• Home
• Conditions
• Diagnosis
• treatment
• The team
• News/events
• Contact

• Osteoporosis
• Osteoarthritis

• Osteoporosis

• Osteoporosis
• Balloon Kyphoplasty

• Dr Gerard Hall
• Mr Peter Hamlyn
• Dr Jerry Healy
• Dr Richard Keen
• Dr Nigel Kellow
• Dr Justin Lee
• Mr Andy McEvoy
• Mr Hilali Noordeen
• PGH Nutritionist
• PGH Physiotherapy Dept.

Treatment of Osteoporosis

What treatments are available?

First and foremost it is important to have a full assessment of future risk of fracture. This is dependent upon a persons risk factors, their bone density scan and, sometimes, blood tests. If the risk of fracture is considered low or medium, then lifestyle advice is usually given and most doctors will consider dietary supplements and monitoring bone mass with a DEXA scan every 1-3 years. Exercise programmes will help to slow future bone loss. If the patient has a high risk of future fracture, then a bone-protective drug may be considered.

Drug treatments

There are now a number of different medications available that have been shown to reduce the risk of fractures. Many of these drugs have been studied in well conducted international trials providing us with very solid and robust data. Described below are the commonest drugs used to prevent bone loss:

Bisphosphonates

These are the most widely used drugs worldwide for the treatment of postmenopausal osteoporosis. There are a number of different drugs licensed for use in the UK in this group as listed;

• Alendronate (Fosamax) – oral
• Risedronate (Actonel) - oral
• Ibandronate (Bonviva) – oral and injection
• Zoledonate (Aclasta) – annual injection only

The bisphosphonates act by preventing bone loss and stabilising bone turnover and may reduce fracture risk by 50%. The oral preparations are usually taken once weekly. The patient takes the tablet with a full glass of water in the morning on waking and must stay upright without taking food or drink for the next 30-60 minutes. The tablets are usually well tolerated though some patients may experience indigestion and heartburn. Intravenous preparations are proving increasingly popular and offer an alternative for patients who may get side effects with the oral drugs. The choice is between an injection every 3 months in the clinic (Ibandronate) or an annual 1 hour infusion during a short day-case admission (Zoledronate). Some patients feel flu-like side effects (headache, muscle pain and fever) for 24-48 hours afterwards but otherwise these intravenous treatments are well tolerated. There are reports of bisphosphonates causing damage to the jaw bone (osteonecrosis of the mandible) but this is rarely seen in the field of osteoporosis and is mainly limited to the use of the drugs in patients being treated for types of bone cancer.

Raloxifene (Evista)

This is a derivative of HRT which doesn’t have the same potential side effects on breast tissue as HRT – in fact Raloxifene protects patients against breast cancer and may be a suitable drug in osteoporosis patients with a past or family history of breast cancer. It probably isn’t as effective as the bisphosphonates in preventing certain fractures, though is still an option in those unable tolerate them.

Strontium Ranelate (Protelos)

Strontium acts to prevent bone loss as well as to increase bone formation. Again, it reduces the risk of fracture by about 50%. It comes in a sachet to be mixed with water and taken at night before bed. It is generally well tolerated. There are reports of a very rare (16 patients worldwide; Oct 2007) and early reaction to the drug characterized by rashes and illness.

Teriparatide (Forsteo)

This is a self administered, subcutaneous injection given daily for eighteen months. It increases bone mass more than other treatments though the reduction of fracture risk is much the same. It is much more expensive than other treatments and therefore less widely used in the UK but is used mostly in patients with severe osteoporosis.