American Medical Association Family Medical Guide - American Medical Association [694]
• Gonadotropin-releasing hormones Long-term treatment with gonadotropin-releasing hormones for endometriosis by women who already have low bone density can decrease bone density more by reducing the woman’s natural level of estrogen.
• Antacids containing aluminum Taking large quantities of antacids that contain aluminum can weaken bones because the aluminum replaces calcium in bones.
• Cyclosporine Therapy with cyclosporine to prevent organ rejection after a transplant interferes with the growth of new bone.
• Heparin The anticlotting medication heparin can weaken bones by reducing bone growth factors in the blood.
Medication
Some prescription drugs are available for preventing and treating osteoporosis by slowing or stopping bone loss, increasing bone density, and reducing the risk of fractures. Your doctor may prescribe one of the following medications:
Bisphosphonates
Bisphosphonates such as alendronate and risedronate slow bone loss and increase bone density in the spine and hips in women and men who have osteoporosis, including osteoporosis that develops from long-term use of corticosteroid medications such as prednisone or cortisone. To reduce digestive system side effects, take these medications on an empty stomach first thing in the morning with a glass of water. Remain upright, and don’t eat or drink anything or take any other medications for at least half an hour after taking bisphosphonates.
Calcitonin
Calcitonin is a naturally occurring hormone (produced by the thyroid gland) that is involved in calcium absorption and bone metabolism. In women who are at least 5 years past menopause, a synthetic form of calcitonin taken in a nasal spray once a day or in an injection every day or every other day slows bone loss and increases bone density in the spine. Calcitonin also appears to relieve the pain associated with fractures.
Estrogen
When a woman’s natural production of estrogen slows at menopause (or after surgical removal of the ovaries), taking low-dose estrogen and progestin in hormone therapy (see page 853) can slow bone loss, increase bone density, and reduce the risk of fractures in the hip and spine. Some estrogen compounds are even more effective when combined with bone-building drugs such as alendronate.
Selective estrogen receptor modulators
Selective estrogen receptor modulators (SERMs) such as raloxifene and tamoxifen, which are used for preventing and treating breast cancer (see page 857), also are used for preventing and treating osteoporosis. These medications, which are taken in pill form once a day, prevent bone loss and increase bone density in bones throughout the body. SERMs seem to have the beneficial effects of estrogen on bone without its potentially harmful effects on the uterus or breasts.
Parathyroid hormone
Parathyroid hormone is a naturally occurring hormone produced by the parathyroid glands (the two pairs of pea-sized glands next to the thyroid gland in the neck). Parathyroid hormone stimulates new bone formation by increasing the number and activity of bone-forming cells called osteoblasts. The medication, taken in daily injections, significantly increases bone density in the spine and hip and in bones throughout the body in postmenopausal women and in men and women who have osteoporosis from long-term treatment with glucocorticoids.
Vertebroplasty
Your doctor may recommend a nonsurgical procedure called vertebroplasty to treat a collapsing or fractured vertebra caused by osteoporosis. In this procedure, the doctor administers a local anesthetic and a contrast medium (dye) into the site of the fracture and, using X-rays to guide the needle, injects a liquid that contains bone cement. Antibiotics may be given at the injection site or intravenously (through a vein). The liquid cement hardens over 10 to 20 minutes and stabilizes and strengthens the fractured vertebra. The procedure can relieve back pain by preventing further collapse of the bone.