Osteoporosis and newer medications

Dr. Akshay Jain MD, FRCPC, FACE, CCD, ECNU, DABIM, DABOM, Clinical and Research Endocrinologist, talks about newer medications available to treat Osteoporosis.

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Dr. Akshay Jain MD, FRCPC, FACE, CCD, ECNU, DABIM, DABOM, Clinical and Research Endocrinologist, talks about newer medications available to treat Osteoporosis.
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Featuring Dr. Akshay Jain MD, FRCPC, FACE, CCD, ECNU, DABIM, DABOM, Clinical and Research Endocrinologist

Duration: 3 minutes, 13 seconds

Our understanding of bone health has changed dramatically over the years. We now know that bones are living organs. They consist of osteoblasts, which are cells that are constantly laying down new bone, and osteoclasts, which are cells that are chewing away old bone.

Between the osteoblasts and the osteoclasts, there is a constant rate of bone formation and a rate of bone destruction. When the rate of bone destruction is far greater than the rate of bone formation, bones become quite weak and that is how osteoporosis occurs.

There are two broad types of bone medications. Antiresorptives, which decrease the rate of bone destruction, and anabolics, which increase the rate of bone formation. The newer medications are either stronger, safer antiresorptives, or are anabolics, or even a combination of the two.

It is very important to note that osteoporosis is a chronic condition and one that likely requires treatment for a very long period of time. Some of the newer antiresorptives have long-term data that show these agents have ongoing benefits and are safe even when used for a prolonged period.

The anabolic agents, on the other hand, help build up a bone bank very quickly, and are used for a short duration. The increased bone mass can be maintained for a long duration by ongoing use of antiresorptives.

Bisphosphonates continue to be a good low-cost, generic option that works well for most cases of mild to moderate osteoporosis. However, some people may develop side effects like gastric reflux on oral pills or bisphosphonates, or flu-like symptoms on intravenous bisphosphonates. Also, if despite taking bisphosphonates one still develops worsening bone density, suffers from a fracture, has poor kidney function or has a significant degree of osteoporosis, then other agents should be considered, and these can also be considered as firstline.

Bisphosphonates typically work only on the surface level of the bone and not deep within, which is why many people might still need medications that are more potent. Options include six monthly skin shots of Denosumab, which works at a much deeper level of the bone, or bone-building agents like Teriparatide or Romosozumab, which increase the bone mass, after which one can continue on antiresorptives ongoing.

The risk of osteoporatic fractures in women is higher than the risks of breast cancer, heart attacks and strokes combined. A previous fracture increases the risk of future fractures by 40%, and nearly 23% of women with a hip fracture will die within one year of the fracture. It is very important to use safe and effective osteoporosis medications that reduce the occurrence of such fractures.

Presenter: Dr. Akshay Jain, Endocrinologist, Surrey, BC

Local Practitioners: Endocrinologist

This content is for informational purposes only, and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare professional with any questions you may have regarding a medical condition.