Latest Treatment for Osteoporosis
July 9, 2008
Recently, the US Surgeon General issued a report emphasizing the need to recognize osteoporosis as a public health hazard. It is fortuitous that, in recent years, the use of advanced molecular technologies, including transgenesis,
gene knockout, and gene array have greatly expanded our understanding of how our bones and joints are affected by aging, health and disease. Researchers have gained a better understanding of the precise pathways through which new and old bones are repaired and remodeled. Clearer too are the basic biological properties of the skeleton and how it responds to hormonal, cytokine, and mechanical stimulation.
Latest treatment for osteoporosis
Bisphosphanates (Fosamax)
Bisphosphanates (e.g. Fosamax, Actonel) are a type of medication that helps to regulate calcium and prevent bone breakdown. Bone turnover, or replacement of old bone with new bone, is a normal process within our body. In patients with osteoporosis, the replacement with new bone does not maintain pace with the breakdown of old bone. Bisphosphanates slow the rate of bone breakdown to help maintain bone mass by inhibiting the osteoclast, the cell responsible for bone breakdown.
Calcitonin (Miacalcin)
Calcitonin is a naturally occurring hormone produced by the thyroid gland that can be given as an injection or taken as a nasal spray. Sold under the trade name Miacalcin, calcitonin also inhibits the function of the cells that breakdown bone, the osteoclasts. Calcitonin has long been known to be beneficial in patients with osteoporosis, but the injections were difficult to administer, and had unpleasant side effects. The nasal spray has greatly improved the use of calcitonin, and it is much more commonly used today. Calcitonin has been shown to slow bone loss, and also decrease pain associated with osteoporosis fractures.
A newer class of drugs called bisphosphonates is also available. This drug increases bone density. It also decreases the risk of fracture in adults who already have osteoporosis. Many people are familiar with Fosamax, a commonly prescribed bisphosphonate.
Newer bisphosphonates such as ibandronate and zolendrate are taken much less often. Ibandronate is given orally once a month. It can be given intravenously once every three months. A single dose of zolendrate has been shown to work for up to a year. It’s being tested further for its ability to prevent bone fractures.
There is a downside to these drugs. Studies show the benefit from taking these drugs goes away if the person stops taking it. Some patients have reported heartburn, stomach pain, and diarrhea with bisphosphonates. And recently, there’s been an increase in the number of cases of jaw osteonecrosis with long-term use of bisphosphonate.
Strontium ranelate (Protelos) is used for the treatment of osteoporosis in postmenopausal women. It is usually reserved for women who cannot take bisphosphonates.
It has a dual action of increasing bone formation as well as decreasing bone breakdown and has been shown to reduce the risk of spinal and hip fractures.
Strontium seems to be asociated with an increased risk of blood clots in the veins, but not to the same extent as HRT or raloxifene
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