There are quite a few women (and sometimes men) out there with the dreaded condition known as osteoporosis. First of all, what the heck does that even mean? I’m sure that most of you have heard of it, but what is it? Secondly, I’m also sure that some of you have seen the commercials on TV telling you to talk to your doctor about drug X – it’s supposed to reverse osteoporosis! Is this possible – are there drugs that can reverse this process? How do they work? How might I improve the action of the drug? These are a few of the things we will look at in today’s article.
So, what is osteoporosis? Osteoporosis simply means “porous bones.” The condition causes bones to become weak and “brittle” (kind of like glass is brittle, it will shatter if you hit it). This condition can worsen to the point that a fall, or some mild stresses like bending over or coughing/sneezing can cause a fracture. The most common fractures that can happen are in the spine, hips, ribs, and wrists (although, since the entire skeleton is affected, fractures can happen anywhere).
Unfortunately, there are really no symptoms of this condition until fractures occur. It can be present for decades, in fact. Also, a bone might fracture, but might not do so with pain; in other words, it might not be a complete fracture. So, the condition can go on, until the patient experiences a painful fracture.
How can this be prevented? Can I “catch” osteoporosis??? OK, you cannot “catch” osteoporosis – it is an internal condition, and not caused by some type of “bug.” The best prevention starts before age 30 – yes, you heard me right, before you’re 30. After 30, your bone density begins to go downhill, unless you take preventative steps. The national osteoporosis foundation has 5 steps for the prevention of osteoporosis (you need all 5, one or two will not help enough):
- Get your daily recommended amounts of calcium and vitamin D
- Engage in regular weight-bearing exercise
- Avoid smoking and excessive alcohol
- Talk to your healthcare provider about bone health
- When appropriate, have a bone density test and take medication
I will touch on ONE point above – weight-bearing exercise. Does this mean that you need to become a power-lifter? Of course not – but it does mean that you need to do some sort of resistance exercise, like lifting weights. Don’t have weights? Lift food cans!
OK I lied, I’ll touch on two points – the amounts of calcium and vitamin D. Vitamin D you can get from the sun, as well as fortified milk and other foods, so I’ll just touch on the calcium. There are generally two forms of calcium – calcium carbonate and calcium citrate. There are pros and cons to both.
Calcium carbonate is generally much less expensive, and you don’t need to take nearly as many pills to get your daily dose. If you have a condition where you don’t have as much stomach acid, you’ll have trouble absorbing it, and it may also be constipating (you’ll have trouble going number 2).
Calcium citrate is much more expensive, and you’ll have to take more of it to get your dose. But, it doesn’t need any acid, so if you are taking antacid medications, or have had bypass surgery, this is the way to go for you.
Also, don’t take more than 500mg of calcium at one time – you won’t be able to absorb it, and you’ll be throwing your money away. Here is a table of intake based on your age:
- 0 to 6 months – 210 mg
- 7 to 12 months – 270 mg
- 1 to 3 yrs – 500 mg
- 4 to 8 yrs – 800 mg
- 9 to 18 yrs – 1300 mg
- 19 to 50 yrs – 1000 mg
- 51+ yrs – 1200 mg
Don’t take more than 2500 mg/day – too much of a good thing CAN in fact be a bad thing.
Alright, enough about calcium, prevention, and definitions – what about those of you who already may HAVE this condition. Is there anything you can do about it?
First of all, talk to your doctor, and get a bone density test. This will show whether you have the condition in the first place.
Secondly, begin (or continue) to have some form of light exercise, especially weight-bearing exercise. Be careful about this, and talk to your doctor first if you already have osteoporosis, as this can cause stress fractures.
OK, so the last of the 5 steps was medications. By now, I’m sure all of you have heard of these – they promise to “reverse osteoporosis.” So, what are the medications, and do any of them actually follow through on their claims?
Here are the current medications (that I know of) for the treatment of osteoporosis:
- Fosamax (alendronate Sodium)
- Actonel (Risendronate Sodium)
- Parathar (Teriparatide)
- Evista (Raloxifene)
- Zometa (Zoledronic acid)
- Boniva (Ibandronate Sodium)
- Calcimar, Miacalcin (Calcitonin)
- Vitamin D3 (Cholecalciferol)
Whew – what a list! And yes – there may be others out there that would be prescribed for osteoporosis; this is a short list. If you know of any more, and want questions on them answered, please leave a comment below! So, do any of them work? Well take that on right now:
FOSAMAX (alendronate sodium): basically, the group that this particular drug belongs to binds certain cells in bones. They attempt to slow down the rate at which they break down. Basically, the drug does this by stopping the processes in the cells that break down calcium (called osteoclasts), which prevent your body from getting calcium from the bone. This has two effects – your bone density stops degrading, but your blood calcium levels can fluctuate. Other things that depend on calcium – your heart, for example – may be affected, so it is extremely important that you are supplementing with calcium. Side-effects can include GI bleeding (gastrointestinal) and diarrhea, arthralgia (joint pain), and nonspecific chest pain.
ACTONEL (Risendronate Sodium): has the same basic action as FOSAMAX, but is about 1,000 times more powerful. In some studies, Actonel acts much faster than FOSAMAX, but there have not been any clinical trials to prove this.
PARATHAR (Teriparatide): This is an interesting drug. It is actually a synthetic hormone (parathyroid hormone). Given continuously, it can actually result in bone loss, as it causes more calcium to go into the bloodstream. But, it is given once a day; this intermittent dose actually results in net bone formation, which is good for patients with osteoporosis. Side effects include hypercalcemia (too much calcium in the blood) and hypercalciurea (too much calcium in the urine, is the most common cause of calcium kidney stones). Sometimes, side effects can include dizziness, depression, pain, headache, and leg cramps.
EVISTA (Raloxifene): This is interesting, as it affects two different things. It is an estrogen receptor modulator (it affects estrogen receptors), and works like estrogen does on the bone. It acts as an “anti-estrogen” in other parts, especially breast tissue and the uterus. This results in the prevention and treatment of osteoporosis by slowing bone thinning. It can cause “some” increase in bone thickness, but this to my understanding is minimal. It also greatly lowers (by 66-76%) the risk of breast cancer. Side effects include hot flashes, vaginal dryness, leg cramps, blood clots in deep veins, uterine cancer (very rare), muscle and joint pains, weight gain, and a rash.
ZOMETA (Zoledronic acid): I won’t spend much time on this one, it has about the same method of action as FOSAMAX and ACTONEL, and has the same strength as ACTONEL. This is an IV drug, so you’ll have to visit your doctor’s office when you need a dose. As far as I can tell, this is mostly used in cases of cancer.
BONIVA (Ibandronate sodium): And here we have BONIVA, and so many people have heard of this miracle drug, I’m surprised I’m having to explain it at all… But, here it is anyway. BONIVA is in the same class of drugs that FOSAMAX is – meaning that ACTONEL and ZOMETA are more powerful. So, it has the same side effects, and the same effects as those other drugs. BONIVA is a monthly drug (or a every 3-month injection); FOSAMAX and ACTONEL are once-weekly by mouth. BONIVA was the slowest to show a reduction in fractures, with patients needing to take it for at least 2 years to show real benefit. It is important to note that BONIVA is only approved for fracture reduction in the spine; ACTONEL has approval for spine and non-spine, and FOSAMAX has approval to treat for fracture reduction at the spine and hip. So, even though all of them act though the same mechanism, they are approved for different things.
CALCIMAR, MIACALCIN (Calcitonin): is a naturally occurring hormone that regulates calcium levels in the blood. Basically, it makes the cells that make bone take calcium from the blood and deposit it into the bone. These drugs have been shown to slow the rate of bone thinning, however, have not been shown to be as effective as ACTONEL, FOSAMAX, or BONIVA. This might be used, however, if patients have bad reactions to those other drugs. It also can be used to reduce pain (takes up to 2 weeks) from a vertebral fracture and collapse.
VITAMIN D3 (Cholecalciferol): Mainly used with calcium, vitamin D raises the amount of calcium that can be absorbed by the body. It can be used to treat other bone diseases, but we’re focusing on osteoporosis here.
So, there are a bunch of drugs on the market, and some of them even seem to build bone back up. It is important to note, however, that no long-term studies on any of these has been done (FOSAMAX is the oldest), so they can’t say for sure what the long-term effects of these drugs really is. The best thing to do is prevention – get your calcium and vitamin D, and do weight-bearing exercise. But, if it’s already too late, and you think you might have osteoporosis, talk to your doctor. You will have to take most of the drugs for a very long time to build bone back up, but many of them do seem to work, as far as clinical trials have shown.
Finally, how might you improve the actions of these drugs? Almost universally, they help absorb calcium from the blood into the bone. So, if you don’t have enough calcium, they can’t do their jobs effectively. If you are taking one of these medications, you will need to take a calcium supplement, as well as Vitamin D in order to get the most out of it.
Please comment with any questions, or if you find any information contained in this article that you think might be incorrect. Thanks!