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Monday, September 6, 2010
Osteoporosis
Click here to go directly to Drug Review Osteoporosis is characterized by low bone mass and structural deterioration of bone tissue, which increases the risk of fractures, especially of the hip, spine, and wrist. Osteoporosis can develop without any warning signs, thus people often don't consider prevention or treatment until they have suffered a fracture. Therefore, it is important that people identify risk factors and take immediate action to either prevent or treat osteoporosis.
Causes and Risk Factors Associated with OsteoporosisContrary to popular belief, osteoporosis can strike at any age. However, osteoporosis most commonly affects older post-menopausal women. Up to 20% of their bone mass is lost during the five to seven years following menopause. Factors that increase the risk of developing osteoporosis include: being female, having a small frame, having a family history of post-menopausal osteoporosis, being anorexic, having bulimia, eating a low calcium diet, using corticosteroids or anticonvulsants for a long time, smoking cigarettes, using alcohol excessively, being of Caucasian or Asian descent, and being male with low testosterone levels. Even though being of Caucasian and/or Asian descent is indicated as a risk factor for osteoporosis, people of all backgrounds have been shown to be at significant risk of developing osteoporosis.
How Common is Osteoporosis?According to the National Osteoporosis Foundation, about 10 million Americans have osteoporosis, 8 million of which are women. The incidence of fracture associated with osteoporosis has been reported to be twice as frequent in Caucasian women over age 65 as compared to African-American women over the age of 65. Nevertheless, as previously stated, people of all ethnic backgrounds are at significant risk of developing osteoporosis. In fact, it is estimated that 10% of all African-American women over the age of 50 have osteoporosis.
How Are People Affected by Osteoporosis?Osteoporosis can be very devastating for both men and women. It has been reported that 50% of all women and one in every eight males over the age of 50 will suffer from an osteoporosis-related fracture in their lifetime. Annually, osteoporosis is estimated to be responsible for over 1.5 million fractures. The National Osteoporosis Foundation estimates that in 1995 Americans spent $13.8 billion annually, or $38 million daily, on osteoporosis related fractures. The most devastating statistic is that approximately 24% of people over the age of 50, who suffer a hip fracture, die within one year following the fracture. Clearly, osteoporosis is a very devastating disease that often goes unnoticed.
Non-Drug Therapies for Osteoporosis Prevention and TreatmentAs with most diseases, it is usually best to pursue non-drug therapies before drug therapies because of the risk of side effects, and to avoid the problem of developing adverse drug interactions that are commonly observed in the elderly. The first step is to determine individual risk. People who feel they are at increased risk for developing osteoporosis are often recommended to monitor their bone mass loss via bone density tests. The tests are taken as frequently as once a year, and work by measuring bone density using X-rays and other technology. The bone density test is very effective at detecting osteoporosis if performed regularly, though it can be expensive and inconvenient. Many new systems are being developed, one currently at the University of Wisconsin-Madison, that are much smaller and convenient. These new systems would allow people to have a bone density test performed quickly and accurately in an inexpensive and convenient manner. Bone density tests are useful in detecting osteoporosis before a fracture occurs, and can even assist physicians in predicting the chance of a future fracture. They can determine the rate of bone loss, and even determine the effectiveness of certain treatments. Currently, many treatments aren't adequately evaluated for how effective they really are. Bone density tests will allow for better evaluation, thus improvement of current treatments. Exercise is a very effective and inexpensive method of osteoporosis prevention. Not only does it help reduce the risk of developing osteoporosis, but it improves quality of life and has positive effects on all aspects of a persons health. It is important to note that although exercise is extremely beneficial, people who have already had a fracture or are frail and may already have osteoporosis should avoid exercises that involve twisting of the spine or bending at the waist like high impact aerobics. People should consult a knowledgeable physician before beginning any exercise program. Exercise can be categorized into weight-bearing and resistance exercise. Weight- bearing exercise is where the body has to work against gravity, like an exercise where the legs and feet must bear the weight. Weight-bearing exercises include: jogging, walking, stair climbing, dancing, among others. Swimming and bicycling are not examples of weight-bearing exercise. Resistance exercise includes activities like weight lifting that use muscle strength to improve muscle mass and bone strength. A varied amount of weight-bearing exercise and resistance exercise will effectively strengthen bone and muscle mass, thus decreasing the likelihood of an osteoporosis-related fracture. Click here to learn more about exercise and its benefits in the prevention and treatment of osteoporosis. Another non-drug therapy option for osteoporosis is calcium supplements. The body naturally loses calcium everyday and cannot make its own. Therefore, calcium supplements are often beneficial when diet is insufficient in supplying adequate calcium. Food is the best source of calcium since it is most easily absorbed. However, food is often inadequate. An adequate daily intake of calcium has been defined by the National Academy of Sciences to be 1000-1200 mg daily; This is total calcium, not the amount provided by the supplement. Excessive calcium use should be avoided since it can contribute to the development of kidney stones and other disorders. It is also recommended to accompany calcium supplements with an over the counter form of vitamin D (400 I.U.) to aid in the absorption of the calcium. Click here to get more specific information on what kind of calcium supplement is right for you.
Drug Therapies for the Prevention and Treatment of OsteoporosisThere are currently four different drug-therapy options for osteoporosis. Two of the options, Estrogen Replacement Therapy (or Hormonal Replacement Therapy) and Fosamax (Alendronate), are approved for both the treatment and prevention of osteoporosis. Evista (Raloxifene) is approved for the prevention of osteoporosis, and Miacalcin (Calcitonin) is approved for the treatment of osteoporosis. Many other treatments are currently being investigated but have not yet been approved as of July 1999. “Estrogen Replacement Therapy (ERT), or Hormonal Replacement Therapy (HRT), is effective even when started after age 70. However, in light of the results from the NIH study terminated early in July 2002, there are safer alternatives in the treatment and prevention of osteoporosis than estrogens in combination with progestins. The NIH study showed an increased risk of breast cancer, heart attack and stroke for those taking estrogens in combination with progestins, but not estrogens alone. Although the risk was small there was no significant benefit that outweighed the risk, especially since there are newer, safer therapies available, e.g. Fosamax, Actonel and Miacalcin. Thus, if combination estrogen and progestin therapy (Prempro/Premphase) is beling used only for osteoporosis, we recommend seeking safer, effective alternatives such as Fosamax, Miacalcin, Evista or Actonel. Another treatment/preventive option for osteoporosis is Fosamax (Alendronate). It inhibits the breakdown and removal of bone in the body. It is most effective at reducing the risk of fracture in the hip and spine. Fosamax requires special methods of dosing that must be followed in order for it to work properly. Another drug-therapy option used for the treatment of osteoporosis is Miacalcin (Calcitonin). It is good for women who can't take, or choose not to take, Estrogen (ERT or HRT). It has been shown to be especially effective at increasing spinal bone density. Since Miacalcin is a protein, it requires an unusual dosing method via the nose or intravenous injection. Evista (Raloxifene) was recently approved for use in the prevention of osteoporosis. It is classified as a Selective Estrogen Receptor Modulator (SERM), and it stimulates certain estrogen receptors to elicit its effects on the body. In addition, SERM therapy is thought to be effective at protecting against heart disease, and does not appear to increase the risk of developing breast or uterine cancer. The drug reviews below give a good summary of the benefits and risks associated with each form of therapy. In any case, treatment options should be discussed with a knowledgeable doctor in order to determine what option may be most effective and the least detrimental. We hope this review has provided you with information to help you become informed about the prevention and treatment options for osteoporosis.
Estrogen Replacement Therapy (ERT)
Hormonal Replacement Therapy (HRT)
* This drug is not approved for the prevention of osteoporosis, although it is commonly used in conjunction with estrogens to minimize cancer risks associated with estrogen therapy.
Bisphosphonate Therapy
Selective Estrogen Receptor Modulator (SERM) Therapy
Micellaneous Therapy
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