Osteoporosis Treatment Options: Their Functions, Adverse Reactions
Osteoporosis, a bone disease that increases the risk of bones breaking due to a loss in bone mineral density or mass, can be managed with various medications. The National Osteoporosis Foundation lists several drugs as treatments, including antiresorptive agents, hormone therapies, and anabolic agents.
Antiresorptive Agents
Antiresorptive agents, such as bisphosphonates like Fosamax/alendronate, help slow down bone loss and reduce the risk of fractures. Common mild side effects include gastrointestinal issues such as abdominal pain, esophageal irritation, and acid reflux. Serious but rare risks with long-term use include low blood calcium levels, osteonecrosis (bone death) of the jaw, and atypical thigh bone fractures.
Bisphosphonates, including alendronate, ibandronate, risedronate, and zoledronic acid, are used to treat osteoporosis, each with different administration methods. Because of the risk of jaw osteonecrosis, dental evaluation before treatment is recommended. Bisphosphonates are generally safe if kidney function is adequate.
Hormone Therapies
Hormone therapies, including estrogen and selective estrogen receptor modulators like raloxifene, preserve bone density and reduce fracture risk. Raloxifene lowers vertebral fractures by about 50%. However, these therapies come with potential risks. Side effects and risks include increased chances of thromboembolism (blood clots), endometrial cancer (with estrogen), breast cancer risk modulation (raloxifene reduces breast cancer risk, but estrogen may increase it), stroke, coronary artery disease, and gallbladder disease.
Anabolic Agents
Anabolic agents, like Evenity/romosozumab, work to rebuild bones, repair tiny defects, and increase bone mass. Common side effects include headache, joint pain, muscle spasms, insomnia, and neck pain. Serious risks include osteonecrosis of the jaw, similar to antiresorptive agents. Evenity carries an FDA boxed warning due to cardiovascular risks observed in some patients, so its use is typically reserved for high-risk patients or those who cannot tolerate other therapies.
Other Medications
Denosumab is a RANK ligand inhibitor used to treat osteoporosis, administered as an injection every 6 months. Side effects may include skin infections, back, arm, and leg pain, urinary tract infections, constipation, and rash. Calcitonin is available as a nasal spray or an injection. Bazedoxifene comes in tablet form for daily use, and teriparatide, suitable for males with osteoporosis, requires daily injections. Abaloparatide is not suitable for people with an increased risk of osteosarcoma.
The National Institutes of Health recommend good nutrition, regular exercise, quitting smoking, drinking alcohol in moderation, and setting up the surroundings to help prevent falls to reduce the risk of fractures and further bone loss.
In rare cases, bisphosphonates and denosumab can cause atypical femur fracture and osteonecrosis of the jaw. Hormone therapy may be an option for females with osteoporosis. The types of hormone therapy available include estrogen, estrogen agonist/antagonist, and selective estrogen receptor modulator. Romosozumab-aqqg requires an injection twice a month over 12 months, and abaloparatide also requires daily injections.
Remember, all osteoporosis medications carry potential side effects and risks, ranging from gastrointestinal irritation to rare but serious conditions like osteonecrosis of the jaw or cardiovascular events. Choice of therapy depends on individual risk profiles, kidney function, and tolerance to side effects. Always consult with a healthcare professional before starting any new medication.
[1] National Osteoporosis Foundation. (2021). Drugs for Osteoporosis. Retrieved from https://www.nof.org/patients/treatment/drugs-for-osteoporosis/
[2] National Institutes of Health. (2021). Osteoporosis: MedlinePlus Drug Information. Retrieved from https://medlineplus.gov/druginfo/meds/a682602.html
[3] Food and Drug Administration. (2021). Evenity (romosozumab-aqqg) Injection. Retrieved from https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/evenity-romosozumab-aqqg-injection-medication-guide
[4] National Kidney Foundation. (2021). Bisphosphonates and Kidney Disease. Retrieved from https://www.kidney.org/atoz/content/bisphosphonates
- Osteoporosis, a health condition that increases bone fractures risk due to a loss in bone density or mass, can be managed with various medications.
- Antiresorptive agents, like Fosamax/alendronate, help slow down bone loss and reduce fracture risk; common side effects include gastrointestinal problems.
- Bisphosphonates, such as alendronate, ibandronate, risedronate, and zoledronic acid, are used for osteoporosis treatment with different administration methods.
- Treatment dental evaluation before using bisphosphonates is recommended due to the risk of jaw osteonecrosis.
- Common side effects of bisphosphonates include abdominal pain, esophageal irritation, and acid reflux.
- Serious but rare risks with long-term use of bisphosphonates include low blood calcium levels, osteonecrosis of the jaw, and atypical thigh bone fractures.
- Hormone therapies, like raloxifene, preserve bone density, reduce fracture risk, but come with potential risks and side effects such as increased chances of thromboembolism.
- Estrogen increases endometrial cancer risk, while raloxifene reduces breast cancer risk, but may still increase it.
- Anabolic agents, such as Evenity/romosozumab, work to rebuild bones and increase bone mass, but carry potential side effects like headache, joint pain, muscle spasms, and insomnia.
- Evenity carries an FDA boxed warning due to cardiovascular risks observed in some patients.
- Denosumab is a RANK ligand inhibitor used for osteoporosis treatment, and side effects may include skin infections, pain, urinary tract infections, constipation, and rash.
- The National Institutes of Health recommend good nutrition, regular exercise, quitting smoking, drinking alcohol in moderation, and setting up surroundings to help prevent falls.
- Bazedoxifene and teriparatide are other medications used for osteoporosis, each with different administration routes.
- Abaloparatide is not suitable for people with an increased risk of osteosarcoma.
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