OSTEOPOROSIS DRUGS: Actonel, Fosamax, Evista, et al

There are several different kinds of drugs used to treat osteoporosis. They vary in their side effects, benefits, and costs. Because of potential harm to a developing fetus, it is extremely important that women not only communicate to their doctors that they are pregnant but whether they have any plans to become pregnant. Lingering drugs may still affect pregnancy, so treatment and prevention may have to be through diet and exercise.


Convenient Packaging for Monthly Supply of Actonel
Bisphosphonates are a type of drug approved for both the prevention and treatment of osteoporosis. The two most well known marketed drugs -- alendronate (Fosamax) and risedronate (Actonel) -- prevent existing bone loss and reduce the risk of spinal and hip fractures.

While side effects are generally mild, potential side effects include stomach upset and irritation of the esophagus. Because bisphosphonates are difficult to absorb, these medicines should be taken on an empty stomach. The patient should not lie down or consume food or beverages (other than water) for at least 30 minutes after taking the medicine. The physician may also recommend taking calcium and Vitamin D supplements. If these drugs are not successful patients may have other options.

Raloxifene (Evista)
is another drug used for the prevention and treatment of osteoporosis. Raloxifene is similar to the breast cancer drug tamoxifen. Raloxifene can reduce the risk of spinal fractures by almost 50%. (It does not appear to prevent other fractures, including those in the hip.) It may have protective effects against heart disease and breast cancer, though more studies are required. The most serious side effect of raloxifene is a very small risk of blood clots in the leg veins (deep venous thrombosis) or in the lungs (pulmonary embolus).

Patients may be candidates for synthetic parathyroid hormone -- teriparatide (Forteo) -- a self administered daily injection that stimulates new bone and significantly increases bone mineral density. Side effects may include nausea, leg cramps or dizziness and should not be used before menopause or by those who have undergone radiation therapy. Another option -- calcitonin (Miacalcin) -- available as an injection or nasal spray. It slows bone loss and increases bone density of the spine in women that are post menopausal by more than 5 years. The injections may result in allergic reactions, and the nasal spray may cause bloody nose. Other possible side effects are similar to the bisphosphonates.

On the horizon a new drug, Prestara, a mild androgenic hormone, may be approved for the future and may even be safe for women who desire to get pregnant.


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