The Bone and Joint Clinic


	MEDICINES USED TO TREAT OSTEOPOROSIS Calcitonin (aka Miacalcin Nasal Spray) Benefits • This is very safe medication. • Calcitonin preserves lumbar vertebrae density after menopause • Calcitonin prevents bone loss after ovariectomy. • Calcitonin reduces lumbar fracture risk by 33% in postmenopausal women. • Calcitonin provides analgesia after fracture, especially in spine fractures. • Calcitonin prevents some bone loss seen with long term use of corticosteroids. Special Concerns and Side Effects • Calcitonin needs to be given with supplemental calcium. • Calcitonin does not appear to have much bone protecting effects at the hips. • Rhinitis and sinusitis develop rarely. • Most common adverse effects are facial flushing and nausea. Both of these are rare. Selective Estrogen Receptor Modifier (Raloxifene aka Evista) Benefits • Evista reduces the incidence of breast cancer. • Evista is approved for the primary prevention of osteoporosis. • Evista reduces vertebral fracture by 50% • Evista improves cardiac lipid profiles and thereby may reduce risk of heart disease. • Evista does not increase risk of endometrial cancer of the uterus. Special Concerns and Side Effects • Evista does not appreciably reduce the risk of hip fractures. • 10% of women on Evista report bothersome hot flashes. • Muscle cramps have been associated with Evista use. • Evista increases the risk of venous embolism. This risk is greatest during the first 4 months of therapy. • Patients on Evista should stop taking this drug before taking plane/car rides longer than 4 hours. • Patients on Evista should stop taking this drug prior to hospitalization. Bisphosphonates (Alendronate aka Fosamax & Risedronate aka Actonel) Benefits • These drugs are generally well tolerated. • These drugs are associated with progressive increases in bone density at the hips, spine and total body. • These drugs prevent fractures after just one year of therapy at levels up to 50-65%. • These drugs are effective in men. • These drugs prevent fractures in glucocorticoid-induced osteoporosis. • These drugs may be combined with ERT and calcitonin in order to treat osteoporosis. • These drugs have virtually no drug-drug interactions, since they are metabolized by the liver. • Following cessation of these drugs, bone density benefits are sustained for at least 10 years. Special Concerns and Side Effects • These drugs may cause chemical esophagitis, erosive esophagitis and esophageal strictures. • More common side effects of these drugs include: nausea, abdominal pain, indigestion, diarrhea and muscle pains. • These drugs are contraindicated in patients who are unable to sit or stand upright for at least 30 minutes. • These drugs are contraindicated in patients with abnormalities of the esophagus that delay esophageal emptying (such as esophageal strictures and achalasia). • Actonel is associated with a lower incidence of gastric side effects than Fosamax. Teriparatide (aka Forteo) Benefits • Forteo works rapidly to increase bone density, especially in the spine. Special Concerns and Side Effects • Forteo costs 10 times more than bisphosphonates. • Forteo must be taken by daily injection. • Forteo must be refrigerated or it will degrade. • Forteo caused an increased risk of bone cancer in laboratory animals during its testing. • Forteo does not yet have evidence for reducing the risk of hip fractures.