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Treatment Options

If you are diagnosed with osteoporosis, there are treatment options that your doctor may recommend. There are several types of osteoporosis medication that can be taken in different ways (e.g. oral tablets, a nasal spray, injections and an intravenous infusion) and a range of dosing schedules (e.g. daily, weekly, once-a-month, every six months or yearly). Ask your doctor about dosing options that may better fit your lifestyle.

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Treatment Options to Help Fight Osteoporosis


 

What drug therapies are currently available to help fight osteoporosis?

If you are diagnosed with osteoporosis, your doctor may prescribe medication to help slow bone loss, increase bone density and therefore help reduce the risk of fractures. Today there are osteoporosis medications that may be more convenient for your lifestyle. Discuss how you like to take your medication and how often you would like to take it with your doctor. Your doctor may also recommend that you take calcium and/or vitamin D to supplement your medication. In addition, your doctor may suggest changes to your diet and your daily habits.

There are a variety of prescription drug treatments available to help prevent or treat osteoporosis. In Canada these include bisphosphonates (oral or intravenous), a SERM (selective estrogen receptor modulator), estrogen therapy, calcitonin, PTH (parathyroid hormone) and a RANK ligand (RANKL) inhibitor.

 

Some osteoporosis medications are covered by Government formulary plans however not all of them are. It is important to tell your doctor if you have a Private Drug Plan as you may be covered for a wider choice of medications.

No two people are alike, so your doctor will help you evaluate which treatment is right for you based on your needs, other health conditions you may have, and medications you may already be taking.

As with any medication, side effects may occur when taking osteoporosis medications. Side effects from a particular medication can vary from person to person; some people may experience side effects while others may not. Side effects may also diminish over time as the body becomes accustomed to a new medication. If you are prescribed one of these medications you should read the patient information leaflet enclosed with your medication and consult your doctor or pharmacist if there is anything you do not understand, if you have any concerns or if you want more information.



Bisphosphonates

Bisphosphonates are non-hormonal drugs that work by binding to the surface of bones, thus slowing down their breakdown. Bisphosphonates help to slow bone loss, increase bone density and therefore help reduce the risk of fractures.

In Canada, there are several bisphosphonates indicated for the treatment and/or prevention of osteoporosis in postmenopausal women. Some bisphosphonates are also indicated for the treatment of osteoporosis in men or in patients receiving long term corticosteroid therapy. Your doctor can help you decide which medication and dosage regimen will best meet your needs.

Food, drink and other medications can interfere with the absorption of most oral bisphosphonates (Actonel*, Fosamax*, Fosavance*, generic alendronate and generic risedronate) so it is very important that you wait at least 30 minutes before eating or drinking anything other than plain water after taking your oral bisphosphonate medication in the morning. Didrocal* (or generic etidronate) should be taken at bedtime at least 2 hours after your last food. Following this direction will help make sure that your medication works. Note however that Actonel DR* is a delayed release formulation that should be taken with breakfast. Talk to your doctor or pharmacist to ensure that you are clear on how to take the medication you have been prescribed.

Food, drink and other medications can interfere with the absorption of most oral bisphosphonates (Actonel*, Fosamax*, Fosavance*, generic alendronate and generic risedronate) so it is very important that you wait at least 30 minutes before eating or drinking anything other than plain water after taking your oral bisphosphonate medication in the morning. Didrocal* (or generic etidronate) should be taken at bedtime at least 2 hours after your last food. Following this direction will help make sure that your medication works. Note however that Actonel DR* is a delayed release formulation that should be taken with breakfast. Talk to your doctor or pharmacist to ensure that you are clear on how to take the medication you have been prescribed.


Selective Estrogen Receptor Modulators (SERMs)

SERMs are non-hormonal drugs that act like estrogen in some parts of the body like the bones. In other parts of the body, such as the breasts and uterus, they block the effects of estrogen. SERMs work by binding to estrogen receptors and help build and maintain bone density.

There is one SERM approved in Canada for the treatment and prevention of osteoporosis in postmenopausal women, called Evista« (raloxifene). It is available as tablets that are taken daily.


Estrogen / Hormone Therapy

Following menopause, the body produces much less estrogen. In postmenopausal women already diagnosed as having osteoporosis estrogen hormone replacement therapy may retard further bone loss, it may also contribute to the prevention of osteoporosis when combined with other important non-medical therapies like a diet with adequate calcium and vitamin D, regular weight bearing exercise and smoking cessation. The 2010 Osteoporosis Canada Guidelines recommend estrogen therapy for menopausal women requiring treatment of osteoporosis who also require treatment for vasomotor symptoms (e.g. hot flashes). If you have an intact uterus (i.e. have not had a hysterectomy) your physician may recommend you take both estrogen and progestin therapy.

In Canada there are several hormone replacement therapies available that have indications for the prevention or treatment of osteoporosis in postmenopausal women. These medications can be just estrogen therapy or a combination of estrogen and progestin therapy (EPT). These are available either as patches (Estradot,* Climara Pro* and Estraderm*) that are applied to the skin or as oral pills (Estrace*, femHRT* and Premarin*). Climara Pro* and femHRT* are EPT therapies.


Calcitonin

Calcitonin is a hormone produced by the thyroid gland that works to regulate calcium metabolism. Both synthetic and natural calcitonin can slow down the rate of bone breakdown so that bones can rebuild themselves.

Miacalcin* NS (synthetic salmon calcitonin) is approved for use in Canada for the treatment of osteoporosis in postmenopausal women more than 5 years post menopause with low bone mass relative to healthy premenopausal females. It is available as a daily-use nasal spray.


Parathyroid Hormone (PTH)

PTH is an anabolic hormone that stimulates bone production. Forteo* (teriparatide) is approved for use in Canada and is recommended for treatment of severe osteoporosis in women who are at high risk of fracture or who have failed or are intolerant to other osteoporosis therapy. It is available as a self-administered daily subcutaneous injection.


RANKL Inhibitor

A RANK ligand inhibitor works by binding to the molecule RANKL preventing it from activating the cells that break down bone. A RANK ligand inhibitor helps to slow bone loss, increase bone density and therefore help reduce the risk of fractures.

Prolia* (Denosumab) is a RANK ligand inhibitor approved for use in Canada for the treatment of postmenopausal osteoporosis in women at high risk of fracture. Prolia is available as a twice yearly injection which must be administered by a health care professional.

Speak with your doctor to determine the treatment option that will best fit your lifestyle and individual needs.

* Brand names are registered trademarks of their respective companies.

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Treatment Options

If you are diagnosed with osteoporosis, there are treatment options that your doctor may recommend. There are several types of osteoporosis medication that can be taken in different ways (e.g. oral tablets, a nasal spray, injection and an intravenous infusion) and a range of dosing schedules (e.g. daily, weekly, onceľa-month or yearly). Ask your doctor about oral dosing options that may better fit your lifestyle.


Treatment Options to Help Fight Osteoporosis



What drug therapies are currently available to help fight osteoporosis?

If you are diagnosed with osteoporosis, your doctor may prescribe medication to help slow bone loss, increase bone density and therefore help reduce the risk of fractures. Today there are osteoporosis medications that may be more convenient for your lifestyle. Discuss how you like to take your medication and how often you would like to take it with your doctor. Your doctor may also recommend that you take calcium and/or vitamin D to supplement your medication. In addition, your doctor may suggest changes to your diet and your daily habits.



There are a variety of prescription drug treatments available for people who have been diagnosed with osteoporosis. In Canada these include bisphosphonates, a SERM (selective estrogen receptor modulator), calcitonin or PTH (parathyroid hormone).



Some osteoporosis medications are covered by Government formulary plans however not all of them are. It is important to tell your doctor if you have a Private Drug Plan as you may be covered for a wider choice of medications.


No two people are alike, so your doctor will help you evaluate which treatment is right for you based on your needs, other health conditions you may have, and medications you may already be taking.


As with any medication, side effects may occur when taking osteoporosis medications. Side effects from a particular medication can vary from person to person; some people may experience side effects while other may not. Side effects may also diminish over time as the body becomes accustomed to a new medication. If you are prescribed one of these medications you should read the patient information leaflet enclosed with your medication and consult your doctor or pharmacist if there is anything you do not understand, if you have any concerns or if you want more information.



Bisphosphonates


Bisphosphonates are non-hormonal drugs that work by binding to the surface of bones, thus slowing down their breakdown. Bisphosphonates help to slow bone loss, increase bone density and therefore help reduce the risk of fractures.


In Canada, there are several bisphosphonates indicated for the treatment and/or prevention of osteoporosis in postmenopausal women. Some bisphosphonates are also indicated for the treatment of osteoporosis in men or in patients receiving long term corticosteroid therapy. Your doctor can help you decide which medication and dosage regimen will best meet your needs.
Food, drink and other medications can interfere with the absorption of most oral bisphosphonates (Actonel*, Fosamax*, Fosavance*, generic alendronate and generic risedronate) so it is very important that you wait at least 30 minutes before eating or drinking anything other than plain water after taking your oral bisphosphonate medication in the morning. Didrocal* (or generic etidronate) should be taken at bedtime at least 2 hours after your last food. Following this direction will help make sure that your medication works. Note however that Actonel DR* is a delayed release formulation that should be taken with breakfast. Talk to your doctor or pharmacist to ensure that you are clear on how to take the medication you have been prescribed.


Bisphosphonates available in Canada for the Treatment and/or Prevention of Osteoporosis


Brand

Active Ingredient(s)

Dosage Form

Dosing Options

Aclasta*

Zoledronic acid

Intravenous solution

Annual infusion

Actonel*

Risedronate sodium

Oral tablets

Once-a-month
2 consecutive days a month
Once-a-week
Once-a-day

Didrocal*

Etidronate disodium
Calcium carbonate

Oral tablets

Didrocal once daily for two weeks; then 2 1/2  months (76 days) of 500 mg calcium tablets once daily (provided in package)

Fosamax*

Alendronate sodium

Oral tablets

Once-a-week
Once-a-day

Fosavance*

Alendronate plus Vitamin D

Oral tablets

Once-a-week



Selective Estrogen Receptor Modulators (SERMs)


SERMs are non-hormonal drugs that act like estrogen in some parts of the body like the bones. In other parts of the body, such as the breasts and uterus, they block the effects of estrogen. SERMs work by binding to estrogen receptors and help build and maintain bone density.


There is one SERM approved in Canada for the treatment and prevention of osteoporosis in postmenopausal women, called Evista« (raloxifene). It is available as tablets that are taken daily.


Estrogen / Hormone Therapy


Following menopause, the body produces much less estrogen. In postmenopausal women already diagnosed as having osteoporosis estrogen hormone replacement therapy may retard further bone loss, it may also contribute to the prevention of osteoporosis when combined with other important non-medical therapies like a diet with adequate calcium and vitamin D, regular weight bearing exercise and smoking cessation. The 2010 Osteoporosis Canada Guidelines recommend estrogen therapy for menopausal women requiring treatment of osteoporosis who also require treatment for vasomotor symptoms (e.g. hot flashes). If you have an intact uterus (i.e. have not had a hysterectomy) your physician may recommend you take both estrogen and progestin therapy.


In Canada there are several hormone replacement therapies available that have indications for the prevention or treatment of osteoporosis in postmenopausal women. These medications can be just estrogen therapy or a combination of estrogen and progestin therapy (EPT). These are available either as patches (Estradot,* Climara Pro* and Estraderm*) that are applied to the skin or as oral pills (Estrace*, femHRT* and Premarin*). Climara Pro* and femHRT* are EPT therapies.

Calcitonin


Calcitonin is a hormone produced by the thyroid gland that works to regulate calcium metabolism. Both synthetic and natural calcitonin can slow down the rate of bone breakdown so that bones can rebuild themselves.


Miacalcin* NS, synthetic calcitonin (synthetic salmon calcitonin) is approved for use in Canada for the treatment of osteoporosis in postmenopausal women more than 5 years post menopause with low bone mass relative to healthy premenopausal. It is available as a daily-use nasal spray.


Parathyroid Hormone (PTH)


PTH is an anabolic hormone that stimulates bone production. Forteo* (teriparatide) is approved for use in Canada and is recommended for treatment of severe osteoporosis in women who are at high risk of fracture or who have failed or are intolerant to other osteoporosis therapy. It is available as a self-administered daily subcutaneous injection.


RANKL Inhibitor


A RANK ligand inhibitor works by binding to the molecule RANKL preventing it from activating the cells that break down bone. A RANK ligand inhibitor helps to slow bone loss, increase bone density and therefore help reduce the risk of fractures.


Prolia* (Denosumab) is a RANK ligand inhibitor approved for use in Canada for the treatment of postmenopausal osteoporosis in women at high risk of fracture. Prolia is available as a twice yearly injection which must be administered by a health care professional.


Speak with your doctor to determine the treatment option that will best fit your lifestyle and individual needs.


* Brand names are registered trademarks of their respective companies.