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Osteoporosis treatment puts brakes on bone loss
Osteoporosis treatment may involve medication along with lifestyle change. A Mayo Clinic specialist answers some of the most common questions about osteoporosis treatment.
By Mayo Clinic staff
If you're undergoing osteoporosis treatment, you're taking a step in the right direction for your bone health. But you might have many questions about your therapy. Is the medication you're taking the best one for you? How long will you have to take it? Why does your doctor recommend that you take a weekly pill when your friend takes a pill only once a month?
Kurt Kennel, M.D., a specialist in endocrinology at Mayo Clinic in Rochester, Minn., answers common questions about osteoporosis treatment in women and describes how osteoporosis medications work.
Which medications are commonly used for osteoporosis treatment?
Bisphosphonates are — by far — the most common medications prescribed for osteoporosis treatment. These include:
- Alendronate (Fosamax)
- Risedronate (Actonel)
- Ibandronate (Boniva)
- Zoledronic acid (Reclast)
Hormones, such as estrogen, and some hormone-like medications approved for preventing and treating osteoporosis, such as raloxifene (Evista), also play a role in osteoporosis treatment. But fewer women take these medications for osteoporosis treatment because the bisphosphonates are so effective, especially if you don't have another reason to choose hormonal therapy, such as breast cancer prevention.
Fosamax, along with its generic equivalent alendronate, is a commonly prescribed bisphosphonate that's been on the market for more than 10 years. There's proven experience with its safety. Bisphosphonates really don't affect anything but the bone. Hormones, on the other hand, raise some concerns about what effects they'll have on other parts of the body, such as breast tissue or the circulatory system. With bisphosphonates, doctors have fewer concerns about side effects or medication interactions. These medications tend to be well tolerated, for the most part, by the women who take them.
How do bisphosphonates work?
Bisphosphonates slow the bone breakdown process. Healthy bones are in a state of continuous breakdown and rebuilding. As you get older, and especially after menopause when your estrogen levels decrease, the bone breakdown process accelerates. When bone rebuilding fails to keep pace, bones deteriorate and become weaker. Bisphosphonates basically put a brake on that. These drugs effectively preserve or maintain bone density during menopause — and decrease the risk of breaking a bone as a result of osteoporosis.
How do you know if you're taking the right medication?
Drugs in the bisphosphonate class are more alike than they are different. Some studies show differences in potency or effectiveness at maintaining bone density, but they're all still effective drugs. All bisphosphonates have been shown to reduce the chance of a fracture.
The decision to take one drug over another often is based on:
- Preference
- Convenience
- Adherence to the dosing schedule
Your doctor might recommend a monthly dose of medication if it's going to be better tolerated or better accepted. But if you're the type of person who might forget to take your medicine every month, you might do better taking it once a week.
Is there an advantage to an injected bisphosphonate versus a daily or monthly oral regimen?
There may be. Two infusion medications — those that are injected directly into your vein — have been approved for osteoporosis treatment:
- Ibandronate (Boniva injection), infused once every three months
- Zoledronic acid (Reclast), infused once a year
Adherence to osteoporosis medication dosing schedules is an important consideration. Researchers report that most women taking an oral bisphosphonate stop treatment or take less than the fully prescribed amount of medication after one year of therapy. This reduces the effectiveness of the medication. An injection given quarterly or yearly, on the other hand, ensures that women are fully protected until their next treatment.
Switching to an injected medication provides an alternative if you already take several pills a day to manage other health conditions or if you experience unbearable stomach upset from oral bisphosphonates.
How long should you take a bisphosphonate for osteoporosis treatment?
Up to five years of treatment with bisphosphonates is safe and effective. The scientific literature is full of good studies of all the bisphosphonate medications that prove their safety and show their effectiveness at preventing fractures of the hip and spine for up to three to five years.
Beyond five years of treatment, there's less certainty. There just haven't been many long-term studies done. One thing that is known, though, is that even if you stop taking the medication, its positive effects can still persist. That's because after taking a bisphosphonate for a period of time, you build up the medicine in your bone.
Because of this lingering effect, some experts believe it's reasonable for women who are doing well on treatment — those who have not broken any bones and are maintaining bone density — to consider taking a holiday from their bisphosphonate after taking it for five years. But if you're at high risk of fractures or you have very low bone density, taking a break from your osteoporosis medication may not be a good idea.
How long can a holiday from osteoporosis medication be?
If you're at low risk of fractures, you could take one year or even up to five years off. Expert recommendations vary, however, so talk with your doctor to tailor the best strategy for your situation.
If you take a holiday from your osteoporosis medication, will you need to restart treatment at some point?
If you experience a major decline in your bone density or you have a fracture, you likely need to go back on therapy.
Some women approach taking a holiday from their medications by establishing a predetermined restart date with their doctors. So, for instance, you could take a break of one or two years, all the while knowing you'll restart your medicine when that period is over.
Next page(1 of 2)
- Kennel KA (expert opinion). Mayo Clinic, Rochester, Minn. July 14, 2009.
- Rosen HL, et al. Overview of the management of osteoporosis in postmenopausal women. http://www.uptodate.com/home/index.html. Accessed May 26, 2009.
- Rosen HL. Bisphosphonates in the management of osteoporosis in postmenopausal women. http://www.uptodate.com/home/index.html. Accessed May 26, 2009.
- Bilezikian JP. Efficacy of bisphosphonates in reducing fracture risk in postmenopausal osteoporosis. The American Journal of Medicine. 2009;122(suppl):S14.
- Rabenda V, et al. Adherence to bisphosphonates therapy and hip fracture risk in osteoporotic women. Osteoporosis International. 2008;19:811.
