DRUGS & CONDITIONS

WHAT IS OSTEOPOROSIS?

Osteoporosis is a disease in which bones become fragile and break easily. If left unchecked, osteoporosis can progress painlessly until a bone breaks (fracture). Any bone can be affected, but of special concern are fractures of the hips, spine, and wrists. Osteoporosis and bone loss can be treated. In many cases, fractures can be prevented. 

Throughout life, old bone is removed and new bone is added to the skeleton. During childhood and adolescence, new bone is added faster than old bone is removed. As a result, bones become heavier, larger, and denser. Peak bone mass is reached around age 30. From that point on, more bone is lost than is replaced, usually at a slow rate. When women reach menopause and their estrogen level drops, bone loss begins to more rapidly exceed bone replacement. If not treated, excessive bone losses may lead to osteoporosis. Osteoporosis is more likely to occur if optimal bone mass was not achieved during the bone-building years.

Bone density also plays a role in bone health. Bone density is determined in part by the amount of calcium, phosphorus, and other minerals contained within the framework of the bone. As the mineral content of a bone (especially calcium) decreases, the bone becomes weaker. Getting enough calcium and vitamin D and exercising regularly can help ensure that bones stay strong throughout life.

An estimated 10 million Americans have osteoporosis, and 4 of 5 are women. Another 43 million have low bone mass. One in two women and up to one in four men aged 50 and older will break a bone due to osteoporosis.


Last Modified Date: April 6, 2015 © CVS/caremark. All rights reserved. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

RISK FACTORS FOR OSTEOPOROSIS

A risk factor is something that increases your likelihood of getting a disease or condition. White women and older women are most at risk for osteoporosis. But low bone density and osteoporosis can be common in other groups as well. If you have a number of risk factors, ask your doctor what you can do to reduce your risk.

Risk Factors for Women

Women are at greater risk of developing osteoporosis than men. This is because they have smaller, thinner bones than men and have a sudden drop in hormones — especially estrogen — at menopause.

Estrogen Deficiencies

Estrogen deficiencies occur as a result of:

  • Menopause: Natural or menopause induced by surgically removing the ovaries or those damaged by radiation or chemotherapy, increases your risk of osteoporosis. The risk of fracture increases significantly 5-7 years after menopause. 
  • Amenorrhea (cessation of menstruation before menopause): Amenorrhea may occur with eating disorders, such as anorexia nervosa, or with excessive or intensive exercise, such as long distance running.

Risk Factors for Men

Osteoporosis happens less often in men because:

  • Men have larger skeletons
  • Their bone loss starts later and progresses more slowly
  • They have no period of rapid hormonal change and bone loss

Hormonal Deficiencies

In men, deficiencies of testosterone and, to a much minor extent, estrogen play a role in the development of osteoporosis. This may be related to:

  • Advanced age
  • Certain conditions that reduce testosterone levels (eg, mumps, treatment for prostate cancer)
  • Hypogonadism (a severe deficiency in the male sex hormone)

By age 65 or 70 though, men and women lose bone mass at about the same rate. In fact, men are more likely than women to die within a year of breaking a hip.

Testosterone and Estrogen Deficiencies

Testosterone and estrogen (small amounts) help your bones stay strong. Low levels of these hormones can result in bone loss and osteoporosis in men. Some men lose testosterone as they age. Others have low levels after receiving androgen deprivation therapy to treat prostate cancer. After age 50, a man is more likely to break a hip due to osteoporosis than he is to develop prostate cancer. 

Risk Factors for Everyone

Aging

Bones become thinner with age. So the older you are, the higher your risk for osteoporosis.

Family History

A family history of osteoporosis or broken bones may increase your risk of osteoporosis.

Previous Fracture

If you have broken a bone after age 50, you are at risk of breaking another.

Dietary Factors

Your risk of developing osteoporosis increases if you don’t get enough calcium or vitamin D (from your diet, supplements, or the sun). Vitamin D helps your body absorb calcium. Getting enough protein, vitamins, and minerals is also important for bone health. Too much alcohol or caffeine may also increase your risk of osteoporosis.

Lack of Exercise

Regular exercise, especially weight-bearing and resistance exercise, helps strengthen bones. Therefore, if you do not exercise on a regular basis, you may increase your risk of developing osteoporosis. Individuals who do not exercise regularly also tend to have weaker muscles and poorer balance, which can lead to falls and fractures.

Smoking

Smokers may absorb less calcium from their diets. Women who smoke may have low levels of estrogen. If you smoke or have a history of smoking, you have a higher risk of developing osteoporosis.

Bone Structure and Body Weight

Small-boned women and underweight people of both sexes have an increased risk of osteoporosis. Individuals who have a thin, small or petite body frame are at increased risk of low bone density and fracture.

Ethnic Background

Ethnic groups have differences in bone mass and density. White women and Asian women are at highest risk for osteoporosis. African-American and Hispanic women are at risk too, but less so.

Medications

The long-term use of certain medicines increases your risk of osteoporosis. Examples include:

  • Aluminum-containing antacids
  • Certain anti-seizure medicines
  • Aromatase inhibitors
  • Cancer chemotherapeutic drugs
  • Cyclosporine A and FK506 (Tacrolimus)
  • Gonadotropin releasing hormone (GnRH) 
  • Heparin
  • Lithium
  • Medroxyprogesterone acetate for contraception 
  • Methotrexate
  • Proton pump inhibitors (PPIs) 
  • Selective serotonin reuptake inhibitors (SSRIs) 
  • Steroids (glucocorticoids) 
  • Tamoxifen (premenopausal use)
  • Thiazolidinediones 
  • Thyroid hormones in excess

Talk to your doctor before stopping or reducing your medicine.

Chronic Diseases

Certain chronic diseases and conditions may cause bone loss and increase your risk for osteoporosis:

  • Autoimmune disorders: rheumatoid arthritis, lupus, multiple sclerosis, and ankylosing spondylitis
  • Digestive disorders or surgeries: celiac disease, Crohn’s disease, ulcerative colitis, weight loss surgery, gastrectomy, and gastrointestinal bypass procedures
  • Endocrine/hormone disorders: diabetes, hyperparathyroidism, hyperthyroidism, Cushing’s syndrome, thyrotoxicosis, missing periods, premature menopause, low testosterone and estrogen levels in men
  • Blood disorders: leukemia, lymphoma, multiple myeloma, sickle cell disease, thalassemia, and other blood and bone marrow disorders
  • Neurologic/nervous system disorders: stroke, Parkinson’s disease, multiple sclerosis, and spinal cord injuries
  • Mental illness: depression, anorexia nervosa and other eating disorders
  • Cancer: breast or prostate
  • Other diseases and conditions: HIV/AIDS, chronic obstructive pulmonary disease, female athlete triad, kidney disease, liver disease, organ transplants, polio and post-polio syndrome, poor diet, scoliosis, and weight loss

There may be other diseases or conditions that cause bone loss. Talk with your doctor to find out if your current conditions may be causing bone loss.


Last Modified Date: April 6, 2015 © CVS/caremark. All rights reserved. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

SYMPTOMS OF OSTEOPOROSIS

Osteoporosis is often referred to as a silent disease. The associated bone loss usually occurs without symptoms. As a result, you may not know that you have osteoporosis until a strain, bump, or fall causes a bone to break.

In the early stages of osteoporosis, there is usually no pain or other symptoms. Once the bones have been weakened, you may have the following symptoms:

  • Vertebral fracture, which may initially be felt or seen in the form of:
    • Sharp back pain that does not go away
    • Loss of height over time, with stooped posture (kyphosis). With normal aging, everyone has some loss of height. However, a loss of one inch or more is significant and may indicate osteoporosis.
  • Fracture of a bone, such as the wrist or hip, due to the bones becoming over-brittle. This is sometimes the first symptom of osteoporosis.

If you have osteoporosis and back pain, see a doctor who is trained to treat osteoporosis. Also have your height measured once a year and have it written in your chart.


Last Modified Date: April 6, 2015 © CVS/caremark. All rights reserved. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

SCREENING FOR OSTEOPOROSIS

The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.

Screening Tests

The main screening test for osteoporosis is called a bone mineral density (BMD) test. This is a painless and safe method of measuring your bone mass. . A BMD test can detect osteoporosis before a fracture occurs and can estimate your risk of having a fracture in the future.

With a BMD test, your bone mass is measured and then compared to that of either (1) a healthy 30-year-old adult (T-score) or (2) the expected bone mass of someone your age and body size (Z-score). Because low BMD is common among older adults, comparison to peers your age can be misleading. The results of a BMD test will indicate whether you have normal bone density, low bone density (called osteopenia), or full-blown osteoporosis.

There are several types of BMD tests that are used to screen for or diagnose osteoporosis.

Screening Guidelines

Currently there is no consensus within the medical community regarding BMD screening tests. The decision whether to screen is usually made on an individual basis based on your risk factors. The National Osteoporosis Foundation recommends bone density testing if:

  • You are a woman aged 65 or older
  • You are a man aged 70 or older
  • You break a bone after age 50
  • You are a women of menopausal age with risk factors
  • You are a postmenopausal woman under age 65 with risk factors
  • You are a man aged 50-69 with risk factors


Your doctor may also recommend a bone density test if you have:

  • An x-ray of your spine showing a break or bone loss in your spine
  • Back pain with a possible break in your spine
  • A height loss of ½ inch or more within 1 year
  • A total height loss of 1 and ½ inches from your original height


For older men, the American College of Physicians (ACP) recommends that your doctor assesses your risk factors for osteoporosis. The ACP also recommends that you have a dual-energy x-ray absorptiometry (DXA, a type of BMD test) done if you are at an increased risk and are a candidate for drug therapy.


Last Modified Date: April 6, 2015 © CVS/caremark. All rights reserved. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

TALKING TO YOUR DOCTOR ABOUT OSTEOPOROSIS

You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with osteoporosis. By talking openly and regularly with your doctor, you can take an active role in your care.

General Tips for Gathering Information

Here are some tips that will make it easier for you to talk to your doctor:

  • Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.
  • Write out your questions ahead of time, so you don't forget them.
  • Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.
  • Don't be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.

Specific Questions to Ask Your Doctor

About Your Risk of Developing Osteoporosis

  • Based on my medical history, lifestyle, and family background, am I at risk for osteoporosis?
  • How do I know if someone in my family had or has osteoporosis? (What physical signs or symptoms should I be looking for?)
  • Am I currently taking any medication that puts me at higher risk for developing osteoporosis?
  • How can I prevent osteoporosis?
  • How do I know if my bone density is low?
  • How do I know if I have fractured a bone in my spine?

About Treatment Options

  • How do I best treat osteoporosis?
  • What medications are available to help me? 
  • What are the benefits/side effects of these medications? 
  • Will these medications interact with other medications, over-the-counter products, or dietary or herbal supplements I am already taking for other conditions? 
  • Do any of the medications I am taking for other conditions cause dizziness, light-headedness, disorientation, or a loss of balance that could lead to a fall? 
  • Do any of the medications I’m taking contribute to bone loss? 
  • Are there any alternative or complementary therapies that will help me?

About Lifestyle Changes

  • How much calcium is right for me?
  • How do I best obtain this calcium? 
  • Should I be taking calcium supplements? Do I need to worry about my vitamin D intake? 
  • Are there other dietary changes I should make? How do I go about it? 
  • Should I engage in exercise? 
  • What kind of exercise is best? 
  • How often should I exercise? 
  • How do I get started with an exercise program?
  • If I've already broken a bone, should I still exercise? What precautions should I take?
  • Should I stop drinking alcohol? 
  • How can I find help to quit smoking? 
  • What can I do to decrease my risk of falling? 
  • Should I rearrange things in my home?

About Your Outlook

  • How do I know that my prevention or treatment program is effective?
  • Will you regularly monitor my bone density?
  • Will I lose height?

Last Modified Date: April 6, 2015 © CVS/caremark. All rights reserved. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

PREVENTION AND REDUCING BONE LOSS

As with most health issues, diet and exercise are the key to getting and staying healthy. Here are some tips:

  • Watch your weight. Try to gain weight if you're underweight.
  • Diet. You need a diet rich in both calcium and Vitamin D, which helps your body absorb calcium and build strong bones. The best option is to get the nutrients naturally. For calcium, eat low-fat dairy products and green leafy vegetables; for vitamin D, seek out fortified products (like milk and cereal) or foods naturally rich in vitamin D like eggs and fatty fish such as salmon.
  • Get some sunshine. Your skin makes vitamin D from sunlight. Your body can store vitamin D and use it later. But many people stay out of the sun because of concerns about skin cancer. This limits the ability of the skin to make vitamin D. Most people need to get vitamin D from other sources, such as food and supplements. 
  • Exercise at least 30 minutes on most days of the week. Experts recommend regular "weight-bearing" exercise (in which your feet and legs bear the weight of your body), such as walking, Tai-Chi, stair climbing, tennis, or dancing. This type of exercise can slightly improve your bone density and also gives you strength, agility and balance which will help you avoid falls. Non-weight-bearing exercises (like swimming or biking) will help build muscle but do not provide much benefit to your bones.  Add weight-bearing exercise for your bones as part of your weekly program. Weightlifting 2-3 times a week also helps prevent bone loss and may even increase bone density slightly. You can start at almost any age. 
  • Cut down on bad habits. Don't smoke tobacco, cut down caffeine intake and drink alcohol only in moderation. All these substances have been linked to osteoporosis. 
  • Have a bone density test and take medications when appropriate. 

Last Modified Date: April 6, 2015 © CVS/caremark. All rights reserved. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

PROTECT YOURSELF FROM BONE FRACTURES AND BREAKS

Just remember that your bones aren't as strong as they used to be, even if your muscles are. Falls are especially dangerous for people with osteoporosis. Here are some ways to prevent injury:

  • Don't lift heavy objects.
  • Don't overdo the exercise; start an exercise program like walking slowly and gradually build up speed and distance.
  • Wear good shoes: no heels or slippery soles.
  • Don't let your pride get in the way of using a cane or walker if it helps you.
  • Have handrails installed on stairways.
  • Try to avoid icy, wet, and slippery surfaces; use nonslip mats and have grab bars installed in the bathroom.
  • Check your vision and hearing so you can better avoid falls; get a new prescription for your glasses if necessary.
  • Use bright lamps and night-lights.
  • Remove throw rugs or use skid-proof backing on them; keep your floors uncluttered to help avoid falls.
  • Use a cordless phone so you don't have to walk as far to get the phone. Or think about using a personal emergency-response system. Then you can call for help if you do fall.

Last Modified Date: April 6, 2015 © CVS/caremark. All rights reserved. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

REDUCING YOUR RISK OF OSTEOPOROSIS

Your bones grow and strengthen during childhood, but bone accumulation is not completed until you are in your twenties. The bone mass you attain before age 30 is your peak bone mass. The more bone you have at the time of peak bone mass, the less likely you are to break a bone or get osteoporosis later in life. After you reach peak bone mass, you may slowly start to lose more bone than you make. Bone loss usually speeds up in both men and women in midlife.

Childhood is also a critical time for the development of lifestyle habits conducive to maintaining good bone health throughout life. For example, exercising promotes strong bones. Cigarette smoking, which usually starts in adolescence, may negatively affect your ability to achieve peak bone mass.

Here are some tips on reducing your risk of osteoporosis:

Eat a Healthy Diet

Good nutrition is essential for normal growth. A balanced diet, adequate calories, and appropriate nutrients are the foundation for development of all your tissues, including bone. Inadequate intake of calcium and vitamin D is thought to contribute to the development of osteoporosis.

Calcium

Calcium is the nutrient most important for attaining peak bone mass and for preventing and treating osteoporosis.

You can increase your calcium intake by eating more calcium-rich foods such as low-fat and non-fat milk, yogurt, cheese, sardines, soy foods, and broccoli. Many foods such as orange juice, breakfast bars, and cereals are now fortified with calcium, as well. You can increase the calcium content of home-baked goods by adding non-fat powered dry milk to them. If you are unable to get adequate calcium in your diet, talk to your health care provider or a registered dietitian (RD) about a supplement.

High dietary protein, caffeine, phosphorus, and sodium can adversely affect calcium balance, but the effects may not be as important in individuals with adequate calcium intakes. Experts still disagree about the exact amounts of calcium and vitamin D that people need to stay strong and healthy. Here are some current recommendations:

Source Calcium
National Osteoporosis Foundation
  • Women age 50 and younger: 1,000 mg daily
  • Women age 51 and older: 1,200 mg daily
  • Men age 70 and younger: 1,000 mg daily
  • Men age 71 and older: 1,200 mg daily
Institute of Medicine
  • Women and men age 50 and younger: 1,000 mg daily
  • Men aged 51-70: 1,000 mg daily
  • Women age 51-70: 1,200 mg daily
  • Women and men age 71 and older: 1,200 mg daily

Vitamin D

Vitamin D is required for optimal calcium absorption and is also important for your bone health. Your skin manufactures vitamin D in response to direct exposure to sunlight. But using sunscreen decreases the amount of vitamin D you can get through your skin.

Older adults and people who are exposed to little sunlight may have difficulty meeting vitamin D requirements. Most infants and young children in the U.S. have adequate vitamin D intake because of supplementation and fortification of milk. During adolescence, when consumption of dairy products decreases, vitamin D intake may be inadequate, and this may negatively affect calcium absorption. Adolescence is also the most critical time for building bone mass that helps protect against osteoporosis later in life.

You can get more vitamin D by:

  • Eating foods naturally high in vitamin D, such as oily fish, beef liver, cheese, and egg yolks
  • Eating foods with added vitamin D, such as milk, cereal, orange juice, or yogurt
  • Taking a vitamin D supplement

Remember that excess vitamin D from supplements or cod liver oil can be toxic.

Experts still disagree about the exact amounts of vitamin D that people need to stay strong and healthy. Here are some current recommendations:

Source Vitamin D
National Osteoporosis Foundation
  • Women and men age 50 and younger: 400-800 IU daily
  • Women and men age 50 and older: 800-1,000 IU daily
Institute of Medicine
  • Women and men age 70 and younger: 600 IU daily
  • Women and men age 70 and older: 800 IU daily

Other Dietary Factors

You already know that calcium and vitamin D are important for bone health. Here are some other nutrients you need for strong bones:

  • Magnesium: beet greens, okra, tomato products, artichokes, plantains, potatoes, sweet potatoes, collard greens and raisins
  • Potassium: tomato products, raisins, potatoes, spinach, sweet potatoes, papaya, oranges, orange juice, bananas, plantains and prunes
  • Vitamin C: red peppers, green peppers, oranges, grapefruits, broccoli, strawberries, brussels sprouts, papaya and pineapples
  • Vitamin K: green leafy vegetables, such as kale, spinach, turnip greens, collards, Swiss chard, mustard greens, parsley, romaine and green leaf lettuce, broccoli, and cabbage

A healthy diet also includes getting enough protein, fruits, and vegetables. Excessive dieting or not getting enough calories can also be bad for bone health.

Due to side effects and medication interactions, talk to your doctor or dietician before you begin taking dietary supplements.

Exercise Regularly

There is strong evidence that regular physical activity in childhood and adolescence contributes to higher peak bone mass. Exercise can help maintain or even modestly increase bone density in adults. Exercise during later years, combined with adequate calcium and vitamin D intake, may help slow the decline in bone density associated with aging. Some evidence indicates that weight-bearing and resistance exercises are most likely to be beneficial.

To help reduce bone loss, engage in regular weight-bearing exercise. Examples include walking, jogging, tennis, dancing, hiking, and racquetball. Strength training (lifting weights) can also help increase your bone density and keep your muscles strong, so that you are less likely to fall.

If you have osteoporosis, avoid high-impact exercise like running or high-impact aerobics. Instead, ask your doctor about weight-bearing exercise. And always check with your doctor before you start any exercise program. A physical therapist or rehabilitation specialist can give you specific exercises to strengthen your back, teach you safe ways of moving during your daily activities, and help you create an effective exercise program.

Do Not Smoke

Smokers may absorb less calcium from their diets. Women who smoke may have low levels of estrogen. If you smoke or have a history of smoking, you have a higher risk of developing osteoporosis.

Avoid Excessive Alcohol and Caffeine

Alcohol has several negative effects on bones. Alcohol can interfere with vitamin D metabolism, which results in impaired calcium absorption. It also increases magnesium excretion. In addition, alcoholics tend to have diets that are lacking in many key nutrients, including calcium and vitamin D.

Heavy drinking can affect hormone production in both women and men. In premenopausal women, chronic alcohol use can result in irregular menstrual cycles. This reduces estrogen levels, increasing the risk of osteoporosis. Testosterone production may be affected in alcoholic men. Low testosterone levels have been linked to a decrease in bone formation.

Heavy alcohol consumption is associated with an increased risk of fracture. Alcohol affects your balance and gait making you more prone to stumble, trip, or run into objects.

Caffeine in high amounts can also cause bone loss. It interferes with calcium absorption and causes a small increase in the amount of calcium in the urine. Make up for any calcium loss by getting enough calcium to meet your body’s needs. Eat calcium-rich foods or take calcium supplements if you need them. Don’t substitute caffeinated drinks for milk and calcium-fortified juices.

Do you prefer soft drinks and sodas to coffee or tea? Certain soft drinks and sodas, especially colas, have caffeine and phosphorus. Like calcium, phosphorus is in your bones. Your body needs phosphorus. But some studies suggest that too much phosphorus can lower the amount of calcium your body absorbs. So far, there is no connection between the carbonation from soft drinks and bone loss. Again, if you choose soft drinks, just be sure to get enough calcium as well.

Talk to Your Doctor About Preventive Medicines

Current medicines approved by the U.S. Food and Drug Administration (FDA) have been shown to lower fracture risk in people who have had fragility fractures and/or osteoporosis (diagnosed by DXA). FDA-approved medicines for the prevention and/or treatment of postmenopausal osteoporosis include:

Bisphosphonates

Alendronate sodium

Alendronate is from a class of drugs known as bisphosphonates. It is approved for:

Ibandronate sodium

Ibandronate is another bisphosphonate. It is approved by the FDA for the prevention and treatment of postmenopausal osteoporosis.

Risedronate sodium

Risedronate is also a bisphosphonate. It is approved for the:

Alendronate, risedronate, and ibandronate must be taken on an empty stomach, first thing in the morning, with 8 ounces of plain water (no other liquid).

Zoledronic acid

Zoledronic acid is a bisphosphonate approved:

Zoledronic acid is given once a year or once every two years by infusion through the veins.

Calcitonin

Calcitonin is FDA-approved for the treatment of osteoporosis in women who are at least five years past menopause. This treatment is used when alternative treatments are not suitable. It is taken as an injection or a nasal spray.

Estrogen/hormone therapy (ET/HT)

ET/HT is approved for the:

Estrogen Agonist/Antagonist (formerly called SERMs)

Raloxifene

Raloxifene is one of a class of drugs called estrogen agonists/antagonists. It is approved by the FDA for the:

Raloxifene is available as a pill and should be taken once a day, with or without meals.

Tissue-Selective Estrogen Complex: Conjugated estrogens/bazedoxifene (Conjugated estrogens with estrogen agonist/antagonist)

Conjugated estrogens/bazedoxifene

This medicine is approved for women:

Conjugated estrogens/bazedoxifene is taken by mouth as a pill. It is only for postmenopausal women who still have a uterus. Like other products with estrogen, it should be used for the shortest amount of time possible and be consistent with treatment goals and risks for each woman.

Parathyroid Hormone: PTH (1-34), teriparatide

Teriparatide is an anabolic (bone-building) agent approved for:

Teriparatide is given by injection under the skin.

RANK Ligand (RANKL) Inhibitor: Denosumab

Denosumab is approved by the FDA:

Denosumab is given by injection under the skin every six months by a health professional.

Have a Bone Mineral Density Test

Osteoporosis often has no symptoms and can go undetected for years. For that reason, early diagnosis is important. A bone mineral density (BMD) test can find osteoporosis and determine your fracture risk. BMD is a painless safe test that measures the density (mass) of your bones. Talk to your healthcare provider about whether you are a candidate for a BMD test.

Talk to Your Doctor About Your Medicines

Some medicines that you are taking may contribute to osteoporosis. Examples of these medicines include:

  • Aluminum-containing antacids
  • Certain anti-seizure medicines
  • Aromatase inhibitors
  • Cancer chemotherapeutic drugs
  • Cyclosporine A and FK506 (Tacrolimus)
  • Gonadotropin releasing hormone (GnRH)
  • Heparin
  • Lithium
  • Medroxyprogesterone acetate for contraception
  • Methotrexate
  • Proton pump inhibitors (PPIs)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Steroids (glucocorticoids)
  • Tamoxifen (premenopausal use)
  • Thiazolidinediones
  • Thyroid hormones in excess

Last Modified Date: April 6, 2015 © CVS/caremark. All rights reserved. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

SUPPORT AND RESOURCES

HHS Office of Women's Health: Osteoporosis

Address:

US Department of Health and Human Services—Office on Women's Health

Phone:

1-800-994-9662

Description of services provided:

The Office on Women's Health (OWH) vision is to ensure that "All Women and Girls are Healthier and Have a Better Sense of Well Being." Its mission is to "provide leadership to promote health equity for women and girls through sex/gender-specific approaches." The website provides health and wellness information, statistics and health tools for the public and medical professionals.

Internet Address:

Women's Health.org

www.4women.gov

National Osteoporosis Foundation

Address:

1232 22nd Street NW
Washington, DC 20037-1292

Phone:

202-223-2226

Description of services provided:

At the NOF's website, you'll find "Fast Facts" on all aspects of osteoporosis-from risk factors to treatment options. You can also search a nation-wide database of healthcare professionals who treat osteoporosis, purchase educational materials, join a support group, and become an advocate for osteoporosis research and education.

Internet Address:

http://www.nof.org/

NIH Osteoporosis and Related Bone Diseases ~ National Resource Center

Address:

Bldg. 31, Rm. 4C02
31 Center Dr., MSC 2350
Bethesda, MD 20892-3676

Phone:

301-496-8190

Description of services provided:

This site covers osteoporosis as well as more rare bone diseases. In addition to the basics, this organization provides information on osteoporosis in men, Asian-American women, and Latino women. Several handouts are in Spanish, while others are large print or low-literacy.

Internet Address:

http://www.niams.nih.gov/bone/


Last Modified Date: April 6, 2015 © CVS/caremark. All rights reserved. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.