Understanding medication for osteoporosis

Osteoporosis is a skeletal disorder characterised by compromised bone strength predisposing to an increased risk of fracture. Osteoporosis develops after menopause, when estrogen levels drop precipitously. These changes lead to bone loss, usually in the trabecular (spongy) bone inside the hard-cortical bone.

What Women Need to Know?

Being female puts you at risk of developing osteoporosis and broken bones. Here are some facts:

Of the estimated 10 million Indian with osteoporosis, about 80 per cent are women.

Approximately one in two women over age 50 will break a bone because of osteoporosis.

A woman's risk of breaking a hip is equal to her combined risk of breast, uterine and ovarian cancer.

Reasons why women are more likely to get osteoporosis than men?

Women tend to have smaller, thinner bones than men.

Estrogen, a harmone in women plays an important part in maintaining bone strength. Starting at about age 30 through onset of menopause, women lose a small amount of bone every year as a natural part of the aging process.

Other risk factors for developing osteoporosis include:

Advanced age: Osteoporosis occurs frequently in those over age 65.

Heredity: Family history of osteoporosis or fracture on the mother's side.

Menstrual history: early menopause can exacerbate this risk.

Underweight women: Women who are underweight for their height.

Lifestyle: Risk factors include calcium and/or vitamin D deficiency; little or no exercise (especially weight-bearing exercise); alcohol abuse; smoking; too much cola/soda.

Medications: Drugs like cortisone used for long term in high doses in case of asthma, lung disease. Thyroid medications in high doses can contribute to osteoporosis.

Medical problems: Certain medical problems can increase risk of developing osteoporosis e.g., rheumatoid arthritis, emphysema, chronic bronchitis, hyperthyroidism, chronic liver disease, intestinal disease

Prevention:

Improving calcium nutrition,

Vitamin D intake,

Regular exercise program

Hormonal replacement therapy is very essential and should be started in time

Calcitonin to prevent further fractures,

No smoking and moderate alcohol intake.

Postmenopausal woman calcium intake of 1 gram per day appears to be necessary to effect a positive impact of exercise on bone mineral density in spine

Who needs treatment with a medication?

National Osteoporosis Foundation (NOF) recommends treatment with medication for people who have low bone density (T-score between -1.0 and -2.5). T-scores are numbers that doctors use to measure bone density based on the way your bones look on imaging.

v Bisphosphonates — Bisphosphonates are medications that slow the breakdown and removal of bone (ie, resorption). They are widely used for the prevention and treatment of osteoporosis in postmenopausal women. These drugs need to be taken first thing in the morning on an empty stomach with a full glass of plain water. You then need to wait for a half hour or an hour, before eating or taking any other medications.

Alendronate — Alendronate reduces the risk of vertebral and hip fractures, and it decreases the loss of height associated with vertebral fractures. It is available as a pill that is taken once per day or once per week.

Risedronate — Risedronate reduces the risk of both vertebral and hip fractures. Risedronate is approved for both prevention and treatment of osteoporosis. It can be taken once per day, once per week, or once per month.

Ibandronate — Although ibandronate reduces the risk of bone loss and vertebral fractures, there is no proof that it reduces the risk of hip fractures, so it is not recommended as often as alendronate and risedronate. Ibandronate can be used for prevention and treatment of osteoporosis. It is available as a pill that is taken once per day or once per month. It is also available as an injection that is given into a vein once every three months.

Zoledronic acid — A once-yearly, intravenous dose of zoledronic acid is also available for the treatment of osteoporosis. This medication is given into a vein (by "IV") over 15 minutes and is usually well tolerated. Zoledronic acid can improve bone density and decrease the risk of vertebral and hip fractures.

Estrogen-like medications — Selective estrogen receptor modulators (SERMs), produce some estrogen-like effects in the bone. These medications, which include raloxifene and tamoxifen, provide protection against postmenopausal bone loss.

Hormone therapy — In the past, hormone therapy with estrogen or estrogen-progestin was considered the best way to prevent postmenopausal osteoporosis, and it was often used for treatment.

Denosumab — is an antibody directed against a specific protein involved in the formation of cells that break down bone. Denosumab improves bone mineral density and reduces risk of fracture in postmenopausal women with osteoporosis. It is given as an injection under the skin once every six months.

Parathyroid hormone PTH— are unique osteoporosis drugs in that they are the only medications that work by stimulating bone formation. The other medications described above work by reducing bone resorption (anti-resorptives). Clinical trials suggest that PTH therapy is effective in the treatment of osteoporosis in postmenopausal women.

Post menuposal Osteoporosis Screening

Experts suggest screening for osteoporosis for women 65 years and older and for women under 65 who have gone through menopause and have risk factors (such as past fracture, certain medical conditions or medications, or cigarette or alcohol use).

Screening involves physical examination, discussion of the person's history, and measurement of bone density through imaging tests.

- (The writer is a consultant orthopedic surgeon)