New Treatments for Osteoporosis
Posted on 11/15/2000
Researchers are always looking for new ways to treat diseases. But sometimes treatments for one part of the body actually help another part, as well.
That’s the case with fluoride. Many people can’t remember when toothpaste didn’t contain fluoride. Now there’s evidence that the fluoride in drinking water isn’t only good for teeth, it’s good for our bones, too.
Researchers in a multicentre study in Oregon, Minnesota, Maryland and Pennsylvania collected information about fluoridated water exposure and factors known to affect risk for osteoporosis from 7,129 women. Beginning in 1986, the women underwent bone mineral testing in three areas of the body.
Among the 3,218 women who had continuous exposure to fluoridated water, bone mineral density averaged up to nearly 3 percent higher than among the 2,563 women with no exposure. That adds up to a 31 percent reduced risk of hip fracture for those women with continuous exposure to fluoridated water and a 27 percent reduced risk of vertebral fracture.
The study authors, whose research appeared in the October 7, 2000, issue of the British Medical Journal, say, “If fluoridation does reduce the risk of hip fracture, it may be one of the most cost-effective methods for reducing the incidence of fractures related to osteoporosis.”
In an editorial that accompanied the published findings, Dr. Hannu W. Hausen of the University of Oulu, in Finland, comments, “The finding that long-term exposure to fluoridated water does not increase the risk of osteoporotic fractures among elderly people should alleviate remaining concerns about the safety of fluoridation.”
Other treatments
Currently there is no cure for osteoporosis, but as the study with fluoride shows there are steps you can take to prevent it, or to slow or stop its progress. The National Osteoporosis Foundation offers the following information treatments for the disease.
Estrogen replacement therapy/hormone replacement therapy
Estrogen replacement therapy (ERT) is approved for the prevention and management of osteoporosis. ERT has been shown to benefit postmenopausal women by:
Reducing bone loss
Increasing bone density in the spine and hip
Reducing the risk of hip and spinal fractures
When estrogen is taken alone, it can increase a woman’s risk of developing cancer of the uterine lining (endometrial cancer). To eliminate this risk, physicians prescribe the hormone progestin in combination with estrogen (hormone replacement therapy or HRT) for those women who have an intact uterus.
Side effects may include:
Nausea
Bloating
Breast tenderness
High blood pressure
Blood clots
Some studies indicate a relationship between estrogen use and breast cancer, while other studies indicate no relationship at all. The issue of a relationship between breast cancer and estrogen use is still to be determined.
Alendronate sodium (Fosamax)
Alendronate is approved for both the prevention and treatment of osteoporosis. In postmenopausal women with osteoporosis, alendronate reduces bone loss, increases bone density in both the spine and hip, and reduces the risk of both spine fractures and hip fractures.
Side effects are uncommon but may include:
Abdominal or musculoskeletal pain
Nausea
Heartburn
Irritation of the esophagus
Alendronate also is approved for treatment of steroid-induced osteoporosis in men and women as a result of long-term use of glucocorticoid medications such as prednisone or cortisone and for the treatment of osteoporosis in men.
Risedronate sodium (Actonel)
Like ERT/HRT and alendronate, risedronate slows bone loss, increases bone density, and reduces the risk of spine and non-spine fractures. Few side effects were reported, and these were similar to those reported with placebos (inert substances). Side effects included:
Stomach upset
Constipation
Diarrhea
Bloating
Gas
Headache
Risedronate also is approved for use by men and women to prevent or treat steroid-induced osteoporosis that results from long-term use of medications such as prednisone or cortisone.
Raloxifene (Evista)
Raloxifene is approved for the prevention and treatment of osteoporosis. It appears to prevent bone loss at the spine, hip, and total body. Raloxifene produces small increases in bone mass. After three years of use, raloxifene reduces the risk of spine fractures by about 50 percent. While side effects were not common, those reported included hot flashes. Additional research studies on raloxifene will be on going for several more years.
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Reviewed by Steven J. Adashek, MD, FACOG