New drugs enlisted to battle osteoporosis

On Call

March 19, 1996|By Dr. Simeon Margolis | Dr. Simeon Margolis,SPECIAL TO THE SUN

My wife is 66 and suffers from severe osteoporosis. Could you tell me if there are any new treatments for her disorder?

Osteoporosis results from an imbalance between the continuing processes of calcium removal from bone (bone resorption) and calcium entry into the bone (mineralization or bone formation). When resorption overtakes formation, the result is a decrease in bone density and strength.

A diagnosis of osteoporosis is made in postmenopausal women when bone mineral density is at least two standard deviations below the average level found in premenopausal women.

The major danger of osteoporosis is bone fracture, particularly in the spine (vertebrae) and hip (femur).

Two new and effective medications have, in fact, recently been approved by the Food and Drug Administration to treat osteoporosis. Before considering their use, however, your wife should not forget about other important measures to treat osteoporosis. These include limiting alcohol, not smoking, exercising regularly, taking adequate amounts of calcium every day (up to 1500 mg a day), vitamin D supplementation (400 to 800 International Units), and estrogen replacement.

Other treatable causes of osteoporosis include excessive blood levels of thyroid hormone, either due to overproduction by the thyroid gland or too large a replacement dose of thyroid hormone. (Men also get osteoporosis and low levels of testosterone are a contributing factor.)

One of the new drugs is alendronate (Fosamax), which increases bone mineral density by inhibiting bone resorption while allowing new bone formation to proceed in a normal manner. Studies have shown that alendronate, 10 mg daily, progressively increased bone mineral density throughout the skeleton, including the spine and hip, and reduced by 48 percent the number of women who had new vertebral fractures.

Alendronate must be taken only with a full glass of plain water, first thing in the morning on an empty stomach. You should not lie down or take any medications, drink beverages or eat for at least 30 minutes after taking the alendronate. The drug is well tolerated; the most common side effects are crampy abdominal pain and diarrhea.

The other recently approved product is a nasal spray form of the hormone salmon calcitonin, a synthetic protein similar to a hormone produced by cells in the human thyroid gland. Long available for use by injection, the calcitonin nasal spray (Miacalcin) also inhibits excessive bone resorption and increases bone mineral density in the spine, but does not do so in the hip.

The drug is administered by a single daily spray in one nostril.

Treatment with Miacalcin is associated with fewer side effects than with the injected salmon calcitonin. Rhinitis (nasal inflammation) and other nasal symptoms are the major side effects, and periodic nasal examinations are recommended.

Based on their effectiveness, the preferred order for using drugs to treat osteoporosis in postmenopausal women is as follows: estrogen, alendronate, salmon calcitonin.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

Pub Date: 3/19/96

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