|
Table 1. Osteoporosis therapies,
mechanisms, benefits ad risks |
|
Medication |
Primary
Mechanism |
Benefits |
Risks |
| Conventional ERT |
Inhibits bone resorption |
Improves vasomotor symptoms
of menopause |
Increased risk of
estrogen-related cancer, venous thrombosis, hypertension, gallbladder
disease. |
| Calcitonin |
Inhibits bone resorption |
No estrogenic effect;
analgesic effect on bone pain |
Secondary
hyperparathyroidism; anti-CT antibody production
Injectable: nausea, vomiting, vertigo.
Intranasal: rhinitis, nasal irritation |
| Bisphosphonates |
Inhibits bone resorption |
No estrogenic effect |
Gastric erosion, thyroid
adenoma (rats); Safety of
Tx. > 4 years not known |
| Sodium Fluoride |
Stimulates osteoblasts (bone
formation) |
Increases bone mineral
density for up to 5 years |
Abnormal bone crystallinity;
no decrease in hip fracture rate; decrease in cortical bone in favor of
trabecular bone; acute GI nausea, vomiting, and hemorrhage |
| Selective Estrogen Receptor Modulators (Raloxifene) |
Inhibits bone resorption |
Estrogen effect on bone and
lipids; not on breast or uterus |
Increased risk of venous
thrombosis, pulmonary embolism; fatal liver toxicity; ovarian tumors and
hepatic cancer (animals) |
| Ipriflavone |
Inhibits osteoclast and
enhances osteoblast activity |
No estrogen effect; fewer
side effects; analgesic effect on bone pain |
GI upset |