Treatment Options for Premenopausal Women With Osteoporosis

Pam Flores Health Guide January 30, 2009
  • According to Dr. Susan Ott, Professor of the University of Washington Bone Physiology Course, "Bisphosphonates are NOT APPROVED for prevention of osteoporosis in premenopausal women." (Bisphosphonates include drugs like Fosamax, Boniva, and Actonel). Okay I understand that statement, but what about those who have established primary osteoporosis, with fragility fractures, and are premenopausal?  Does this mean there might be other options for treatment since we aren't talking about women with osteopenia who want to try to prevent osteoporosis?

     

    There are a growing number of women who are young and who don't have a secondary cause of osteoporosis, like those mentioned in PJ Hamel's excellent blog "Young Female Athletes--at Risk For Osteoporosis."  These women are screened for all secondary causes, before they are given a diagnosis of idiopathic or primary osteoporosis.  This screening is very important because, if a secondary cause is present, it can be treated, and much differently than what you would do for osteoporosis. 

     

    Hyperparathyroidism and celiac, are just two of the secondary causes that would be treated entirely differently than osteoporosis, which cause bone loss.

     

    The main concern with osteoporosis drugs is the risk of birth defects in children. Dr. Susan Ott, council member of the American Society of Bone and Mineral Research explains the drug's use during pregnancy. "Women who are pregnant should not take bisphosphonates. If women are already taking a bisphosphonate and want to become pregnant, it is not clear how long they should wait." So would it be possible for women to use these drugs if pregnancy is delayed? 

     

    If you are in a situation similar to this, speak with your doctor and find out if you would qualify for antiresorptives or anabolic treatment.  The antiresorptives are: Fosamax, Calcitonin, Actonel, Boniva, Reclast and HRT and, Forteo is an anabolic. 

     

    Most doctors recommend taking birth control while participating in any of these treatments, and if an unplanned pregnancy occurs, diligent monitoring of mineral metabolism, and bone markers is necessary.  If you use one of the antiresorptive medications and plan on having more children in the future, doctors are recommending you wait to get pregnant giving the drug a chance to leave your body, since it has a relatively long half life. 

     

    Another option for premenopausal women with osteoporosis may be Forteo.  Forteo has a half life of less than several hours, so if taken prior to pregnancy the concern about residual drug levels in the body would be non-existent.  Forteo has the added benefit of stimulating new bone growth, which is very important in fracture healing, and prevention.  Forteo is limited to a two year course, so this may be enough to reverse the low z-scores these women have.  Since these women are still producing hormones that should help to maintain any gains made during the course of treatment with Forteo.

     

    Columbia University is currently conducting a study on Forteo treatment in women with idiopathic premenopausal osteoporosis.  If you think you might be interested in this, see this link explaining the clinical trial.

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    These drugs are approved for post-menopausal women, but don't we need to rethink the benefits that these drugs posses in improving rapidly declining bone loss in young women with no other treatment alternative.

     

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