Treatments for Osteoporosis

 

If you are found to have low bone density or osteoporosis, putting you at higher risk of fractures, you will usually be recommended to start the treatments below. In certain cases where other medications such as steroids can increase your risk of developing osteoporosis, the same treatments are used.

 

Calcium and Vitamin D supplements

If you are struggling to get enough calcium each day via your diet, then a supplement is beneficial. We usually give this along side vitamin D as they are both required to support bone health.

 

The most common tablets prescribed are:

• Adcal D3- 1 tablet twice daily
• Calcichew D3 forte- 1 tablet twice daily

 

If your calcium intake meets the recommended requirements of 700mg daily, then vitamin D can be prescribed alone such as Fultium D3- 1 tablet daily.

 

Bisphosphonates

 

What are Bisphosphonates? 

Bisphosphonates are a group of drugs that are used to reduce the risk of broken bones. Bones are constantly being broken down and built back up by special bone cells called osteoblasts and osteoclasts. This helps remodel the bone. When this process is out of balance, bones can become thin and weak as more bone is broken down than built back up. Bisphosphonate drugs are medications that alter this balance and prevent bone from being broken down and increase bone strength.

 

What are bisphosphonates used for?

Bisphosphonates are used to strengthen bones and prevent fractures in weak bones. They are primarily used for osteoporosis and can also be prescribed for people with Paget’s disease.

 

How are they taken?

Bisphosphonates come in a couple of different forms, they are most commonly taken as tablets, but they can be given intravenously- in a drip via a vein. They are usually prescribed along side calcium and vitamin D supplements.

 

Tablets:

• Alendronic acid is the most common bisphosphonate prescribed. This is a weekly tablet that is taken first thing in the morning on an empty stomach with a large glass of water. It is important to wait upright (sitting or standing) for 30 minutes after taking it before having breakfast, this is to help it be absorbed and prevent any side effects that can occur.
• Risedronate is taken in the same way and can be either a daily or weekly tablet.
• You should not take calcium and vitamin D supplements at the same time as your bisphosphonate as it can prevent absorption, wait at least 2 hours.
• The tablets are usually given for 5 years and then your bone density is reviewed to see if you need a further 5 years of treatment.

 

Intravenous drips

• Zolendronic acid is a bisphosphonate that is given once a year through a drip into a vein in the arm. The drip is given slowly over 15 minutes.
• It is usually reserved for if you have developed side effects or struggle with the tablets.
• Zolendronic acid is given either as a single dose or as a drip once a year for 3 years. Your bone density will then be reviewed at 5 years to see if you need a further course.
• You will require a blood test to check your calcium, vitamin D and kidney function before the drip.
• You should continue your calcium and vitamin D supplements every day for the full 5 years.

 

Side effects

There are a few possible side effects that can occur with taking bisphosphonate drugs, these are:

• Inflamed food pipe, heartburn, swallowing difficulties
  • Ensure the tablet doesn’t stay stuck in your food pipe by remaining upright for 30minutes after taking it with a full glass of water.
• Bone, joint or muscle pain
  • Often an initial response when you start the medication and can be relieved with paracetamol.
• Diarrhoea
  • This occurs rarely in around 3 in every 100 people.
  • Ensure you stay hydrated until it settles.
• Constipation
  • Occurs in 3 out of every 100 people.
  • Eating a well balanced diet with lots of fibre and fluids can prevent this.
• Headache
  • Occurs rarely, simple pain killers can help relieve this.
• Inflammation of the eye
  • Called uveitis or scleritis and occurs around once in every 100-1000 patients.
  • Results in pain and blurred vision, speak to your doctor about this.
• Osteonecrosis of the jaw
  • This is a very rare problem due to delayed healing in the jaw, usually after dental procedures.
  • Any dental work should be carried out before you start bisphosphonates and annual check ups should be carried out.
• Unusual fractures of the thigh bone
  • This is a rare type of fracture that can occur after a long time on treatment.

 

In addition to the possible side effects above, getting the drip form, zolendronic acid has 2 other possible side effects to be aware of:

• ‘Flu-like’ symptoms
  • These occur in every third person, usually after the first drip.
  • They usually settle after a couple of days.
• Irregular fast heart beat
  • This is called atrial fibrillation.
  • It is very uncommon and it is not clear whether it was caused by the medication.
  • You heart rate will be monitored before, during and after the drip.
  • If it occurs and doesn’t settle you may need medications to slow down the heart rate.

 

Cautions of use

Contraindications with other conditions

• If you have swallowing problems, digestive problems or suffer from Barrett’s oesophagus, tablet bisphosphonates should be avoided.
• In severe kidney problems, other medications are preferred.

Operations

• If you require dental surgery, bisphosphonates should not be started until after you have healed.

During pregnancy and breastfeeding

• Bisphosphonates are only used in females after the menopause.

Alcohol

• Excess alcohol can cause osteoporosis and falls so keeping within the recommended weekly 14 units is advised.

Vaccinations

• There are no contraindications to any vaccines.

 

Denosumab

 

What is Denosumab?

Denosumab is treatment for osteoporosis that helps prevent bone loss. Bones are constantly being broken down and built back up by special bone cells called osteoblasts and osteoclasts. This helps remodel the bone. When this process is out of balance, bones can become thin and weak as more bone is broken down than built back up. Denosumab is a protein called an antibody that blocks a protein that’s involved in stimulating bone resorption, therefore reducing bone loss.

 

How is it taken?

Denosumab is an injection that is given into the fat between the skin and muscle (subcutaneous) every 6 months. It is continued long-term.

It is important to take calcium and vitamin D supplements whilst you are receiving these injections.

Although denosumab can be given to patients with lower kidney functions, you will need to get your bloods checked for your kidney function, calcium and vitamin D levels before each injection.

 

Side effects

There are a few side effects that some patients can experience whilst taking denosumab, these include:

• Skin infections
  • These are rare and occur in around 4 in every 1000 people.
  • If you notice your skin getting red, swollen and painful and you feel unwell you should see your doctor.
• Low blood calcium levels
  • This occurs in 1 out of every 2000 people
  • If you experience muscle cramps, twitches or numbness and tingling in your hands and feet or around your mouth, speak to your doctor to get your bloods checked.
• Osteonecrosis of the jaw
  • This is a very rare problem due to delayed healing in the jaw, usually after dental procedures.
• Unusual fractures of the thigh bone
  • This is a rare type of fracture that can occur after a long time on treatment, it occurs at low force.

 

Cautions of use

Contraindications with other conditions

• If you have a latex allergy, the needle cover contains a derivative so it should be avoided.
• If you have a rare inherited disorder of fructose (fruit sugar) denosumab is not suitable.

During pregnancy and breastfeeding

• Denosumab is only used in females after the menopause.

Alcohol

• Excess alcohol can cause osteoporosis and falls so keeping within the recommended weekly 14 units is advised.

Vaccinations

• There are no contraindications to any vaccines.

 

 

Teriparatide

 

What is Teriparatide?

Teriparatide is a man made version of parathyroid hormone. Parathyroid hormone is a hormone that is naturally produced by the body to help regular calcium. It is usually produced by the parathyroid glands, which are small glands that are found in the neck.

Parathyroid hormone regulates calcium and reduces the risk of broken bones in osteoporosis.

Bones are constantly being broken down and built back up by special bone cells called osteoblasts and osteoclasts. This helps remodel the bone. When this process is out of balance, bones can become thin and weak as more bone is broken down than built back up. Parathyroid hormone increases the amount of bone that it built up, helping to strengthen bones.

It is often used in patients who have lots of spinal fractures and in those where other treatments haven’t been as effective.

 

How is it taken?

Teriparatide is given as a daily injection. It is a subcutaneous injection, meaning it is given into the layer of fat between the skin and muscle. The duration of treatment is usually for 2 years.

It is important to ensure that you are getting enough calcium and vitamin D whilst taking teriparatide, this may need to be as supplements.

 

Side effects

There are a few possible side effects that some people can experience whilst taking teriparatide, they usually settle down once your body is used to the injections, these include:

 

• Joint paints
• Headache
• Dizziness
• Low mood

 

Cautions of use

Interactions with other medications

• Your doctor or pharmacist will check that none of your medications interact.

Contraindications with other conditions

• If you have known high blood calcium, or have overactive parathyroid glands, teriparatide is not suitable.
• Teriparatide is contraindicated in patients with severe kidney or liver problems.
• It cannot be used in patients with Paget’s disease or certain cancers that have spread to the bones.

During pregnancy and breastfeeding

• Teriparatide is usually only used in patients after the menopause.

Alcohol

• Excess alcohol can cause osteoporosis and falls so keeping within the recommended weekly 14 units is advised.

 

Useful Links

Versus Arthritis: http://www.versusarthritis.org

Royal Osteoporosis society: http://www.theros.org.uk