Most of the medications described below are proven to increase bone density and lower the risk of fractures. Some have also been proven to lower the risk of fractures in the spine and the hip. Many studies on the effectiveness of these medications have been done in postmenopausal women. Some of the studies were also done in men and in patients taking cortisone medications, which greatly increase the risk of osteoporosis. The risk of fractures dropped over six to twelve months. Many researchers believe that the quick improvement in fracture risk is due to microscopic changes in the structure of the bones that makes them stronger and less likely to break. These microscopic changes happen in addition to the improvement of the total amount of bone present.
The most effective medications to prevent fractures are listed below. These medications have been used mainly in postmenopausal women, but are being used as well in men with osteoporosis, in men and women who take prednisone, and in some perimenopausal women. Your doctor can help you decide whether any of them are appropriate for you.
Actonel (risedronate) is a bisphosphonate, a group of medications that reduces the activity of cells that cause bone loss, to produce a net increase in bone density. Unlike estrogen, the bisphosphonates are not hormones. Instead, bisphosphonates build overall bone mass by slowing the removal of bone while allowing more bone to continue to be formed. Over 95 percent of those treated with bisphosphonates increase their scores on bone density testing.
Actonel in particular has been shown to lower the risk of spinal fractures by up to 69 percent in one year. In clinical trials, Actonel decreased the chance of spinal fractures in patients taking cortisone medications by 70 percent in one year. It also reduced the risk of hip fractures in women with osteoporosis by about 60 percent after three years.
Fosamax (alendronate) is also a bisphosphonate. In clinical trials of postmenopausal women with osteoporosis, Fosamax reduced bone loss and increased bone density in both the spine and the hip. Fosamax also reduced the risk of spine fractures by up to 62 percent at two years and hip fractures by 56 percent at four years.
Fosamax and Actonel are usually taken once a week, but can also be taken daily. Once you are up for good in the morning, take it with a 6- or 8-ounce glass of water. Orange juice or coffee can decrease the amount of medication absorbed. It's important not to lie down for 30 to 60 minutes after taking Fosamax or Actonel. After that time you can drink or eat. This usually prevents any symptoms of esophageal irritation such as indigestion, heartburn, or abdominal discomfort.
Most people do not have problems taking one of these medications, but potential side effects include heartburn, indigestion, or abdominal discomfort; muscle, bone, or joint soreness or aches; other problems such as nausea, vomiting, diarrhea, or constipation are uncommon. If you already have an esophageal problem, especially a narrowing of the esophagus (esophageal stricture), check with your doctor before you take one of these medications.