What are they
For the prevention and treatment of osteoporosis, drugs belonging to different classes are used, united by the ability to influence the metabolism of bone tissue.
How they work
Since bone metabolism is characterized by a continuous renewal of tissue by the two types of cells that compose it – osteoclasts responsible for the reabsorption of old bone tissue and osteoblasts responsible for the production of new bone tissue – drugs are used to counteract osteoporosis that can interfere with the activity of these cells.
Based on their mechanism of action, therefore, antiosteoporotics can be divided into two groups, depending on whether they block the activity of osteoclasts (anti-resorptive drugs) or promote the activity of osteoblasts (stimulatory drugs of bone neoformation).
What are they?
Let’s see which are the drugs that belong to the group of antiresorptives and which to the group of stimulators of bone formation.
| Antiresorptive | Stimulators of bone neoformation |
|---|---|
| Bisphosphonates (alendronate, risedronate, etidronate, clodronate, ibandronate, pamidronate and zoledronate) | Parathyroid hormone (hormone produced by the parathyroid glands) |
| SERMs or selective estrogen receptor modulators (raloxifene, bazedoxifene, lasofoxifene) | Teriparatide (synthetic analogue of parathyroid hormone) |
| Hormone replacement therapy (HRT) for menopause (consisting of estrogen or more often estrogen + progestin) | |
| Denosumab (monoclonal antibody that works by blocking the maturation process of osteoclasts) |
Endowed with a dual action, both anti-osteoclastic and pro-osteoblastic, it is instead strontium ranelate.In the treatment of osteoporosis may be additionally recommended calcium and vitamin D supplementation, to be assessed according to age and food intake.
Directions
The drugs whose use for the prevention and treatment of osteoporosis is currently more consolidated are bisphosphonates; These include in particular alendronate and risedronate, approved for both postmenopausal female osteoporosis, male osteoporosis, and osteoporosis induced by prolonged intake of corticosteroids.
The prescription of parathyroid hormone and teriparatide is usually reserved, due to the caution required in their use and the high cost, to patients at higher risk (who have already had vertebral or femur fractures) and to those who have not benefited from anti-resorptive drugs.
Strontium ranelate, SERM and HRT are indicated for the treatment of postmenopausal osteoporosis, but only in cases where bisphosphonates are not effective or tolerated, in view of the potentially dangerous side effects.
In particular, HRT, once widely adopted for the treatment of menopausal disorders and for the prevention of postmenopausal osteoporosis, is now recommended only in selected cases (for example women with early menopause), in which it must still be used at the lowest effective dose and for the shortest possible period.
Denosumab, recently introduced, is approved for postmenopausal osteoporosis.
Effects
Alendronate and risedronate may cause irritation up to ulcerative lesions in the esophagus.
The adoption of formulations prepared for weekly or monthly administration alongside the observance of the recommended intake methods (swallow the tablet quickly with an entire glass of water, without chewing it or letting it dissolve, and after taking avoid lying down for at least 30 minutes) drastically reduces the risk of these side effects.
However, these compounds should be used with caution in individuals with current or previous esophagitis or peptic ulcer.
In addition, cases of osteonecrosis of the jaw have been reported among patients receiving bisphosphonates (especially zoledronate and pamidronate) as a possible side effect of the drugs.
Taking SERM is associated with an increased risk of venous thromboembolic events and worsening of some symptoms (especially hot flashes) of menopause.
The intake of strontium ranelate is associated with an increased risk of venous thromboembolic events and can cause, in cases of individual hypersensitivity, even serious allergic reactions.
Prolonged use of HRT (both estrogenic and oestrogen-progestin) increases the risk of serious cardiovascular disorders (myocardial infarction, stroke) and breast cancer.
Taking parathyroid hormone and teriparatide causes an increase in the concentration of calcium in the blood, which should be carefully monitored, and is contraindicated in patients with renal insufficiency.
For denosumab, among the most common side effects are described: low back pain, increased cholesterolemia, bladder infections.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
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