Boniva®, Fosomax®, Actonel®, Forteo®… Evista®? If you’ve been diagnosed with osteoporosis or osteopenia, and changes in diet and lifestyle haven’t resulted in raising those T-scores, you may be poised on the brink of a new and very confusing world: drug treatment.
Right now, I’m trying the supplements and exercise route to increase my bone density. But if that doesn’t work—and I’ll find out next month—I’ll probably have to make some decisions about drugs. So I decided I’d best find out as much about them as I can. And since I’m pretty good at explaining things in language we all can understand, I thought I’d share with you what I’m discovering.
Let’s start with the main classes of osteoporosis drugs: bisphosphonates; parathyroid hormone/anabolic drugs; estrogen; calcitonin; and selective estrogen receptor modulators (SERMs).
Do you really need to remember these words? No; they won’t be on the next quiz. But be aware that you may hear them as your doctor rattles off information about the drug you’re about to start taking. Let’s look at what they are, and how they work, one by one. This will be a general overview; later on, I’ll go into more depth about each drug.
Bisphosphonates (bis-foss-fo-nates, if you want to know how to pronounce it): This is the most common class of osteoporosis drugs, and includes Boniva, Fosomax, Reclast®, and Actonel. Also called anti-resorptives, these drugs work by slowing the rate at which your bones “shed,” or lose their substance.
Your bones are always “remodeling;” they break down, and they build back up. Over the course of your life, the pendulum swings from more bone growth/less breakdown (when you’re young), to more breakdown/less growth (when you’re older). But the pendulum swings farther for some of us than for others; if your bones break down way quicker than they build up, then you have osteoporosis.
And what do bisphosphonates do? They slow the pace of bone breakdown, putting it more in balance with bone buildup. Thus your bone density increases. How do they do this? By hindering the cells (osteoclasts) that break down your bones; and perhaps by stimulating the cells (osteoblasts) that build up your bones.
Parathyroid hormones: Currently, there’s only one FDA-approved drug in this class, thus only one used for osteoporosis treatment in the U.S.: Forteo.
Your body manufactures parathyroid hormones, which stimulate your osteoblasts to build bone. Forteo is the synthesized (manufactured) version of this hormone. In effect, it increases bone density by just the opposite method of a bisphosphonate: it stimulates bone buildup (osteoblasts), rather than slowing down bone breakdown (osteoclasts). Forteo also helps your body absorb calcium, which is key to bone buildup.
Estrogen: There are various forms of estrogen available on the market. The broader class of these drugs, known as hormone replacement therapy drugs (HRT), have been taken by millions of women to deal with the side effects of menopause, one of which is osteoporosis. The most common examples of HRT include Prempro® and Premarin®.
