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December 2002
Medications
for postmenopausal osteoporosis prevention
Risk of osteoporosis increases after menopause, when levels of estrogen
— which helps preserve bone density — drop. Until recently,
most doctors recommended long-term hormone replacement therapy (HRT)
to treat postmenopausal women who need medication to prevent bone loss.
But things changed after results from a large trial on a common HRT drug
showed that estrogen plus progestin (as the medication Prempro) did more
harm than good. An increased risk for breast cancer and cardiovascular
events outweighed the benefits of less colorectal cancer and fewer fractures.
(See the Update from July 2002 for more information on the trial.)
Health experts now encourage most women who have been taking long-term
HRT for osteoporosis prevention to consider an alternative. Fortunately
there are several options. Each of the FDA-approved treatments (see chart)
has potential benefits and risks that women and their doctors should
weigh before making a decision. Even with HRT’s proven risks, it
may still be a good choice for certain women — especially in lower
doses, which recent data have shown to have bone benefits comparable
to higher, standard doses.
Approved medications
for osteoporosis prevention |
Medication |
How to take it |
Bone benefits |
Side effects |
Comments |
Alendronate (Fosamax) |
Orally, once daily in the morning or as a larger
dose once a week; take with 6–8 ounces of water and stay
upright for 30 minutes. |
Increases bone density at the spine and hip; reduces
spinal and hip fracture risk. Side effects uncommon. |
Heartburn, nausea, inflammation of the esophagus,
muscle pain. |
Interferes with cells that break down bone. Well-tolerated
when taken properly. |
Risedronate (Actonel) |
Orally, once daily in the morning or as a larger
dose once a week; take with 6–8 ounces of water and stay
upright for 30 minutes. |
Increases bone density at the spine and hip; reduces
spinal and hip fracture risk. Side effects uncommon. |
Abdominal pain, nausea, constipation, joint pain. |
Interferes with cells that break down bone. Well-tolerated
when taken properly. |
Raloxifene (Evista) |
Orally, once daily, any time. |
Increases bone density (but less so than alendronate
or risedronate); reduces spinal fracture risk. Side effects uncommon. |
Hot flashes, leg cramps, deep-vein blood clots. |
Acts like estrogen in bone but is an anti-estrogen
in breast tissue; may reduce breast cancer risk. |
Estrogen (Premarin, Estrace, other brands) |
Orally, once daily, any time; or weekly by skin
patch. |
Increases bone density; some evidence for fracture
reduction. |
Increases the risk for breast cancer (after 4–5
years) and cardiovascular events when combined with a progestin
(as Prempro) and taken orally. |
May be recommended if other medications are not
tolerable or menopausal symptoms persist. |
Sources: Boosting Bone Strength: A
Guide to Preventing and Treating Osteoporosis, Harvard
Health Publications, Boston, 2000; Managing Osteoporosis,
Part 3: Prevention and Treatment of Postmenopausal Osteoporosis, American
Medical Association, 2000; Osteoporosis: Guide to Prevention,
Diagnosis, and Treatment, Brigham and Women’s Hospital,
Boston, 2002 |
December 2002 Update
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