. 22:3: 276 to 285
    National Osteoporosis Foundation (2006). Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2003:38
    Rosen (2005). Clinical practice: post menopausal osteoporosis. Engl J Med. :595 to 603.