Osteoporosis, or low bone mass, is a serious health problem that affects millions of Americans, according to the National Osteoporosis Foundation (NOF). Women develop osteoporosis more frequently than men, with 80 percent of cases occurring in females. Approximately 50 percent of women and 25 percent of men older than 50 have at least one fracture related to osteoporosis in their lifetime. Bisphosphates, also called bisphosphonates, are the most frequently prescribed drug to treat osteoporosis, but for people who can't take them, other medications are available.
Anabolic Bone-Forming Medications
Unlike bisphosphonates, which prevent bone from being absorbed, anabolic medications help form more new bone. Teriparatide, parathyroid hormone sold as Forteo, increases bone density by building new bone, especially in the spine. Because long-term use caused osteosarcoma, a rare type of bone cancer, in clinical trials with rats, the Food and Drug Administration approved the use of Forteo for only two years, the NOF reports. Forteo is injected daily and can cause leg cramps and dizziness.
Estrogen and Estrogen Agonists/Antagonists
The risk of osteoporosis increases when estrogen levels drop in menopause. Taking estrogen replacement therapy can help keep osteoporosis from developing or progressing, especially if started within four to six years after the onset of menopause, says the Merck Manual. Estrogen, like bisphosphonates, prevents resorption of bone and helps prevent hip and other types of osteoporotic fractures. Estrogen does increase the risk of uterine and breast cancers, heart disease and stroke. Estrogen plus progestin provides a monthly withdrawal bleed and decreases the risk of uterine cancer.
Estrogen agonist/antagonist medications provide some of the benefits of estrogen without the risks. Known as selective estrogen receptor modulators, or SERMS, such as raloxifene (sold as Evista), they decrease the risk of spinal fractures by approximately 50 percent, according to Merck. SERMS do not reduce the risk of other types of fractures, however. Hot flashes and leg cramps may accompany Evista use, which may also increase the risk of developing blood clots. Evista should not be taken by women with a history of stroke.
Calcitonin
Calcitonin, another type of anti-resorptive medication sold commercially as Fortical and Miacalcin, is used by women who have been menopausal for at least five years. Calcitonin, like SERMS, reduces fracture risk on the spine and is given by injection or as a nasal spray. Side effects of calcitonin include flushing, skin rash, nausea, runny nose, back pain, headache and nosebleed. Calcitonin can also help decrease pain after an acute fracture, Merck says.
