Osteoporosis Treatment With Bisphosphonates

Taking Fosamax, Boniva, Actonel or Reclast to Treat Bone Loss

Nov 8, 2009

The most commonly used drugs for treatment of osteoporosis are bisphosphanates, drugs that decrease bone removal and the risk of fractures, and increase bone density.

Bone is a living tissue that’s constantly being replaced. Osteoporosis develops when more bone is broken down than is replaced. Cells called osteoclasts break down bone; drug treatment for osteoporosis with antiresorptive drugs like bisphosphantes slows down bone breakdown by osteoclasts.

Osteoporosis and Bisphosphonates: Treatment with Fosamax, Boniva, Actonel, Reclast

Bisphosphonates are approved to treat and prevent osteoporosis. Currently, the drugs approved for use in the US include:

Bisphosphonates are taken on different schedules depending on dose. Once a week dosages are higher than once a day dosages. Reclast is given once a year, via intravenous therapy.

When to Start Drug Treatment: Interpreting T-Score Results

Most doctors start bisphosphonates when bone mineral density testing shows a T score of -2.5 or less, which indicates osteoporosis. If a patient has osteopenia, or a T score higher than -2.5, such as -2.0, doctors may start bisphosphonates if they have other risk factors, such as being very thin or taking corticosteroids, both of which raise the risks of developing osteoporosis.

Some people shouldn’t take bisphosphonates unless their doctor determines that the risk outweighs the benefit. People who have severe kidney disease, problems with their esophagus or reflux, and people with vitamin D deficiency fall into this category.

How To Take Bisphosphonates for Best Absorption and Fewest Side Effects

Taking bisphosphonates correctly help prevent side effects. Bisphosphonates should be:

Patients need to stay upright for 30 minutes after taking the pill, and not drink or eat anything else during those 30 minutes. Because bisphosphonates are absorbed slowly, they can cause irritation of the esophagus.

Bisphosphonates and Osteonecrosis of the Jaw

Studies have shown that bisphosphonates can cause osteonecrosis of the jaw, which can lead to infection and death. However, most cases of osteonecrosis of the jaw (OJN) have occurred in people receiving intravenous bisphosphonates for treatment of cancer..

There is still a risk of osteonecrosis in people taking bisphosphonates, especially in those who are undergoing dental procedures. People taking bisphosphonates should practice good oral hygiene and see their dentist if any of the following develop:

Bisphosphonates Still Best Option for Treating, Preventing Osteoporosis

Despite the small risk of developing OJN, bisphosphonates are still the best treatment and prevention for osteoporosis. It’s important to remember that mortality from hip fracture is considerably higher than the number of deaths related to oral bisphosphate use. Take antiresorptive drugs as prescribed, and follow up with a doctor or dentist if any signs of complication appear.

J Am Dent, "Oral bisphosphonate use and the prevalence of osteonecrosis of the jaw," Sedghizadeh P, DDS, MS et al; Vol 140, No 1, 61-66. 2009

Bone:Official Journal of the International Bone and Mineral Society, "Bisphosphonate efficacy and clinical trials for postmenopausal osteoporosis: Similarities and differences," Steven Boonan; Vol 40, Issue 5,supplement 2 Pages S26-S31 (May 2007)

The copyright of the article Osteoporosis Treatment With Bisphosphonates in Women’s Health is owned by Sharon Perkins. Permission to republish Osteoporosis Treatment With Bisphosphonates in print or online must be granted by the author in writing.