Treatment Options for Osteoporosis

Expert Patient Christine Miller shares some of the different treatment options available for individuals with osteoporosis, and explains why treatment choices should balance physician expertise and patient preferences.

Osteoporosis is a disease that causes bones to weaken and break. The most common bones affected are the hip, wrist and vertebrae. Approximately 10 million people in the US currently have osteoporosis. Estimates are that fifty percent of women and 25% of men will have it in their lifetime and the population with osteoporosis will increase as the population ages. Post-menopausal women; people taking steroids to threat arthritis, asthma, and other diseases; and people who are inactive are at risk for developing osteoporosis. Osteoporosis is diagnosed generally by results of a type of x-ray called a bone density test. Fractures due to osteoporosis can result in decreased mobility, increased functional impairment, decreased quality of life and increased likelihood of mortality. Simple, common steps to reducing bone loss are participating in weight-bearing exercise on a regular basis (such as walking and lifting light weights), taking calcium and vitamin D supplements, and avoiding tobacco and excessive alcohol.

There are also several types of prescription medications available including oral and IV bisphosphonates (medications such as Fosamax and Aredia that inhibit bone resorption to help prevent fractures of the hip and spine), hormonal replacement therapy and recombinant human parathyroid hormone (rhPTH). Oral bisphosphonates are taken either once per week or monthly, depending on the medication. IV bisphosphonates can be administered either every three months or once per year. Instead of preventing resorption, rhTPH helps to stimulate bone growth through daily injections. It has been shown to increase bone density and decrease osteoporotic fractures by approximately 60%. Each medication has positive effects on preventing bone loss that patients must weigh against the possibly bothersome physical side effects as well as the treatment schedules and costs of treatment.

A new study published in the October issue of Arthritis & Rheumatism recommends that treatment decisions should be based both on physician expertise and patient preferences in order to promote patient autonomy, increase patient satisfaction and improve compliance. The researchers studied the treatment preferences of 212 men and women who were recently diagnosed with osteoporosis. The researchers concluded that patient preferences are strongly influenced by the routine of administration. They found that although rhPTH may have some added benefits the other medications do not, patients dislike taking daily injections and therefore would prefer taking bisphosphonates. They also found varying preferences among patients for taking bisphosphonates weekly oral medications versus yearly IV administration. For example, patients with poorer self-reported health status, patients with high perceived risk of fracture, and those who prefer to treat health problems without doctors or prescription drugs were more likely to choose the annual infusion. The researchers concluded that since patients have poor records of sticking with their medications and treatment over the long-term, physicians should be mindful of including their patients in the decision making process and take into account individual preferences for medication routine.