If you have broken a bone as a result of osteoporosis then you are more likely to break another. The aim of all drug treatments is to lower your risk of future fractures and there are a range of effective medications that do just that. Some are available only from specialists.
These are the most commonly prescribed drugs used to treat osteoporosis.
The main drugs in this range are alendronic acid or alendronate (Fosamax), ibandronate (Bonviva), risedronate (Actonel) and zoledronic acid (Aclasta). These drugs have been shown to reduce the risk of broken bones in the spine, and in some cases, the hip.
They are licensed to treat post-menopausal women and some are licensed for men and people taking corticosteroids for conditions such as asthma/arthritis. Most are available in tablet form – either daily, weekly or monthly - they are non-hormonal and act by slowing down the rate of bone loss. Side effects can include irritation of the gullet and these drugs may not be suitable for people with stomach/bowel trouble or kidney problems.
Ibandronate and zoledronic acid are administered in hospital via a drip or injection into a vein in the arm. These are often prescribed by specialists rather than GPs. Pamidronate (also administered via a drip) is only prescribed by specialists as it is not licensed to treat osteoporosis.
Other drug treatments for osteoporosis
Raloxifene (Evista) is a selective estrogen receptor modulator (SERM). This type of drug, which is taken as a daily tablet, mimics the action of the female hormone oestrogen, giving protection to bones while simultaneously blocking the oestrogen’s effect on other organs, such as the womb and breast. It is only prescribed to women to reduce the risk of spinal fractures and may be used if bisphosphonates are not suitable. Raloxifene (Evista) is currently the only SERM licensed to treat osteoporosis.
Strontium ranelate (Protelos)
Strontium ranelate (Protelos) appears to have an impact on both the cells that build bone and those that break it down. It is unclear how this works to reduce the risk of broken bones. Strontium ranelate (Protelos) is a sachet of powder which is mixed in water and is taken once a day at bedtime.
Parathyroid hormone (PTH) treatment (Preotact, Forsteo)
Parathyroid hormone injections can only be prescribed to those people most severely affected by spinal fractures who meet certain criteria. It works by building new bone and is given as self-administered injections daily for between 18 and 24 months. It is not prescribed by GPs and is only available from specialists.
Denosumab belongs to a group of drugs called ’monoclonal human antibodies’.
It blocks a substance involved in bone development called Rank Ligand that stimulates the activity of osteoclasts – the cells that break down bone.
As a result bones become stronger and break less easily. This drug is given as an injection under the skin every six months usually in a hospital clinic although it may be available in some GP surgeries.
Calcium and vitamin D
There are a number of calcium and vitamin D supplements which are most often prescribed by doctors to older people to help prevent broken bones.
Less commonly used treatments
Calcitonin is a hormone that occurs naturally in the body which, by acting on the skeleton, regulates the amount of calcium in the blood. In the past calcitonin was used as a treatment for osteoporosis. However, it has now been withdrawn from use.
Calcitriol (Rocaltrol) is effective in reducing fractures in women and is taken as a daily dose of tablets. There is no data on its effectiveness in preventing broken bones in men with osteoporosis but it may be prescribed at specialist centres. It can be prescribed by GPs but people on this drug need careful monitoring. Some GPs may refer you to a specialist.
Hormone Therapy or Hormone Replacement Therapy (HRT)
Hormone therapy or hormone replacement therapy replaces oestrogen (and sometimes progesterone) in women and testosterone in men. HRT in women is no longer a first line treatment for osteoporosis but is useful to tackle menopausal symptoms with added bone protection back-up.
Testosterone can sometimes be prescribed for men if their osteoporosis is found to be because of low levels of this hormone (known as hypogonadism).
Why are most drug treatments only licensed to treat post-menopausal women?
Broken bones as a result of osteoporosis mainly affect post-menopausal women. One in two women over the age of 50 is expected to be affected in the UK. Research and drug development has focussed on post-menopausal women as they are the largest group at risk of osteoporosis.
Osteoporosis is less common among men, pre-menopausal women and children so these groups are more likely to be looked after by specialists, such as rheumatologists, endocrinologists, gynaecologists, who have experience of prescribing drugs outside the normal licence.
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