Date: Wed, 22 May 2002 13:48:12 -0700 (PDT) [and subsequently updated, most recently 10/24/2005, plus incomplete updates 7/4/2015]
From: "Dave Burton" <email address elided>
Subject: bisphosphonates: drugs for osteoporosis / bone recalcification

Dear Jeannie,

I suggest that you ask your doctor whether you should be
taking a bisphosphonate (probably Actonel daily) and a
calcium supplement.

Bisphosphonates include:
Actonel (risedronate):    http://www.actonel.com/ and http://www.google.com/search?hl=en&q=actonel
Fosamax (alendronate):    http://www.google.com/search?hl=en&q=fosamax
Aredia (pamidronate):     http://www.google.com/search?hl=en&q=aredia
Zometa/Reclast (zoledronate):     http://www.google.com/search?hl=en&q=zometa
Skelid (tiludronate):     http://www.google.com/search?hl=en&q=skelid
Didronel (etidronate):    http://www.google.com/search?hl=en&q=etidronate (considerd obsolete)
Boniva/Bondronat/Bondronate (ibandronate): http://www.google.com/search?hl=en&q=ibandronate and http://www.wellspringrx.com/drugInfo/boniva.jsp
Bonefos/Ostac (clodronate): http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500265.html
incadronate (YM175)  -- never got approved
minodronate (YM529)  -- approved in Japan, but not in the USA
[2014 update: romosozumab  -- in trials, looks promising]


Currently, the two first/best choices for general use are
probably Actonel and Fosamax.  Fosamax is probably as effective
as Actonel, but Fosamax may be more likely to cause irritation
of the esophagus.  They are both priced at about $2.20/day,
regardless of dosing schedule.

Boniva and Zometa/Reclast are new and promising.  Boniva is the most
recently approved bisphosphonate for treatment of osteoporosis.
It was approved in May, 2003, but I don't know whether or not
you can actually buy it yet; it will apparently be priced
at about $5/day.  Zometa is from the same company as Aredia
(Novartis), and is touted as a better replacement for Aredia,
particularly in cancer patients.

Bonefos is available in Canada but not in the USA.  One study
indicates that it might be uniquely useful for breast cancer
patients.

Most of these are taken orally.  I think that Aredia and Zometa
are by injection or IV drip.  That's an option which is useful
if there's a problem with taking oral medications like Fosamax
and Actonel (e.g., if they upset your stomach).


This story says a yearly IV drip with the new bisphosphonate
Zometa (zoledronate) might be as effective as daily Actonel or
Fosamax pills:
http://detnews.com/2002/health/0203/06/a01-428770.htm  (or here)


This Web page about osteoporosis says that Didronel is older and
much less effective than Fosamax:
http://www.orthohelp.com/osteopRX.htm  (or here)


Here's an article, "NIH panel issues consensus report on
osteoporosis":
http://www.osteoporosis.org/NIH%20Panel.htm or
http://www.cnn.com/2000/HEALTH/women/03/29/osteo.recommendations/  (or here)


Here's an excerpt from the above article, about Fosamax & Actonel:

"Drug treatments available
Since the 1980s, the Food and Drug Administration has approved
several osteoporosis drugs.  Alendronate, or Fosomax, can reduce
the incidence of fractures of the spine, arm and leg, but it
irritates the esophagus in 10 percent of patients.  Risedronate,
or Actonel, is as effective as Fosomax in preventing fractures
but without the same side effects.  Another option, raloxifene,
or Evista, prevents spinal fractures, but there is no evidence
it prevents other fractures."

(Note: "Fosamax" seems to sometimes be spelled "Fosomax.")


Here's the NIH report about which that article was written:
http://odp.od.nih.gov/consensus/cons/111/111_statement.htm  (or here)


Here's an excerpt from that report, which recommends weight
training:

"Physical activity is necessary for bone acquisition and
maintenance through adulthood.  Complete bed rest [has]
devastating effects on bone.  Trials of exercise intervention
show most of the effect during skeletal growth and in very
inactive adults.  Effects beyond those directly on bone,
such as improved muscular strength and balance, may be very
significant in fracture-risk reduction.  Trials in older
adults have successfully used various forms of exercise
to reduce falls.  High-impact exercise (weight training)
stimulates accrual of bone mineral content in the skeleton.
Lower impact exercises, such as walking, have beneficial
effects on other aspects of health and function, although
their effects on BMD have been minimal."


Here's another excerpt from that report, about Fosamax, Actonel,
and Didronel (etidronate):

"Randomized placebo-controlled trials (RCTs) of cyclic
etidronate, alendronate, and risedronate analyzed by a systematic
review and meta-analysis have revealed that all of these
bisphosphonates increase BMD at the spine and hip in a
dose-dependent manner.  They consistently reduce the risk of
vertebral fractures by 30 to 50 percent.  Alendronate and
risedronate reduce the risk of subsequent nonvertebral fractures
in women with osteoporosis..."


Here's another excerpt from that article, this one about Evista
(raloxifene) and Tamoxifen:

"The development of selective estrogen receptor modulators
(SERMs) has been an important new thrust in osteoporosis
research.  The goal of these agents is to maximize the beneficial
effect of estrogen on bone and to minimize or antagonize the
deleterious effects on the breast and endometrium.  Raloxifene,
a SERM approved by the FDA for the treatment and prevention of
osteoporosis, has been shown to reduce the risks of vertebral
fracture by 36 percent in large clinical trials.  Tamoxifen, used
in the treatment and prevention of breast cancer, can maintain
bone mass in postmenopausal women.  However, effects on fracture
are unclear."

See also http://health.yahoo.com/health/centers/strongbones/16  (or here)
and http://www.womanlab.com/english/professionals/OnGoingStudies1.htm   (or here)

Evista (raloxifene) is the only SERM currently approved for
treatment of osteoporosis:
Evista (raloxifene):   http://www.google.com/search?hl=en&q=evista

But others are being investigated:
Lasofoxifene:  http://www.google.com/search?q=Lasofoxifene
Bazedoxifene:  http://www.google.com/search?q=Bazedoxifene
Ospemifene:    http://www.google.com/search?q=Ospemifene
Arzoxifene:    http://www.google.com/search?q=Arzoxifene


Here's a brochure for a vertebroplasty workshop for doctors,
featuring Dr. Steven A. Dunnagan of Radiology Associates, Little
Rock, as one of the instructors.  For $1500, you, too, can learn
how to glue broken vertebrae back together (if you are a doctor):
http://www.baptisthealth.net/Images/multimedia/Vert.pdf
(Well, that link seems to be defunct, but there are lots of other
articles on the web about this topic:
http://www.google.com/search?q=percutaneous+vertebroplasty&hl=en)
Kyphoplasty is a newer variant of vertebroplasty.


Here are two articles about hip protectors:

http://webmd.lycos.com/content/article/1728.64878  (or here)

http://www.healthandage.com/patient/fpubli.htm?content=../publi/0601030611/060103p0611.htm
or http://www.healthandage.com/Home/gm=20!gsq=hip+protectors!gid2=1068  (or here)


Here's a Mayo Clinic report about hip fractures.  I was surprised
to read that 90% of hip fractures are of the femur, not the pelvis:

http://www2.mayohealth.org/mayo/9805/htm/hip.htm
or http://www.mayoclinic.com/invoke.cfm?objectid=419A8D9F-47F1-465B-827E9C0EAAE02467  (or here)


Here's an article about an at-home test for bone mass loss:

http://www.imaginis.com/osteoporosis/news/news8.22.2001.asp (or here)


Here's some information about a potentially serious side effect of
taking bisphosphonates:

http://www.ada.org/prof/resources/topics/osteonecrosis.asp
http://www.hc-sc.gc.ca/dhp-mps/medeff/advisories-avis/public/2004/aredia_zometa_pa-ap_e.html
http://www.hc-sc.gc.ca/dhp-mps/medeff/advisories-avis/prof/2004/aredia_zometa_hpc-cps_e.html

-Dave



Here's an informative link:
http://www.crha-health.ab.ca/clin/cme/conf/ltc2001/cs1_hanley.pdf  (or here)

And another:
http://www.medscape.com/viewarticle/447818_1 or http://www.medscape.com/viewprogram/2203  (or here)

And another:
http://www.well-connected.com/report.cgi/fr000018.html


Here's a web page similar in style to this one, but on a different
topic -- statins and other cholesterol-lowering drugs:
http://www.burtonsys.com/cholesterol.html

Here's a web page similar to this one, but about Prilosec and generic
omeprazole (super-antacids for heartburn and GIRD):
http://www.burtonsys.com/omeprazole.html