Osteoporosis Treatment
While there is no cure for osteoporosis, a disease in which bones become brittle and weak, various medicines and lifestyle approaches can help slow the rate of bone loss and reduce your risk of bone fractures.
It’s important to talk with your doctor about the best osteoporosis treatment options for you. All drugs have side effects, and some osteoporosis drugs have rare side effects that could actually harm your bones.
Your doctor can develop your osteoporosis treatment plan based partly on your fracture risk. Besides looking at your bone mineral density and personal variables, one way of quantifying fracture risk is by using FRAX, a fracture risk assessment tool developed at the University of Sheffield in the United Kingdom. (1)
FRAX calculates the 10-year probability of experiencing a bone fracture based on a person’s risk factors, such as age and family history, as well as the person’s bone mineral density at the femoral neck — the section of bone that connects the femur (thigh bone) to the “ball” of the hip joint (known as the femoral head).
Bone mineral density is measured with a dual energy X-ray absorptiometry (DXA or DEXA) test, a low-radiation X-ray.
If your fracture risk is determined to be low and you are diagnosed with osteopenia, you may be advised to make lifestyle changes — such as adopting a healthy diet, performing more weight-bearing exercise, stopping smoking if you smoke, and cutting back on alcohol if you drink — and to take precautions to reduce your risk of a fall, but not to take medication.
If you are at increased risk for a break in the near future, your doctor may prescribe a medication to try to restore the balance of bone resorption and formation in your body.
A variety of types of drugs are prescribed for osteoporosis, including:
The hope is that these therapies will lower the risk for fractures, which is the ultimate goal of treatment.
The most commonly used osteoporosis drugs are bisphosphonates, which slow bone loss by slowing the bone breakdown part of the bone remodeling cycle. (2,3)
Bisphosphonates include:
All of these drugs are approved for postmenopausal women, and all but Boniva are also approved for men.
Common side effects of bisphosphonates include gastrointestinal issues, such as nausea, heartburn, and stomach pain.
The drugs may also cause muscle, bone, and joint pain, and bisphosphonates given intravenously (by IV) may cause flu-like symptoms. If these symptoms arise, it is usually during infusion, but they generally resolve one to two days afterward.
In very rare cases, atypical fractures of long bones, such as the thighbone, have been reported by patients who have taken bisphosphonate therapy for more than five years. However, the risk is extremely low.
Additionally, bisphosphonates have — in rare cases — been associated with jawbone deterioration (osteonecrosis). Your doctor may advise you to complete any significant dental work prior to starting bisphosphonate therapy.
Other medication for osteoporosis includes:
Calcitonin, raloxifene, bazodocifene, abaloparatide, and romosozumab are approved only for post-menopausal women, while teriparatide and denosumab are also approved for men at high risk of fracture.
In some cases, these drugs are used only in certain populations (peri- or post-menopausal women and women at high risk of breast cancer, for example) or only in people for whom other osteoporosis treatments haven’t worked.
Evenity has a black box warning because of data linking the drug to an increased risk of cardiovascular adverse events. (4,5)
At one time, hormone therapy was the only approved treatment for osteoporosis in women. It fell out of favor after the hormone therapy arms of the Women’s Health Initiative (WHI) study were stopped early in 2002 and 2004 because of safety concerns.
Early analyses appeared to link combined estrogen and progestin with an increased risk of breast cancer and cardiovascular disease and more harm than benefit overall in postmenopausal women. Estrogen alone appeared related to an increased risk of stroke and no benefit for coronary artery disease. (6)
But later analyses have not found the same risks associated with hormone therapy.
For example, a follow-up study published in 2017 found that neither estrogen plus progestin taken for a median of 5.6 years, nor estrogen alone taken for a median of 7.2 years, was associated with increased risk of all-cause, cardiovascular, or cancer mortality during a cumulative follow-up of 18 years. (7)
If you have persistent menopausal symptoms or cannot take other medication for osteoporosis, your doctor may recommend hormone therapy for osteoporosis. (8)
All medications have risks and benefits that patients should discuss with their doctor. When the benefits clearly outweigh the risks, then patients, in conjunction with their doctors, should consider medical treatment.
A 2016 study found that infusions of stem cells shed by babies into their mother’s amniotic fluid may help treat rare bone conditions, as well as osteoporosis. (9)
Scientists investigated whether stem cells collected from human amniotic fluid and given to mice through infusions could help strengthen weak bones in mice. They discovered that they could, and that the stem cells released growth factors that made the mice’s bone cells multiply and mature more effectively.
The treatment led to 78 percent fewer fractures in animals that were bred to have a brittle bone disorder, according to researchers, who hope to begin a clinical trial in humans soon.
Additionally, in a 2016 study, researchers in Toronto infused stem cells from healthy mice into other mice that had osteoporosis. Researchers reported that the mice with osteoporosis grew stronger skeletons, and that their bones regained the healthy coral-like appearance that osteoporosis destroys. (10)
However, it should be noted that while animal studies can be promising, that does not always translate to efficacy in humans. Further studies are needed to show safety and efficacy in humans.
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