Q: Which osteoporosis drug is the safest? I have been told to take Evista, but am hesitant because of the risk of stroke.
A: There are a number of drugs available to treat or prevent osteoporosis. There is no single best (or safest) drug. The choice depends on:
--The reason your doctor recommends treatment
--Medical problems you have
--Your preference on how often to take a dose and how to take it (such as a pill or injection)
First, make sure you're getting enough calcium, vitamin D and weight-bearing exercise, such as walking. Some people get enough calcium and vitamin D, but the average American could use some help from supplements. Medications (such as corticosteroids or excessive thyroid hormone), smoking and heavy drinking can also contribute to osteoporosis risk.
If your osteoporosis was confirmed by bone density testing or if you have had a low-impact fracture, treatment options include:
--Bisphosphonates (Fosamax, Actonel, Boniva, Reclast, and generic forms). These drugs inhibit the cells that break down bone. Side effects include heartburn, esophageal damage, abdominal pain and bone pain. A rare complication is osteonecrosis of the jaw. With this condition, the bone in the jaw dies, causing pain and poor wound healing after dental procedures.
One advantage of these drugs is that they don't have to be taken every day. Fosamax and Actonel can be taken once a week. Oral Boniva can be taken once a month. The intravenous form can be taken every three months. Reclast is given intravenously once a year. The intravenous options are an advantage for people who cannot tolerate pill forms of bisphosphonates or who cannot remain upright for 30 to 60 minutes after taking them.
--Raloxifene (Evista). This drug can reduce bone loss through an estrogen-like effect. A unique "side-effect" is that its use is associated with a reduced risk of breast cancer. Some of the other risks are similar to those of estrogen. That's why Evista is usually avoided for people with a history of stroke or blood clots in the legs or lungs.
--Teriparatide (Forteo). This is a form of parathyroid hormone. It is usually reserved for severe osteoporosis that does not respond to other treatments. It's injected daily. It is generally not a first choice because of this. It may cause dizziness, leg cramps, constipation, and muscle weakness.
Finally, there is cost to consider. A generic bisphosphonate is typically much less expensive than a brand name medication. Talk to your pharmacist about the options and find out what your insurance will cover.
(Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center, Boston, Mass.)
(For additional consumer health information, please visit www.health.harvard.edu.)
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