Most women tolerate Evista without problems, but potential side effects include hot flashes, clot formation in some blood vessels, muscle soreness, weight gain, or a rash.
Miacalcin (nasal calcitonin) and Calcimar (calcitonin) are approved for the treatment of osteoporosis in women who are at least five years beyond menopause. Calcitonin is a hormone (but not an estrogen) that's involved in calcium regulation and bone metabolism. It is usually taken as a single daily nasal spray (Miacalcin) or sometimes as an injection under the skin (Calcimar). In postmenopausal women, calcitonin increases bone density, particularly in the spine. Some have found that Miacalcin (the nasal spray) increased bone density, especially in the first year, but had less effect in the second year of treatment. Studies have shown that Miacalcin lowered the risk of fractures in the spine by 36 percent.
Some patients find that calcitonin also helps relieve pain from spinal fractures.
The most common side effects reported with Miacalcin nasal spray are a runny nose and other signs of nasal irritation. Potential side effects of calcitonin include flushing of the face and hands, increased urinary frequency, nausea, and skin rash.
Forteo (teriparitide) is a synthetic version of parathyroid hormone, which is naturally produced in the body and stimulates bone formation. It actually builds new bone by increasing the activity and number of bone-forming cells called osteoblasts. All other approved osteoporosis treatments, including Fosamax, Actonel, Evista, Miacalcin, and estrogen, are antiresorptive -- that is, they slow the rate of bone loss by interfering with bone-destroying cells called osteoclasts.
In clinical trials, Forteo reduced the risk of spinal fractures by 65 percent at nineteen months. This medication is used in patients who have osteoporosis with a high risk of fractures, or for patients with osteoporosis who have failed to respond to or experienced side effects with other medications. It is given as a subcutaneous injection daily.
The most common side effects of Forteo are dizziness and leg cramps. It is not given for more than two years. Persons who have had Paget's disease (a disease of the bone), radiation treatment to bones, bone cancer, or high blood calcium levels should not take Forteo. As always, talk with your doctor about the benefits and risks of Forteo (or any treatment) to prevent fractures from osteoporosis.
Excerpted from the book Reversing Osteopenia: The Definitive Guide to Recognizing and Treating Early Bone Loss in Women of All Ages by Harris H. McIlwain, M.D., and Debra Fulghum Bruce, Ph.D., with Laura McIlwain Cruse, M.D., and Kimberly Lynn McIlwain, M.D. Copyright © 2004 Harris H. McIlwain, M.D., and Debra Fulghum Bruce, Ph.D.; (Owl Books; October 2004; $15.00US/$20.95CAN; 0-8050-7622-0).
Authors Harris H. McIlwain, M.D., a board-certified rheumatologist, is the founder of the Tampa Medical Group. He has served as chairman of the Florida Osteoporosis Board since its inception five years ago. Town and Country has twice named him one of its Best Doctors in America.
Laura McIlwain Cruse, M.D., and Kimberly Lynn McIlwain, M.D., are rheumatologists and board-certified internists in Florida.
Debra Fulghum Bruce, Ph.D., has written more than 2,500 articles and 65 books on various health topics.
