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Are there any prescription treatments for osteoporosis?

Estrogen replacement therapy (ERT) can prevent the large loss of bone mass that women experience soon after menopause. Examples of drugs used in ERT include conjugated estrogen (brand name Premarin) and estradiol (>Estrace). Such drugs can increase bone density by 5 percent, lower the risk of a broken wrist or hip from 1 in 15 to 1 in 50 over a five year period. Like all medications, ERT has positive and negative effects. It’s very important for you and your doctor to discuss the risks and benefits of ERT.

For women who can’t take estrogen, other medicines are available. Medications like raloxifene (brand name >Evista), alendronate (>Fosamax), and calcitonin (>Miacalcin nasal spray) have been shown to slow bone loss. Evista increases bone density by 2.5 percent and lowers the risk of spine fractures from 1 in 25 people to 1 in 50 people. Fosamax increases bone density by 5 to 10 percent and reduce the risk of hip fractures from 1 in 50 women to 1 in 100 women >Actonel increases bone density by 1.6 to 5 percent and reduces the risk of fractures from 1 in 12 people to 1 in 20 people. Actonel reduces the risk of hip fracture among women with osteoporosis. Miacalcin reduces the risk of spine fractures from 1 in 8 people to 1 in 13 people.

Another promising alternative is a class of drugs called HMG-CoA reductase inhibitors or “statins”. Doctors prescribe statins such as pravastatin (>Pravachol), simvastatin (>Zocor), lovastatin (>Mevacor), and fluvastatin (>Lescol) to lower cholesterol levels in the blood and to reduce the risk of heart disease. Researchers have found a link between the use of statins and a lower risk of fractures. Early information suggests that statins may reduce fractures by increasing bone density. Scientists will have to conduct more studies to determine the role and benefits of statins in reducing fractures.

Sources:
Applied Therapeutics: The Clinical Use of Drugs. Applied Therapeutics, 1995.
Micromedex Healthcare Series. Micromedex, Inc., 2000.
Eastell, R. "Drug Therapy: Treatment of Postmenopausal Osteoporosis," New England Journal of Medicine. 338 (1998).
Watts, N. "Focus on Primary Care: Postmenopausal Osteoporosis," Obstetrical & Gynecological Survey. 54 (1999).
Meier, CR. "HMG-CoA Reductase Inhibitors and the Risk of Fractures," The Journal of the American Medical Association. 283 (2000).
Wang PS. "HMG-CoA Reductase Inhibitors and the Risk of Hip Fractures in Elderly Patients," The Journal of the American Medical Association. 283 (2000).
Ettinger, B. "Reduction of Vertebral Facture Risk in Postmenopausal Women with Osteoporosis Treated with Raloxifene: Results from a 3-Year Randomized Clinical Trial," The Journal of the American Medical Association. 282 (1999).
Chestnut, C. "A Randomized Trial of Nasal Spray Salmon Calcitonin in Postmenopausal Women with Established Osteoporosis: the Prevent Recurrence of Osteoporotic Fractures Study," The American Journal of Medicine. 109 (2000).
Harris, S. "Effects of Risedronate Treatment on Vertebral and Nonvertebral Fractures in Women with Postmenopausal Osteoporosis: A Randomized Controlled Trial," The Journal of the American Medical Association. 282 (1999).
Komulainen, MH. "HRT and Vit D in Prevention of Non-Vertebral Fractures in Postmenopausal Women; a 5 Year Randomized Trial," Maturitas. 31 (1998).
McClung, M. R. “Effect of Risedronate on the Risk of Hip Fracture in Elderly Women” The New England Journal of Medicine 344, (2001).

This answer prepared 3/6/01.

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