The decision to start a medication to halt or reverse bone loss should be made only
after a thorough medical evaluation and with expert medical advice. Some experts
consider that there are too many unanswered questions about their value to advise
people with osteopenia to start bone-strengthening drugs, especially those with a
low FRAX score. However, most fractures among women occur to those with
osteopenia, and a new study suggests that the treatment of osteopenia is advisable.
A 6-year study of women with osteopenia (T score between -1 and -2.5) found that
treatment with IV zoledronate at 18-month intervals reduced the risk of fracture by
37%.
If osteoporosis is present, most experts consider it a mistake to let fears about the
rare side effects of bone-strengthening drugs deter initiation of them. A woman’s
risk of a fracture at some time in her life is 50%, and when indicated, drug treatment
can reduce that risk by half.
More than 20 medications are available for the prevention and/or treatment of osteoporosis.
68 Studies have consistently shown that, depending on the drug and the
patient population, treatment reduces the risk of vertebral fracture by 30% to 70%,
nonvertebral fractures by 15% to 20%, and hip fractures up to 40%. Among the
possible drug therapies are bisphosphonates (usually the first choice for drug treatment);
estrogen agonists/antagonists (also called selective estrogen receptor modulators
or SERMS); calcitonin; parathyroid hormone; estrogen therapy; hormone
therapy; and recently various biologics.
In 2019, a monoclonal antibody romosozumab
(Evenity), a drug that promotes bone growth and inhibits bone resorption,
was approved by the FDA. Although effective in the prevention of osteoporotic
fractures, romosozumab may increase the risk of heart attack, stroke, and cardiovascular
death, so careful patient selection is advisable.
Poor compliance is one of the most important treatment problems. Studies show
that only 40% of patients take treatment for more than one year. At two years, only
20% of patients are still taking their medication. The use of bone-strengthening
drugs has declined after extensive publicity about rare but serious side effects.
An estimated one to four of 10,000 patients taking these drugs will sustain
an atypical broken thigh bone (femur), and one in 100,000 will suffer from bone
death (osteonecrosis) and deterioration of the jawbone with the risk heightened by
long-term, high-dose use.
This blog presents opinions and ideas and is intended to provide helpful general information. I am not engaged in rendering advice or services to the individual reader. The ideas, procedures and suggestions in that are presented are not in any way a substitute for the advice and care of the reader’s own physician or other medical professional based on the reader’s own individual conditions, symptoms or concerns. If the reader needs personal medical, health, dietary, exercise or other assistance or advice the reader should consult a physician and/or other qualified health professionals. The author specifically disclaims all responsibility for any injury, damage or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this blog or participating in any programs described in this blog or in the book, The Building Blocks of Health––How to Optimize Your Health with a Lifestyle Checklist (available in print or downloaded at Amazon, Apple, Barnes and Noble and elsewhere). Copyright 2021 by J. Joseph Speidel.
