Treatment

There are a number of good treatments for primary osteoporosis, most of them medications. Two new medications, alendronate and calcitonin (in nose spray form), have been approved by the FDA (Food and Drug Administration). They provide people who have osteoporosis with a variety of choices for treatment. For people with secondary osteoporosis, treatment may focus on curing the underlying disease.

Drugs

For most women who've gone through menopause, the best treatment for osteoporosis is hormone replacement therapy (HRT), also called estrogen replacement therapy. Many women participate in HRT when they undergo menopause, to alleviate symptoms such as hot flashes, but hormones have other important roles as well. They protect women against heart disease, the number one killer of women in the United States, and they help to relieve and prevent osteoporosis. HRT increases a woman's supply of estrogen, which helps build new bone, while preventing further bone loss.

Some women, however, do not want to take hormones, because some studies show they are linked to an increased risk of breast cancer or uterine cancer. Other studies reveal the risk is due to increasing age. (Breast cancer tends to occur more often as women age.) Whether or not a woman takes hormones is a decision she should make carefully with her doctor. Women should talk to their doctors about personal risks for osteoporosis, as well as their risks for heart disease and breast cancer. Most women take estrogen along with a synthetic form of progesterone, another female hormone.The combination helps protect against cancer of the uterus.

For people who can't or won't take estrogen, two other medications can be good choices. These are alendronate and calcitonin. Alendronate and calcitonin both stop bone loss, help build bone, and decrease fracture risk by as much as 50%. Alendronate (sold under the name Fosamax) is the first nonhormonal medication for osteoporosis ever approved by the FDA. It attaches itself to bone that's been targeted by bone-eating osteoclasts. It protects the bone from these cells. Osteoclasts help your body break down old bone tissue.

Calcitonin is a hormone that's been used as an injection for many years. A new version is on the market as a nasal spray. It too slows down bone-eating osteoclasts.

Side effects of these drugs are minimal, but calcitonin builds bone by only 1.5% a year, which may not be enough for some women to recover the bone they lose. Fosamax has proven safe in very large, multi-year studies, but not much is known about the effects of its long-term use. That's why estrogen medications may still be the medicine of choice for a few years, as researchers continue to study other drugs. Several medications under study include other biphosphonates that slow bone breakdown (like alendronate), sodium fluoride, vitamin D metabolites, and selective estrogen receptor modulators. Some of these treatments are already being used in other countries, but have not yet been approved by the FDA for use in the United States.