Newsletters

Summer 2008

Inside Bones: How Osteoporosis Drugs Work

Osteoporosis is a disease that weakens bones and makes them susceptible to fracturing (breaking), sometimes with little or no trauma. If you have osteoporosis, you may be comforted in knowing that there are many medications that can make your bones stronger and reduce the risk of fractures. You are probably interested in the effectiveness, safety, convenience, and cost of taking medication.  Physicians are interested in the same sort of issues, but usually think in terms of the balance between risk and benefit.

At New Mexico Clinical Research & Osteoporosis Center, we go a few steps further, since we not only care for patients with osteoporosis, but we are also involved with developing new treatments.  In addition to thinking about the risk and benefit of drugs that are currently available, we have a strong interest in what makes bones strong, and what makes them break when they shouldn’t. A thorough understanding of the causes of osteoporosis allows us to do a better job of finding new treatments.

We know that bone is more than a structure to keep our bodies from collapsing. The skeleton is an active organ that is continually being renewed through a process called bone turnover. This is done by the resorption or dissolving of bone in many small packets, followed by replacement of new bone. When this process is out of balance (bone resorption exceeds formation), then osteoporosis eventually develops.

Medications that treat osteoporosis all have an effect on bone turnover, by either reducing bone resorption, increasing bone formation, or both. Most medications work by reducing bone resorption. These include Fosamax, Actonel, Boniva, Reclast, Evista, Miacalcin, and Fortical. They all increase the strength of the bone you have and reduce the risk of fractures. They are taken daily, weekly, monthly, every 3 months, or every 12 months, depending on the medication and the route of administration.

One drug, Forteo, is different than the others. It is classified as a bone-building drug. Forteo increases bone formation and builds new bone where bone has been lost. Its use is normally restricted to two years.  Forteo is less convenient than the other drugs (it is given by daily self-injection, much the same as a diabetic taking insulin shots) and it is more expensive, but for the right patients it is the best drug.

Some exciting new drugs in development are targeted to individual molecules that control the process of bone resorption or formation. You will learn more about these drugs in future issues of this newsletter.

E. Michael Lewiecki, MD                                    
Lance A. Rudolph, MD

This page update 07/09/08