Monday, May 17, 2010

Osteoporosis Drugs Offer New Hope

Osteoporosis or ‘porous bone,’ is characterized by low bone mass and structural deterioration of bone tissue. It leads to bone fragility and an increased risk of fractures of the hip, spine and wrist.

According to endocrinologist Esther Krug, M.D., the director of the Sinai Hospital Center for Bone Health, there are risk factors you can control - make sure that you are getting the recommended dose of calcium, stop smoking and avoid excessive alcohol use. However, factors like age, gender and body frame size - small thin-boned women are at higher risk for osteoporosis - are beyond your control. Luckily, new treatment options make it easier to find some relief.

“The treatment of osteoporosis is developing really fast,” Krug says.

The goal of physicians like Krug is to keep patients from fracturing their bones and ending up in the hospital. Caregivers of an elderly parent should consider adding a rubber bath mat in the shower or tub, make sure the house is free of clutter, and use plastic or carpet runners on slick floors to prevent slipping.

Why does grandma's body react so much worse to a fall than yours?

Krug explains that your body stops adding new bone after age 30, with rapid bone loss beginning around age 50. Women lose bone mass faster after menopause. Fractures are a key cause of disability in post-menopausal women, and it is estimated that there are 1.5 million fractures from osteoporosis each year costing America $18 billion annually.

Plus, a 2004 report by the U.S. Department of Health and Human Services Surgeon General estimates there are 800,000 trips to the emergency room and 500,000 hospitalizations stemming from osteoporosis.

While fall prevention is important, endocrinologists may recommend daily or monthly bone-building medications for severe cases of bone loss.

“If taken as prescribed, the medication lowers the rate of bone loss dramatically,” Krug says.

In 2007, the New England Journal of Medicine published an article detailing results of a three-year trial involving a once-yearly injection of zoledronic acid for treatment of postmenopausal osteoporosis. Those patients receiving the medication were nearly 8 percent less likely to develop a break in the lower back than those who were not receiving it. The FDA approved zoledronic acid for treatment of osteoporosis in 2007.

The injections of zoledronic acid, known as Reclast, allow some patients to bypass oral medication, which for some patients causes stomach upset. Nursing home residents who exhibit a low rate of compliance may benefit more from a yearly injection rather than taking another pill.

Krug, who tends to see the most extreme cases of osteoporosis, estimates roughly 25 percent of her patients are taking Reclast.

“It does liberate the patient,” she says. ‘So far, it’s performing well, and it is well tolerated by patients.”

Other injectable treatment options include Boniva, which is given four times a year. And another new drug on the market – Forteo - builds bones, cutting the risk of fracture in half.

At Northwest Hospital’s Outpatient Infusion and Cancer Therapy Center, nurses see an average of one to two patients a week for Reclast treatment, says Northwest's Mary DeClue, R.N.

“With Reclast, it’s one appointment and you are done for the year," DeClue says. "There is a lot of work done on our end to make sure all the lab work is in order, and then we call the patient to set up an appointment."

She says the nurses have not received any negative feedback about side effects, other than fatigue. But experts warn that these medications should not be prescribed unless proper indications are met – patients should talk with their doctor about the best treatment for them.

(Adapted from MdMD for Life, 2010)

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