Other Osteoporosis Medications That May Help Prevent Spinal Fractures
There are many different types of medications that doctors may prescribe to treat osteoporosis and help reduce the risk for a painful spinal fracture. One class of drugs are the bisphosphonates that includes alendronate, ibandronate, risedronate and zoledronic acid. In this article, we include other types of medications your doctor may prescribe to help you avoid or manage low bone mineral density (BMD).
Brand Names: Fortical, Miacalcin
What it does: It helps treat osteoporosis in postmenopausal women who are at least five years beyond menopause. Calcitonin slows bone loss and increases bone density in the spine. It may reduce the risk of spinal fractures.
How to take it: Daily nasal spray or injection.
- The nasal spray is stored in the refrigerator until the first use; then should be kept at room temperature. The nasal spray should be primed (pump bottle until full spray is produced) before the first use.
- Calcitonin nasal spray is administered as a single spray into one nostril each day. Alternate nostrils daily.
- Calcium (at least 1000 mg elemental calcium daily) and vitamin D (at least 400 international units daily) supplements are recommended with the use of calcitonin.
Potential side effects: Runny nose, headache, back pain, or nosebleed. The injectable calcitonin may cause an allergic reaction and flushing of the face and hands, urinary frequency, nausea and a skin rash. There has been an increased risk in the development of cancer with the use of calcitonin nasal spray. Therefore, its use is suggested when alternative treatments are not a suitable option.
Tests required: Blood tests to check calcium levels.
Brand Name: Prolia
What it does: It helps to treat osteoporosis in postmenopausal women at high risk of fracture. Denosumab also increases bone mass in men with osteoporosis at high risk of fracture. This medication may be used to treat bone loss in men and women, who are receiving certain treatment for cancer. The drug may help reduce the risk for breaking bones in the spine, hip and other bones.
How to take it: By injection every six months (in a doctor’s office). Calcium and vitamin D supplements are recommended with the use of denosumab.
Potential side effects: Denosumab may lower the calcium levels in the blood. Signs of low calcium levels include muscle spasms, muscle twitches or cramps; numbness and tingling in the fingers, toes or around the mouth. The drug may also cause skin rashes, back, arm or leg pain, increase in cholesterol levels or infections. Denosumab may cause severe jaw bone problems and unusual fractures in the thigh bone.
Testing required: Blood test before each dose to confirm that blood calcium levels are normal.
Brand Name: Evista
What it does: It helps to prevent and treat osteoporosis in postmenopausal women. Raloxifene increases bone mineral density and reduces the risk of spine fractures. It is approved to decrease the risk of breast cancer in women with osteoporosis and in women without osteoporosis who are at high risk of invasive breast cancer. Raloxifene works by affecting estrogen receptors in the body.
How to take it: Daily in tablet form with or without food.
Potential side effects: Hot flashes, leg cramps, swelling and temporary flu-like symptoms. This medication may increase the risk for blood clots (deep-vein thrombosis vein thrombosis and pulmonary embolism).
Who shouldn’t use it: Raloxifene should not be taken by women at increased risk for stroke. This includes women who have had previous strokes, transient ischemic attacks (TIA), atrial fibrillation or uncontrolled high blood pressure.
Teriparatide Parathyroid Hormone (PTH) (1-34)
Brand Name: Forteo
What it does: It treats osteoporosis in postmenopausal women and in men at high risk of breaking a bone. It may help reduce the risk of spinal fracture.
How to take it: Self-administered as a daily injection from a preloaded pen that contains a one-month supply of medicine. The medication can be injected into your abdomen or thigh. The medication pen device is stored in the refrigerator.
Potential side effects: Decrease in blood pressure when you change positions, which can cause you to feel dizzy, notice a fast heartbeat or feel faint. This can occur within 4 hours after you take the injection; however, those symptoms usually go away after a few hours. Other side effects include leg cramps, nausea and increase in calcium levels in your blood.
Who shouldn’t use it: People with Paget’s disease (abnormal bone formation), or those whose bones have not fully formed or matured. PTH should not be taken by people with increased blood calcium levels, metabolic bone disease such as hyperparathyroidism, or bone cancer.
Estrogen and Hormone Therapy
Multiple brands available
What it does: It may help prevent osteoporosis in postmenopausal women by reducing bone loss. The therapy may help increase BMD in the spine and hip, and reduce the risk of hip, spine and other fractures. It relieves menopausal symptoms (eg, hot flashes). However, this therapy is no longer a first-line approach for the treatment of osteoporosis due to increased risk of cancer, stroke or blood clots in other areas of the body.
How to take it: In tablet form or as a skin patch (ie, transdermal). Estrogen therapy alone is only prescribed for women who have had a hysterectomy or partial hysterectomy because therapy can increase a woman's risk of developing endometrial cancer. A progestin hormone is administered with estrogen if a woman has an intact uterus.
Potential side effects: Side effects of estrogen therapy can include vaginal bleeding, breast tenderness, swelling and headache.
Who shouldn’t use it: Women who have had breast cancer or are at high risk for breast cancer. Women who have a history of blood clots.
How Your Doctor Determines if Your Osteoporosis Drug is Working
It is important to make sure the medication your doctor prescribes is effectively working to prevent or manage your osteoporosis and risk for fracture. During your treatment, your doctor will periodically order certain tests.
Tests may include:
- Blood or urine tests to measure enzymes, proteins and other substances predictive of your BMD—the density or strength of your bones.
- Blood tests to measure markers of bone formation, such as bone-specific alkaline phosphatase (Bone ALP or BALP) or osteocalcin; a marker of bone loss called urinary N-telopeptide of type I collagen, or uNTX; and levels of vitamin D, which is essential for the body’s absorption of calcium.
- Bone densitometry, also called bone scanning or dual-energy x-ray absorptiometry (DXA).