Osteoporosis

Medication for osteoporosis

The current medicines licensed for osteoporosis aim to prevent further bone loss and to reduce the risk of fractures. Osteoporosis is classified as a ‘chronic condition’ which means that existing medication does not cure it but can alleviate symptoms and improve the health of bones.
The drugs licensed in Britain to treat osteoporosis are:
 
Antiresorptive drugs which reduce bone loss
  • Bisphosphonates including: alendronate (Fosamax), risedronate (Actonel), ibandronate (Bonviva), and zoledronate (Aclasta).
  • Raloxifene (Evista).
  • Denosumab (Prolia) blocks a substance involved in the development of osteoclasts.
  • Calcium and vitamin D.

Anabolic drugs which stimulate bone formation

  • Teriparatide (Forsteo) this hormone helps to regulate calcium levels and the activity of cells involved in bone formation.

Taking medication

Many people with osteoporosis try different bisphosphonates in order to find the right one that will improve bone density and reduce the risk of having fractures and also the least problematic side effects. Many people said that it took some time to find the drug treatment that works for them. To have the best treatment with the least side effects is the ideal but some people faced more difficult treatment options than others, particularly if they had other medical conditions. Many people we talked with started with the cost effective generic drug, alendronate, to see how they got on with it before doctors suggested other options.

People on bisphosphonates mentioned a range of side effects including acid reflux, swallowing problems, scarred oesophagus, indigestion, aching joints - particularly in the hips. Sometimes the symptoms are worrying enough for people to have tests to eliminate other more potentially serious illnesses. Three women have noticed that their medication apparently caused gum problems. A few people reported minimal or no side effects.
Some of the people we talked to were clearly concerned about side effects and often learn about these from the medicine's package insert or from friends and the internet. Health professionals explain side effects but the information is poorly retained.
 
Several people were concerned about the short and long term side effects of medication but it hadn’t stopped most people taking it. One commonly used expression was “all drugs have side effects but I want to feel better.” However Susan and Susannah were so concerned about the side effects that they decided not to take the medicine.
People were also prescribed calcium and vitamin D mostly Calcichew D3 Forte and Adcal D3. Women diagnosed before the arrival of medication for osteoporosis said that they were usually prescribed calcium as well as HRT.
Reasons for taking medication
Many people took medication because they believed it gave them a far better chance of maintaining or improving their quality of life. Some did it because they worried about the prospect of being incapacitated and dependent on others in their old age. Others, because they want to increase bone density to avoid having more fractures. While others, having regained bone, wanted to maintain it. Trust in medical knowledge was also mentioned as reason for taking medication.
But it is not always easy to comply with a treatment which you feel is not making you feel any better, especially if you are experiencing side effects from the medication. Some people didn’t know how effective their current medication was because they hadn’t had a DXA scan in the last two years or so. Several people complained that they couldn’t see an immediate effect on their symptoms, particularly if they had pain. But a few men and women did think that their current medication was not working for them because they hadn’t seen any improvement in their pain levels nor had it stopped them from continuing to have fractures. So, some admitted that at times, it was easier or tempting to forget to take their medication particularly if they were having adverse side effects from it. Infusions treatments are done in hospital, which involves travelling to hospital for treatment which could be difficult for elderly or disabled people. A few people have had other serious medical conditions and not enough medical advice to make them aware of the need to have treatment for their osteoporosis.
Teriparatide (Forsteo)
A few people with severe osteoporosis and who had already tried other drug treatments with not much improvement were put forward by their consultants to get funding for the more recently licensed drug, teriparatide (Forsteo). Forsteo is administered through subcutaneous injections. This 24 month treatment is expensive and there are guidelines as to who can get it on the NHS: namely women and men over the age of sixty-five, with two or more fractures, very low bone density, and who are unable to tolerate, take or have an unsatisfactory response to bisphosphonates.
Diana, who is seventy, was recommended teriparatide by her private consultant shortly after she was diagnosed. Robert with the support from his consultant campaigned to get the treatment under the NHS. These people were all experiencing severe pain as a result of severe spinal osteoporosis and Sheila was confined to a wheelchair. Those who have already completed their treatment said that their DXA scan showed an improvement on their bone density. Sheila and Robert however, still need morphine patches for the pain which is the result of deterioration of bone health before diagnosis and before teriparatide was given. Victoria Iris is eighty-three years and is currently undergoing teriparatide treatment. She said that injecting is not a problem but the paperwork can be confusing.
Hormone replacement therapy (HRT)
HRT is still used to prevent osteoporosis where other drugs may be contraindicated (should not be used by this person). Some forms of HRT are approved to treat a woman with osteoporosis. There are concerns, however, about the possible health risks of hormone therapy in relation to an increase in the risks of breast cancer, heart attacks, stroke and blood clots, especially in women over 65 years. (For more information see our section on HRT and the menopause).  Irene was diagnosed with breast cancer after taking HRT for almost a year. She underwent a lumpectomy and radiotherapy. HRT was stopped.

Several women were prescribed HRT before developing osteoporosis and then later went on to be diagnosed with it. Likewise those put on HRT after diagnosis (in the 1960’s) felt that it did not stop them from losing bone or having fractures. Margery was treated with HRT and a biphosphonate and said that it had improved her condition. Keith was put on Testogel; a hormone replacement treatment for men to increased testosterone levels, but he had an adverse reaction to the treatment. Bisphosphonate can be used instead of male hormone replacement therapy.

Very few people we talked to had participated in clinical trials. A few women were invited to take part on a DXA scan study and only Sarah participated on a clinical trial testing a drug for osteoporosis. But she said that her experience wasn’t a positive one because the people doing the trial did not send her diagnosis of osteoporosis to her GP and it meant several years delay before Sarah was put on medication for her condition. 

All the drugs currently used in the UK are licensed for post-menopausal women. Some drugs are licensed for use by men. For premenopausal women and younger men these drugs can be used but with the guidance of the specialist.

Several people think that their GP hasn’t given them much information about the condition and how their medication works. The repeat prescription style doesn’t provide the opportunity to discuss any concerns they may have. Because of this, a few have seen a private consultant in order to find out more about osteoporosis and their treatment options, as well as talking about their own particular concerns. Insufficient information or advice from their doctor led to a few women deciding not to take their medication (see also Communicating with health professionals).

 

Last reviewed June 2017.
Last updated June 2017.

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