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    Osteoporosis Medications and Drugs

    Depending on the condition of the person diagnosed with osteoporosis and the risk factors of the individual, a doctor may either choose to treat the sufferer by natural (nutrients, exercise) methods alone or by use of osteoporosis medications. If you need medicines then there are two main forms of drugs that are available:

    1. Antiresorptive: these inhibit bone resorption
    2. Anabolic agents: these stimulate bone growth and the formation of bone tissue.

    In the United States there are currently seven antiresorptive agents that have been approved by the FDA (2007), and one Anabolic agent.

    1. Antiresorptive
    a. Bisphosphonates: Alendronate; Risedronate; Ibandronate
    b. Selected Estrogen Receptor Modulator (SERM) Raloxifene
    c. Estrogen
    d. Calcitonin
    2. Anabolic
    a. Teriparatide

    Common Names of Osteoporosis Drugs

    In the United States of America the most widely prescribed medications for the treatment of osteoporosis are the antiresorptive bisphosphonates. Some of the common names of these products and of the other antiresorptive agents are as follows.

    1. Fosamax: Alendronate - manufactured by Merck
    2. Actonel: Risedronate - manufactured by Proctor & Gamble
    3. Boniva: Ibandronate - manufactured by Roche
    4. Evista: Selected Estrogen Receptor Modulator Raloxifene (SERM) - manufactured by Eli Lily
    5. Prempo: Estrogen
    6. Miacalcin: Calcitonin - manufactured by Novartis
    7. Forteo: The anabolic agent recombinant parathyroid hormone teriparatide is manufactured by Eli Lily. It acts differently from the other osteoporosis drugs listed above as it stimulates bone remodeling mechanisms into building more bone.
    8. Prolia: The human monoclonal antibody Denosumab. This acts by inhibiting RANK ligand receptors present in osteoclast precursor cells.

    Non Osteoporosis Specific Drugs in Common Use

    Other drugs that are not approved specifically for osteoporosis, but are often used in the treatment of the osteoporosis condition due to their effects on bone mineral density include:

    1. Aredia: - Intravenous pamidronate - manufactured by Novartis, this is often used in the treatment of osteoporosis for people who cannot tolerate oral bisphosphonates.
    2. Zometa/Aclasta/Reclast: Zoledronic acid - manufactured by Novartis; this is approved by the FDA for treatment of malignamt hypercalcemia and of multiple myeloma; A single 4mg dose of Zometa has been shown to increase bone mineral density for up to a year. Reclast was approved for use in postmenopausal women for the treatment of osteoporosis in 2007.
    3. Protelus: Strontium Ranelate. Not approved in the USA, but in common use in Europe, Australasia and Asia. Closely related to calcium. Can stimulate osteoblasts in the bone remodeling cycle.

    It can be seen from the above that there are many types of medicinal treatments for osteoporosis available; discussion with your doctor should help you to find the best osteoporosis medication for you. Further information on all of these drugs is given in other parts of the osteoporosis advice site.

    Although in general taking osteoporosis drugs is safe for most people, there are certain groups of people who should avoid them due to possible side effects.

    Some of the risk groups vary from drug to drug and information on the possible side effects associated with the medication is available in the pamphlet that comes with the treatment. If you begin to suffer from any of the side effects, you should discuss them with your doctor immediately and it may be necessary for you to discontinue the use of osteoporosis medications, or switch to alternative ones. Remember that your own personal circumstances will have a major impact upon the correct osteoporosis treatment for you.

    Known bisphosphonates side effects

    The way that you take bisphosphonate osteoporosis treatments is very important. This is because one of the side effects of bisphosphonates is damage to the esophagus; including esophagitis, esophageal erosions and esophageal ulcers.

    It is therefore recommended to take time over taking your medication. Usually it is best to take them with water in the morning before any food has been consumed, and to remain in an upright position for 30 to 60 minutes (dependent upon the bisphosphonate that is being taken). Be sure to read the pamphlet that comes with your medication in full for the correct way to take your medicine. Some people may not be able to tolerate oral bisphosphonates and may require injections or alternative therapy.

    Other common side effects, in addition to possible damage to the esophagus, when taking bisphosphonates as an osteoporosis medication include inflammation of the eyes, musculoskeletal pains, and jaw necrosis.

    If you get any of these side effects then you should consider stopping the osteoporosis medication. In addition to these side effects, you should not take osteoporosis bisphosphonate treatments if you suffer from hypocalcemia or renal insufficiency.

    The Link Between Jaw Osteonecrosis and the Use of Bisphosphonates

    One of the things that puts many people off the use of bisphosphonates such as Fosamax, Actonel and Boniva, is its association with jaw osteonecrosis.

    If you have had recent major dental surgery and/or are suffering from metastatic carcinoma or multiple myeloma then you should have a long discussion with your doctor as to whether you should take oral bisphosphonates to treat osteoporosis. It is worth considering the use of other medications and/or natural treatments due to the risk of osteonecrosis of the jaw.

    If you and your doctor feel that it is necessary for you to take bisphosphonates to treat osteoporosis then it is very important that you get a full dental examination before taking oral. Once you are taking your prescribed course, you should not receive any dental surgery unless it is an emergency.

    Why Does Jaw Osteonecrosis Occur?

    It is thought that osteonecrosis of the jaw is a result of over suppression of osteoclast activity when taking bisphosphonates. These osteoclasts are involved in the bone remodeling cycle.

    Risk of Developing Osteonecrosis of the Jaw

    The actual risk of developing jaw osteonecrosis is low at about 0.7 cases per 100,000 person years of exposure. The risks of developing osteonecrosis are much higher in people who have received recent dental treatment, and in those with cancers; especially those taking medications such as corticosteroids or chemotherapy for treatment of the condition.

    References

    Dental management of patients receiving oral bisphosphonate : expert panel recommendations. Am Dent Assoc. :1144–1150. (2006)
    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
    Woo et al (2006) Narrative [corrected] review:and osteonecrosis of the jaws. Intern Med. : 753 to 761.