This is a continuation of the series on osteoporosis. So far we have covered
Part 1: Who’s at risk for low bone density
Part 2: Proper testing and diagnosis
When you test positive for osteoporosis, you doctor will likely have you start meds to build your bone density. Below is an overview of medication options.
Medicines are best for those who have had low trauma fractures or whose bone density is very low or when lifestyle changes are not enough. While medications do tend to work, there is no ideal medication.
There are no magic bullets or quick fixes. It takes time. It is a slow process and everyone is different. No treatment works the same for everyone.
Before you start any medication, you should have a full medical work-up. Your doctor will do this to rule out any secondary causes that may be causing you to lose bone. Some of these causes may include medications, thyroid conditions, digestive issues, etc. Those issues need to be taken care of first.
Be aware that even medications are not a permanent fix. Medications are only temporary. Then you may need to switch to another medicine. That will be temporary too. When you stop taking the medications, you will begin to lose bone again over time. The pace will vary based on the medication. This is why it is important to work on nutrition, exercise and gastrointestinal health as well to help maintain your bone building progress.
There are medications that hinder the breakdown of bones. They are called antiresorptives. There are other medications that boost bone formation. They are called anabolics.
Antiresorptives
Suppress the breakdown or loss of bone.
These are called bisphosphonates. They inhibit cells that remove bone and slow the formation of new bones.
Unfortunately, this can result in an accumulation of old bone.
Should be taken for a limited time. It will linger in the bones after stopping. This may be a benefit by allowing a medication holiday for a little while.
Cons: gastrointestinal problems, irritates the esophagus, not for those with gastric reflux. You need to take it and stay upright for 60 minutes (not lie down or bend over).
Some brands of bisphosphonates: (taken by pill or intravenously)
- Fosamax
- Boniva
- Aconel
- Reclast
- Zometa
Long term use can cause weakening of the bone causing fractures. These commonly occur in the femur (thigh bone) and jaw.
Anabolics
Promotes bone formation.
The first year bone density goes up and then it plateaus. There tends to be a decrease in bone formation after 2 years.
- Forteo -(synthetic parathyroid hormone) Stimulates BOTH bone formation and breakdown, but formation out performs breakdown. Used for advanced cases with high fracture risk. Take for 18-24 months followed by bisphophonates, otherwise you will lose it again within 2 years. Not for those at risk of bone cancer.
- Tymlos – newer drug similar to Forteo, but studies show it is less likely to cause excess calcium. Only for severe cases of osteoporosis. Both drugs are quite expensive.
Hormone Therapy
Reduces bone loss, and reduces fracture risk. Does not increase bone density. So it is best use for prevention.
Non bio-identical hormones risks out weighed the benefits. Risks include blood clots, heart attack, breast cancer, etc.
Bio-identical hormones are a safer choice. As always use the lowest dose for the shortest period of time. It is best to use estrogen and progesterone together.
According to Dr. Lani, this may be the best choice.
Bio identical hormones are not FDA approved, so most doctors will not recommend them.
So that’s it in a nutshell. Talk to your doctor about what is right for you. Establish good nutrition and exercise habits and don’t drink or smoke. Keep this up along side any medication you take.
Next time, we’ll start looking at lifestyle changes.
Some Sources Used:
Bioidentical Hormone Replacement Therapy in Postmenopausal Osteoporosis
Osteoporosis treatment: Medications can help
Simpson, Lani DC, CCD. Dr. Lani’s No-Nonsense Bone Health Guide
Peppers and Planks 