Can One Pill A Month Really Control Your Osteoporosis?

Can you imagine having bones so brittle that bending over or coughing hard could cause a fracture? Anyone with severe osteoporosis knows exactly what that’s like.

Osteoporosis is a disease in which bones become “demineralized,” losing so much calcium that they become weakened and break easily. The fractures occur most often in the hip and spine, and they can have very serious consequences. A hip fracture can interfere with a person's ability to walk and may cause a permanent disability or even death. Spinal fractures can result in loss of height, severe back pain, and skeletal deformity.

According to the National Osteoporosis Foundation, there are an estimated ten million Americans who currently suffer from this condition, and almost 34 million more who are at risk.

Why do so many people suffer from osteoporosis? Probably because it develops at a time when we least expect it.

According to Orna Kolker, M.D., Instructor in Clinical Obstetrics and Gynecology, and Assistant Attending Obstetrician and Gynecologist at New York Methodist Hospital, the origins of the disease actually begin during the teen years. ‘We achieve peak bone mass in our teens. What you build then is what manifests in later life.”

However, building bone density is not entirely within our control. According to Dr. Kolker, 60-70 percent of the amount of bone mass the body builds is directly affected by genetics. The other 30-40 percent is the result of healthy diet, and exercise. There are additional external factors that affect the 30-40 percent, such as:

• Cigarette smoking
• Excessive use of alcohol
• The number of pregnancies a woman has
• Breast feeding (This is short-term and the condition reverses itself after the woman stops breast feeding)
• Drastic weight loss
• Use of steroids

To be diagnosed as having osteoporosis, you must have bone mass density that is 2.5 standard deviations below a young normal adult. The young normal adult baseline was established by standardizing the peak bone mass density in 40-year-old women.

Pre-menopausal osteoporosis is rare, says Dr. Kolker. However, once women enter perimenopause, the interval lasting anywhere from two to eight years in which women transition into menopause, they have stopped building bone and have begun to lose bone density at the rate of one to three percent per year.

Once the diagnosis has been made, Dr. Kolker said there are four lines of defense to stop the demineralization of the bone:

• Calcium supplements with vitamin D – This is typically prescribed when the patient is diagnosed with osteopenia, a condition in which the bone density is 1.5 standard deviations below a young normal adult. Osteopenia is not a disease, but it does require continued monitoring.
• Bisphosphonates – These medications attach to bone tissue, and are absorbed into the osteoclasts, the bone cells that break down bone tissue. Popular forms of these bisphosphonates such as Fosamax, Actonel, and Boniva, act by breaking down the enzyme farnesyl diphosphate synthase (FPPS). The enzyme takes time to rebuild, which halts the demineralization of the bone.

Although all three drugs work in the same way to stop the progression of osteoporosis, why must you take Fosamax and Actonel weekly, but Boniva is only taken once a month? Dr. Kolker said it has to with the pharmacodynamics of the drugs, the way in which the drug acts and the relationship between drug concentration and effect. Boniva is designed to stay in the bone longer, with higher concentrations, and that is why it is only taken once a month.

• Selective Estrogen Receptor Modulators (SERM) – These medications mimic the way estrogen stimulates bone cells to increase the mineral density of bone. They are usually prescribed if there is no change with the bisphosphonates, or if the bisphosphonates have cause esophogitis, an inflammation of the esophagus caused by a reflux of acid-containing fluid from the stomach into the esophagus. Raloxifene is a SERM approved for the prevention and treatment of postmenopausal osteoporosis.
• Estrogen and progesterone therapy - Taking these hormones brings a woman's estrogen and progesterone levels back to premenopausal levels. This slows the demineralization process and causes some increase in bone thickness. Dr. Kolker noted that this used to be the first line of defense against osteoporosis until the study launced in 1991 by the Women’s Health Initiative indicated that this therapy resulted in increased risk of breast cancer, heart attacks, strokes and blood clots. It’s now the last form of treatment doctors use.

Osteoporosis is sometimes referred to as the "silent disease" because people may not know that they have it until their bones are so weak that a sudden fall causes a fracture. However, Dr. Kolker said that there are earlier warning signs that you may have osteoporosis:

• Having a family history of the disease
• Being seriously underweight
• Coming from an Eastern European background
• Having a personal history of fractures
• Smoking or drinking alcohol excessively
• Having kidney stones (urinating calcium instead of it being absorbed) or GI malabsorption syndrome (nutrients like calcium aren’t being absorbed into the bloodstream)

Keep in mind that there is no cure for osteoporosis, but it can be effectively treated. And as more drug companies look for more effective ways to treat the disease, controlling it will become even easier.

In fact, Dr. Kolker says that researchers are already working on a pill to be taken every three months and one that only needs to be taken yearly.