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Management of Osteoporosis with Medications
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Posted on: 07/12/2007
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Patients with osteoporosis who have had a fracture are often treated with medication, but which medication is chosen will depend on the effect desired. Physicians measure the bone mass density (BMD) of patients with osteoporosis to get an idea of how much bone loss has occurred and will also look at other risk factors. BMD is measured with a dual energy x-ray absorptiometry, or DEXA, scan. After the assessments, the physicians determine a t-score that provides the basis for treatment.
There are different guidelines regarding treatment of osteoporosis. The National Osteoporosis Foundation (NOF) and the American Association of Clinical Endocrinologists (AACE) say that at t-score of -1.5 or lower means that the patient should be treated if there are the additional risk factors of having had a fracture and older age. If the patients don't have those risk factors though, this is where the controversy lies. The NOF guidelines say that people without the extra risk factors should only start treatment if their t-score is -2.0 or lower, while the AACE, and the World Health Organization, say that treatment should only start if the t-score is -2.5 or lower. It is also suggested that physicians look at other factors, such as the patient's family history and current lifestyle.
When prescribing medication, there are two categories from which to choose: anabolic agents and anticatabolic agents. The first group, the anabolic agents, help increase bone formation while the second group decreases bone resorption (breakdown). There is only one medication, teriparatide, that is approved as an anabolic agent for the treatment of osteoporosis. Patients with Paget's disease, unexplained high levels of alkaline phosphatase, and other skeletal disorders shouldn't take this medication.
In the second group of medications, there is more choice. Some medications are for the prevention of osteoporosis, while some are for both prevention and treatment. This group includes a hormone called salmon calcitonin, a drug called raloxifene, and several bisphosphonates. There are side effects associated with bisphosphonates that can make them difficult for some patients to take. If a patient has a history of kidney problem, low calcium, or gastrointestinal disorders, they may not be able to take them.
Studies of all of these medications show promise in helping to prevent and treat osteoporosis. The long-term safety data show that the drugs appear to be safe, although there have been incidences of osteonecrotic jaw, or dead bone in the jaw, but it is rare.
The author concludes that treatment with medication should be started immediately in patients with osteoporosis who have broken a bone. She adds that the DEXA scan isn't necessary before treatment, but she be done as soon as is possible.
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References:
Ellen Miller, MD. Current issues and options in the pharmacological management of osteoporosis. In The Journal Of musculoskeletal Medicine. June 2007. Vol. 24. No. 6. Pp. S16-S22.
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