Treatment of osteoporosis is multifaceted. It involves the use of drugs alongside dietary and lifestyle changes. One of the most effective drugs for the treatment of osteoporosis is bisphosphonate. However, there are several other drugs that are also important and effective although few will match bisphosphonates. Nevertheless these drugs can still play a significant role in slowing the progression of bone mass loss. The elderly who are at greater risk of osteoporosis, who may have the more advanced stage of the disease or cannot undertake regular physical need to ensure that drugs are not missed or discontinued.
Bisphosphonates are able to kill off the bone cells that are responsible for resorbing bone. It directly targets the cells which are responsible for the breakdown of bone. Other types of osteoporosis drugs usually have an indirect effect mainly by altering the hormones that regulate bone health and composition.
Even though the action of these drugs are well understood and its ability to preserve bone has been verified, it should not replace good dietary practices and a healthy lifestyle for osteoporotic patients – both men and women. It is only a combination of treatment measures that can ensure long term management of osteoporosis.
This is a hormone from the thyroid gland which can be administered artificially. Normally calcitonin is secreted when the blood calcium levels are too high. Synthetic calcitonin can cause more calcium to be deposited in the bones thereby increasing the bone mineral and its strength. It is administered by the use of a nasal spray or injection.
However, long term or excessive use can weaken the bones and calcitonin should therefore be used in moderation. Adequate supplementation of calcium and vitamin D is also required simultaneously with calcitonin usage.
Parathormone (parathyroid hormone secreted by the parathyroid gland) is known to cause bone to break down and deposit its calcium in the blood. This only occurs when the parathormone levels are continuously high. However, this hormone is able to achieve the opposite effect, that is bone formation, if it is administered intermittently.
Parathormone is administered only through injections.
Estrogen is administered as hormone replacement therapy (HRT) to menopausal women. It is able to act on the bone tissue which has estrogen receptors to stimulate bone development. In addition, estrogen blocks the effects of high parathormone levels which break down bone and deposit calcium into the blood.
Some drugs are not estrogens but have an estrogen-like effect. These drugs are known as selective estrogen receptor modulators (SERMs). Although it is not as effective as estrogen itself in preventing or limiting postmenopausal osteoporosis, it has been shown to be effective in preventing spine fractures. SERMs are not useful for other menopause symptoms.
This drug is effective for preventing spine and hip fractures in women with postmenopausal osteoporosis. It acts by targeting specific compounds which can increase the activity and lifespan of osteoclasts – the cells responsible for bone breakdown. Denosumab is administered through an injection. It should be used along with vitamin D and calcium for maximum benefit.