Dr. Norman B. Gaylis
The treatment of osteoporosis is a very exciting area in which we have made huge progress in the last few years. More recently this year Eli Lilly introduced Forteo, which is an injectable form of parathyroid hormone. It dramatically reverses bone loss and is indicated in individuals who have suffered from repeated bone fractures and have bone loss that is not adequately responding to other forms of therapy. This group of patients, while small, is a group of patients who at this point in time have essentially been untreatable. It illustrates the dramatic strides we are making in treating osteoporosis.
The majority of patients will not require the injectable therapy, as there are other forms of therapy available on the market that will adequately prevent bone loss if administered in time. The group I am referring to is the so-called Bisphosphonates. The two Bisphosphonates are Fosamax, which was the first one introduced, and more recently, Actonel. Both these drugs are taken once a week, cause minimal side effects and are tolerated by the majority of individuals. Obviously, if someone does have a history of esophageal problems we need to be very cautious with the use of this type of medication. The outcome and results of the use of the Bisphosphonates has reduced the incidents of bone fractures significantly and has improved bone densities dramatically.
Another form of therapy, which should be strongly emphasized, which is not hormonal, is the use of a drug called Evista. This is a very smart drug that was designed specifically to stimulate bone production.. At the same time it would appear to have protective benefits on both the breast and new found tissue as opposed to the standard hormonal therapy of estrogen, which has recently fallen into strong disfavor despite its positive effects on the bone. Standard estrogen therapy was given most commonly for many years in a combined fashion with progesterone and has been associated with increased incidence of breast cancer and cardiac disease.
The choice of the drug for the treatment of osteoporosis would depend on the circumstances of each patient. I strongly recommend that an expert in the treatment of osteoporosis evaluate every patients’ own individual circumstances and this will vary from patient to patient. In every situation, the treatments mentioned above have to be supplemented with the use of calcium and vitamin D. Ideally, the calcium should be calcium carbonate to be taken at a dose of 1000 mg of calcium in pre-menopausal women and 1500 mg for post-menopausal women. As I explain to most of my patients, when you build a brick wall, the wall is made out of both bricks and cement so in the base of building bone, the calcium is the cement.