The First 48 Hours: Osteoporosis Medications

While hormone replacement therapy was once commonly used to help ward off osteoporosis, its use has been severely restricted in recent years because of a demonstrated increase in serious medical problems such as stroke and heart disease, and possibly even breast cancer. However, women younger than menopausal age who take hormone therapy because of a hysterectomy or other reason still experience these protective benefits for the bone.

For those whose osteoporosis is severe, some physicians turn to an anabolic medication - specifically, synthetic parathyroid hormone, or teriparatide. Sold under the brand name Forteo, it is taken as a daily injection. Unlike bisphosphonates, it stimulates the bone-building osteoblasts directly. However, some clinical studies have shown an increase in osteosarcoma, or bone cancer, in rats taking high levels of this drug. No such cases have been reported in humans. According to the manufacturer, the safety and efficacy of treatment with Forteo for longer than two years has not been evaluated and therefore is not recommended.

If you have a long history of taking corticosteroids, such as Prednisone, be sure to discuss it with your doctor. The ongoing use of these drugs, as may be needed to treat rheumatoid arthritis or chronic obstructive pulmonary disease (C.O.P.D., or emphysema), has been shown to reduce bone mass. "You're not going to reach peak bone mass," advised Dr. Carlos Lozada, associate professor of rheumatology and immunology at the University of Miami Miami Miller School of Medicine and director of its Rheumatology Fellowship Program, at a seminar he led in May at Cedars Medical Center in Miami, Fla. "The amount you're going to start going down from is lower." In fact, in some cases, doctors prescribe bisphosphonates or other osteoporosis medicines concurrently with the corticosteroids in order to mitigate the risk of a fracture.

A number of new osteoporosis medications, and new formulations of existing treatments, are also working their way through the pipeline from research to reality. For example, the bisphosphonate zoledronic acid - an intravenous medicine now used to treat other diseases - has shown in studies to be effective against osteoporosis. While some doctors are already prescribing it off-label for the condition, for many the cost will remain prohibitive until the drug gains FDA approval for use as an osteoporosis drug and is covered by insurance for that purpose.

Before beginning any medication for osteoporosis, it very important to inform your physician of any other medicines you might be taking, in case of possible side effects or drug interactions. You may also want to reconsider any medicines that could cause sleepiness or dizziness, such as antihistamines or sleep aids, which might increase the risk of a fall. In some cases your doctor may recommend stopping, reducing, or substituting those medications.

Never start or stop any medication without close consultation with your physician. And if you and your doctor establish a prescription regimen, do your best to stick with it. Sadly, studies have shown osteoporosis patients have among the worst compliance rates for medication among those with chronic conditions. Medication sitting in the cabinet has zero effectiveness, so take it as directed or check with your doctor right away if you need to stop because of side effects or some other reason.