Question:Is there a summary of osteoporosis medications that compare effectiveness,
side-effects, contra-indications, etc.
Answer:Hormone replacement therapy (HRT) is used for both treatment and prevention
of osteoporosis. HRT has been shown to improve bone mineral density at both
the spine and hip. In a 3-year study of 875 postmenopausal women, those
treated with estrogen gained 3.5% to 5.0% at the spine and almost 2% at the
hip, while those who received placebo lost almost 2% at the hip and spine.
Studies have shown an approximate 50% reduction in hip fractures in elderly
women who have used estrogen for a mean of 14 years. HRT has also been shown
to reduce the risk of coronary heart disease.
Alendronate is used for treatment of osteoporosis. In a 3-year study,
alendronate increased bone mineral density by 4% to 5% at the hip and about
6% at the spine compared with placebo. It also reduced hip, spine, and
forearm fractures by approximately 50% in postmenopausal women with low bone
mass and vertebral fractures, even in those older than age 65. Alendronate
is also approved for prevention of osteoporosis.
Calcitonin is used to treat osteoporosis. Available as a nasal spray, it is
taken once per day in alternating nostrils. Studies have demonstrated
improvements in spine bone density of 1% to 3% over 2 years, but no change
in hip bone density. In one recent study of postmenopausal women with
osteoporosis, those taking calcitonin had a 37% reduction in vertebral
fractures over 3 years compared with those taking placebo. However, no
investigators have yet demonstrated differences in hip fracture incidence
with calcitonin.
Raloxifene is an estrogen-like drug that has been approved for prevention
and treatment of postmenopausal osteoporosis. In a 2-year study, raloxifene
increased bone mineral density by 1.6% at the spine and hip, compared with
losses of almost 1% at these sites in subjects who received placebo. Recent
studies in postmenopausal women with osteoporosis report an approximate 50%
reduction in vertebral fractures, but there are no data yet to document a
reduction in hip fractures.
