After the age of 40, our bones begin to lose calcium faster than they absorb it, and the gap widens with age, causing osteoporosis. This is the reason why some elderly people are shorter than when they were young. Osteoporosis greatly increases the risk of bone fractures, which not only cause pain and extreme inconvenience, but also increases fatalities after falling. To prevent or delay osteoporosis, supplementing with enough calcium and vitamin D every day is the first step. But if despite taking enough calcium and vitamin D, osteoporosis still occurs after a bone density test, the doctor will start the patient on prescription medications. There are several types of medications that can be used to treat osteoporosis. Due to space limitations, this article only focuses on the two most effective and most commonly used types of medications.
Biphosphonate oral medications: Alendronate (FosamaxⓇ), Risedronate (ActonelⓇ)
Our bones are living organs, constantly shedding aging bone cells and building new bone cells. Within our bones, osteoBlast cells absorb calcium from the blood to create new bone cells, while osteoClast cells remove aging bone cells to allow new bones to grow. Bisphosphonates can inhibit the operation of osteoclasts, thereby reducing the chance of bone cell loss.
There is sufficient data to show that bisphosphonates can increase bone density by 1.6% to 7% after three years of use, and can reduce the risk of bone fractures by 20% to 50%.
Bisphosphonates are usually taken once a week (the long-acting version of Risedronate can be taken once a month), and must be taken on an empty stomach. It is recommended not to lie down within half an hour after taking it to avoid the side effect of acid reflux. Most side effects are limited to gastrointestinal discomfort, and the chance of causing fractures or jaw necrosis is extremely low (the chance is 4.5/10,000).
After long-term use, bisphosphonates can remain in the bones and exert their effects for one to ten years. Therefore, you can discuss with your doctor after taking them for three to five years. If the results of the bone density test are satisfactory three to five years after taking bisphosphonate, you can consult with your doctor if you can stop taking bisphosphonate until the next bone density test
Denosumab: ProliaⓇ, JubbontiⓇ
Denosumab is a monoclonal antibody that prevents osteoclasts from maturing. After three years of treatment, bone density can usually be increased by 5.2% to 8.8%, and the risk of bone fractures can be reduced by 20% to 68%.
Denosumab is injected subcutaneously every six months and can be administered at a clinic or community pharmacy. Side effects are usually mild (fatigue, muscle pain), and most patients experience almost no side effects after the injection. The chance of fracture or jaw osteonecrosis is also extremely low (28/10,000).
Unlike bisphosphonates, the efficacy of denosumab can only last for six months. If denosumab therapy stopped for more than a year, the rate of osteoporosis will begin to accelerate. Therefore, denosumab treatment should not be stopped casually after starting.
Bisphosphonates and denosumab are both very effective in reducing the risk of fractures, with denosumab seems to have a slightly better outcome. However, denosumab is more expensive, about $250 per dose (bisphosphonates: about $60 to $120 per half year). As for bisphosphonate, those who are prone to acid reflux and stomach pain should avoid taking it. Patients who need medication to deal with osteoporosis can consult a doctor.
https://www.osteoporosis.foundation/health-professionals/treatment/bisphosphonates
Int J Clin Pract.2012 Dec;66(12):1139-46. doi: 10.1111/ijcp.12022. Epub 2012 Sep 12.
https://www.drugs.com/medical-answers/prolia-increase-bone-density-3553495
N Engl J Med 2009;361:756-765/DOI: 10.1056/NEJMoa0809493/VOL. 361 NO. 8