Consider the six types of drugs for osteoporosis.
When it comes time to choose what medicine to take for osteoporosis, you have many options. Over the past 10 years, science has come a long way to assist women to cure bone disease.
First step: Make sure you consume enough calcium and vitamin D, advises Eve Skopelitis, doctor, therapist Ochsner Medical Center in New Orleans. "Vitamin D is a major component in the treatment of osteoporosis. Even if patients taking calcium with vitamin D, may still be a lack of vitamin D. In this case, they may need to take vitamin D, which is a prescription - so it's important.
In fact, even if you begin to undergo treatment for osteoporosis, you just need to continue taking these supplements, said Holly Tucker, Doctor, Director, Center for Women's Health at Cleveland Clinic. "Women, after menopause, you need 1,500 milligrams of calcium each day, plus 1,000 units of vitamin D. Some people need vitamin D, a prescribed [Calcitriol]. Lack of vitamin is a serious problem."
Also important: Do weight exercise, do not smoke or abuse alcohol.
Second step: Talk to your doctor about the survey on the label of bone resorption - a blood test or urine test, says Mary Rupp, doctor, endocrinologist at the health center at the University of Texas at Houston.
Bone resorption is a loss of bone mass - and the test can show whether your medicine for osteoporosis, effective on the effects on bone, she explains. "The first survey shows your original data. Take it before you start taking drugs. Then go after a few months of taking the drug again to see if there are changes." Insurance usually covers the cost of two such surveys during the first year of treatment.
Now let's look at the advantages and disadvantages of the six major types of drugs for osteoporosis.
1: Bisphosphonates: Fosamax, Actonel, Boniva, zoledronic acid (Reclast or Zometa)
Bisphosphonates are the basis for the treatment of osteoporosis today. "They are a fundamental component in the treatment of osteoporosis," says Bobo Tanner, Dr., Director of the Osteoporosis Clinic at the University of Vanderbilt in Nashville, Tennessee. "These drugs give patients a lot of choices."
Fosamax was the first cure for osteoporosis, which was approved by the Office for Quality Control of Food and Drug Administration United States 10 years ago, three years after it was approved and Actonel. Boniva and Reclast been approved recently. "Actonel and Fosamax have good results," - says Tanner, "But the information about Boniva and Reclast we do not have."
How they work: These drugs have shown the ability to increase bone density - and Fosamax and Actonel also reduce the risk of fractures of the spine and hip. Actonel works pretty quickly, reducing the risk of fractures within six months, according to Tanner.
"Boniva is not yet shown results in reducing hip fractures, which are concerned," - she added.
Reclast or Zometa increases bone mineral density and showed the property to reduce hip fractures and spine - reduced risk of susceptibility to fractures of spine persists for more than three years. According to information from the manufacturer, Reclast also reduces the susceptibility to fracture wrists, arms, legs and ribs. Reclast demonstrated the properties to reduce mortality among people who have already been broken, said Tanner.
Options dose: Taking bisphosphonates can be very flexible - depending on whether you want to take medicine for osteoporosis once a day, once a week or once a month - well, you can take the drug by injection, which is done once a year in the office of your physician.
Options:
Fosamax can be taken once a day or once a week in tablet form.
Fosamax in liquid form can be taken once a week.
Actonel can be taken once a day, once a week or once a month.
Boniva can be taken once a day or once a month in tablet form.
Intravenous injection of Boniva can be done once a year.
Reclast or Zometa can be taken once a year in the form of intravenous injection.
With intravenous injection involved a needle that is inserted in your hand and drip - this is what you put in the hospital. And though this may seem extreme in some way of taking the medicine, it does have its advantages. "Intravenous drug goes directly into the bone, completely bypassing the gastrointestinal tract," - said Skopelitis.
The procedure itself takes about 5 minutes in the case of Boniva, and 5 minutes in the case of Reclast - and you're free for a year. "For some patients, this is a very practical option," - says Tanner.
Mode of taking the pills: Medication for osteoporosis in tablet form is not so simple. You do not just have to swallow a pill. You must comply with specific instructions.
A pill - it's the first thing you should do in the morning - on an empty stomach.
After the reception you can not sit or lie down.
You can not eat and drink.
Wait 30 - 60 minutes, until the body absorbs the medicine.
After that, you can take other medicines.
The longer it will take before you have something to eat, the greater the chance that a cure for osteoporosis, better digestion by the body. "Your stomach must be empty," - said Skopelitis. "You must be sure that your competitors do not have gastrointestinal medicine." You can take other drugs later - but not before taking drugs for osteoporosis.
Such a strict regime of taking is very important, says Tanner, as the body can absorb quite a bit of medication. The body absorbs only about 1% of the drug - "so, make sure you get the most out of each dose," - she said.
Selecting: When deciding on the admission of bisphosphonates, you should ask themselves eight questions:
- How often do you want to take medicine for osteoporosis?
- Do not forget if you take the medicine?
- Will you follow a strict regime of taking the pills in the morning?
- Do you take other medicines on a regular basis?
- Do you have any problems with the digestive tract?
- Do you have difficulty swallowing?
- Would you like to take medicine once a year?
- Does your insurance cover the cost of such drugs for osteoporosis?
Bisphosphonates tablets are not recommended for people who have problems with the gastrointestinal tract, such as gastritis or ulcers - as well as people who have serious problems with the esophagus, such as stenosis. "We want to be sure that the patient will be able to learn medicine," - says Tanner. "If they suffer from other diseases, then it is better to consider a variant with an intravenous technique."
Also, for patients who are not subject to concessional pharmaceutical plan - under the terms of health insurance or government programs to provide free medical care to the elderly - intravenous administration of Reclast and Boniva are the best option, says Tanner. "Since it happens in the doctor's office, the cost will be covered." However, you must comply with the terms of their own insured retention and surcharges.
Generic Fosamax: If you have no problem with taking the drug in tablet form, Fosamax is now possible to buy cheaper, generic form. This is a great option if there are financial problems, says Tanner. "Some people can not afford to spend more than $ 4 a month." However, we must know that the generic drug must meet 80% of the original drug, it is not 100% identical to, she says. "For a drug that worked so hard absorbed by our body, I think it's risky."
Possible side effects: These drugs for osteoporosis can lead to stomach upset, cause heartburn for a day or two. "Actonel, it seems, leads to fewer side effects in the gastrointestinal tract," says Rupp.
Some patients complain of pain in muscles and joints during the course of treatment for osteoporosis, but there are some serious problems. "It's not a reason not to take medicine," - says Tanner.
However, side effects are the main reason why people refuse to continue taking drugs for osteoporosis, according to Rupp. In this case study may help to label bone resorption. "It can show the effectiveness of drugs, whether it affects the disease. Some people just need to see this again. It's a positive thing to continue taking the medicine."
Since Reclast in the treatment of osteoporosis is introduced every year, some people are nervous because of side effects - whether they occur throughout the year, says Tanner. "About 20% have flu-like illness, during the first few days after drug administration. In very rare cases, a pain in the bones, which may continue for some time. But this happens in less than 1% of cases. This is a rarity" . Treatment of ibuprofen (eg Advil, Mortin) or acetaminophen (eg Tylenol) helps in the manifestation of these symptoms.
Existing Risks: Anxiety can cause arrhythmia (abnormal heartbeat rhythm). A major study has shown that some patients who were treated with zoledronic acid (Reclast or Zometa), heart rate deviated from the norm more than those who received placebo. Follow-up studies did not give such results. Office of the Food and Drug Administration has advised the U.S. not to stop the patients taking bisphosphonates - but to report on the manifestation of side effects and symptoms to their doctors.
There is also a small risk of osteonecrosis of the jawbone, which can cause pain, swelling, the vulnerability of the bone, local infection and a broken jaw. However, osteonecrosis is rare and occurs in few patients who have undergone chemotherapy or radiation therapy, and for a long time took bisphosphonates, says Tanner. "It happens very rarely," - she said. "The benefit of preventing bone fractures than the risk of osteonecrosis of the jaw bone."
Tucker agrees: "The risk of developing osteonecrosis of the jaw bone is too exaggerated. Horizon Trial Group examined the effects of Reclast 8,000 postmenopausal women and found no increased risk of osteonecrosis of the jaw bone."
2: Evista: Prevention of breast cancer and osteoporosis
Women with osteopenia [low bone density, but not osteoporosis] - or those who have problems with the digestive tract and they can not take bisphosphonates - can choose the drug Evista. Evista - is a selective estrogen receptor modulator (SMRE), which is used to treat breast cancer. The drug is approved by the Office of the Food and Drug Administration United States for use in the treatment and prevention of osteoporosis.
The drug binds to estrogen receptors in the body and has a similar effect of estrogen - including the prevention of bone loss.
Evista helps prevent vertebral fractures but not hip, according to Tucker. "Evista is not as effective as hormone therapy or bisphosphonates for the skeleton. But the Office for Quality Control of Food and Drug Administration United States encouraged the drug for the treatment of osteoporosis, as well as to reduce the risk of breast cancer. So, for women there are additional benefits of Evista ".
Possible side effects: Rarely, but there is a risk of deep vein thrombosis.
3: Forteo: "Builder" of bone
If you have a severe degree of osteoporosis, you may want to take a drug called Forteo. Forteo - a hormone pair of the thyroid gland, which increases bone density and bone strength, in order to avoid fractures. Forteo stimulates kosteformiruyuschie cells called osteoblasts to form bone tissue. This is a cure for osteoporosis, a significant effect on bone density in the spine, reducing fractures and 90%.
Forteo is taken daily for a period of time, and administered by injection. This medication is usually prescribed for osteoporosis for people with severe osteoporosis, or those who had been one or more fractures. You can enter injections themselves at home or with someone.
"Forteo" builds "the bone, while the other drugs, just to protect from fractures" - explains Skopelitis. "Women with severe osteoporosis refuse other drugs and start taking Forteo, which is much stronger."
Possible side effects: Some people complain of dizziness or weakness, rapid heart rate when administered in the form of injection drugs, or nausea, vomiting, constipation, and muscle weakness.
4: Denosumab: In the pipeline
As well as Forteo, a medication for osteoporosis, "builds" of the bone. Tests showed three phases of a reduced level of vertebral fractures and hip. The drug activates osteoblasts kosteformiruyuschie different from Forteo way. This is a new drug for osteoporosis administered as injections, but these injections should be done several times a year. The drug will be available from 2009, according to Rupp.
"Preliminary information on denosumabe we like" - says Tanner. "It may be useful for people who can not tolerate or who do not help other medications."
5: Calcitonin: For a comprehensive treatment
Calcitonin is the first drug for osteoporosis, which was approved in 1984 - and still take it sometimes. This hormone is produced from salmon calcitonin, which helps slow down bone loss, increases bone density and relieves pain. In the process of impact it binds osteoclasts, cells that break down bone, and this prevents loss of bone mass. The major advantage of calcitonin is that it reduces the risk of vertebral fractures.
Calcitonin is often used as an additional medication for osteoporosis or if people can not tolerate bisphosphonates. You can enter in the form of injections.
Possible side effects: diarrhea. Redness of the face or hands, increased urination, loss of appetite.
6: The Hormone Estrogen: Prevention of tides and prevention of osteoporosis
Women who want to get rid of the tides - and prevent osteoporosis - may choose hormone replacement therapy (HRT). However, there are serious risks of heart disease, stroke and of blood clots in the lungs. Also, there is an increased risk of breast cancer, as well as, possibly, other cancers.
These risks disappear once women stop taking HRT, according to new research. But doctors prescribe the smallest possible dose of HRT for the shortest possible period of time, women who delivered tidal restlessness. The benefits of HRT are kosteformirovaniya plus - as it is known that it preserves bone mass and prevent fractures.
Tanner does not support the use of HRT for osteoporosis. "HRT has been quite criticized by the Office for Quality Control of Food and Drug Administration United States - and is classified only for short-term use," - says Tanner. "Another aspect is the fact that HRT has no lasting effect. As soon as you stop taking it, your skeleton menopause, unlike bisphosphonates, which provide long-term effect for several months if not years, after you stop them to take. " Fosamax is in the bones are not over 10 years, he adds.
But Tucker said that "too much hormone is ignored." She is the author of the book, Women's Health: Your body, your hormones, your choice. "It can reduce the susceptibility to all types of fractures in women. If you're 50, you are a woman and you are threatened by osteoporosis, you have hot flashes and other menopause symptoms, think about hormone therapy. If you are under 60 years of age, the benefits outweigh risks."
