New, lower-dose versions of the hormone therapies used to treat symptoms of menopause are currently being developed. The FDA recently approved a low-dose version of the combination estrogen-progestin treatment sold as Prempro, which is expected to be available in the summer of 2003
If you are currently using postmenopausal hormone therapy, talk with your health care professional first before stopping your medication; if you are using it to relieve menopausal symptoms, stopping the medication abruptly could make your symptoms worse. How you taper off your medication will depend on what type of therapy you are using. Conditions such as low bone density may return to pre-therapy levels and require another type intervention, if estrogen or estrogen-progestin therapy is stopped.
There are other drugs and lifestyle strategies to keep bones strong that don't involve the same risks. Other drugs prescribed to prevent and/or treat osteoporosis include the following (see Prevention section for lifestyle strategies):
- Alendronate (Fosamax, from the bisphosphonate class of drugs) is a bone-specific medication approved by the FDA to treat and prevent osteoporosis. Alendronate has been shown to increase bone mass and reduce the risk of spine, hip, wrist and other fractures by approximately 50 percent in women with osteoporosis. Alendronate has also been approved for the treatment of glucocorticoid-induced osteoporosis. Alendronate tablets should be taken on an empty stomach and with a full 6 to 8 ounce glass of water. The manufacturer recommends taking this medication first thing in the morning, at least 30 to 60 minutes before the first food, beverage, or medication of the day. To minimize side effects — which can include irritation of the gastrointestinal tract, other digestive problems, and ulcers — remain in an upright position for at least 30 minutes after taking this medication. Alendronate can be taken daily or as a weekly medicine regimen.
- Calcitonin (Miacalcin) is approved for the treatment of women who are five years postmenopausal and cannot tolerate estrogen therapy. Studies demonstrate that this medication helps maintain bone mass and modestly reduces vertebral fracture risk. It has not been shown to protect against other fractures. Because calcitonin is a protein, it cannot be taken orally as it would be digested before it could work. Instead, it is taken as a nasal spray or (less common) in injection form. Possible side effects include nasal irritation and inflammation.
- Raloxifene (Evista), taken as tablets, is a medication approved for the prevention and treatment of osteoporosis. Raloxifene has positive estrogen-like effects on bone but not on the breast or lining of the uterus. It is from a new class of drugs called selective estrogen receptor modulators (SERMS) that appear to prevent bone loss at the spine, hip and total body. Raloxifene has been shown to reduce the chance of spinal fracture by half in women with osteoporosis, but there is no data confirming that it reduces the risk of any fractures other than those of the spine. Possible side effects include hot flashes, blood clots in the veins (similar to estrogen) and leg cramps.
- Risedronate (Actonel, another type of bisphosphonate drug), taken as tablets, is a bone-specific medication approved to treat and prevent osteoporosis. It has been shown to increase bone mass and reduce the risk of spinal, hip and other nonspinal fractures in women with osteoporosis. It has also been approved for the prevention and treatment of glucocorticoid-induced osteoporosis. To minimize side effects — which can include irritation of the gastrointestinal tract, other digestive problems and ulcers — remain in an upright position for at least 30 minutes after taking this medication. Take any vitamins, calcium and antacids at least 30 minutes after you take risedronate. As always, discuss any symptoms with your health care professional.
- Teriparatide (Forteo), a new drug approved by the FDA in Nov. 2002, is the first medication that actually stimulates bone formation instead of slowing the breakdown of bone. The drug is administered by injection once a day and carries a special warning because in laboratory tests Teriparatide caused cancerous bone tumors in rats. However, such tumors -were not observed in 2,000 people who tested the drug in clinical trials. Side effects may include nausea, dizziness and leg cramps.
Discuss with your health care professional which therapies and lifestyle strategies, such as increasing calcium intake and exercise, are the safest, most effective options to meet your health needs and to prevent osteoporosis.