Phyllis
Kentucky

It is good advice to discuss your treatment options with an endocrinologist—who specializes in hormones, minerals, and bone health—especially when any standard drug therapies for osteoporosis are worrisome or ineffective.

Alternative prescription therapies for osteoporosis may include Evista (tablets with estrogen-like action), Forteo (an injectable form of synthetic parathyroid hormone), and Calcitonin (a nasal spray or injectable form of a hormone involved in calcium metabolism).

Osteonecrosis (bone death) of the jaw, or ONJ, is a very rare complication of bisphosphonate drugs (including Actonel, Fosamax, Boniva, and Reclast) which, when it occurs, typically follows a tooth extraction or other trauma to the jaw, says Dr. Arnold Moses, distinguished service professor of medicine and director of the osteoporosis center located in the Joslin Center at the SUNY Upstate Medical University in Syracuse, New York, and his colleague Dr. Jennifer Kelly, assistant professor of medicine, who explain:

“To avoid ONJ, people taking bisphosphonates are advised to get regular dental checkups and to inform their dentist of all their medications. Authoritative groups emphasize that, in the majority of people with osteoporosis, the value of preventing fractures with bisphosphonates far outweighs the risk of ONJ, since the lifetime risk of an osteoporotic fracture can be up to 50 percent.”

To optimize drug therapy and protect bones for life, experts also recommend the following:

Get at least 1,200 mg of calcium and 1,000 IU of vitamin D daily from foods and supplements.

Walk, dance, or do other weight-bearing exercise regularly.

Don’t smoke.

Building Better Bones The Saturday Evening Post

D,

Urbana, Missouri

Strontium (STRON-tee-um) is a naturally occurring mineral that is closely related to calcium. At best, foods contain a minimal amount of the mineral, but different versions of strontium—used to improve bone health, unlike radioactive strontium, which treats bone cancer—are widely available online and in stores. In the U.S., strontium citrate is sold as a supplement, not a drug, which means data about its long-term safety and optimal dosage are lacking, and the purity of specific products is questionable. Still, evidence suggests that strontium preserves existing bones and helps build new bone tissue. Usually, strontium citrate is taken at bedtime, at least four hours after consuming calcium.

Prescription-strength strontium ranelate is available in Europe for treating osteoporosis. Osteologix, a biopharmaceutical company in Richmond, Virginia, is planning additional studies of its osteoporosis drug, NB S101 (strontium malonate). Assuming testing is successful, the prescription product could be FDA approved and available for use in the U.S. in early 2015.

Strategies for Bone Health The Saturday Evening Post

Considered a hallmark of the bone-robbing disease osteoporosis, mild to severe fractures of the lower back called vertebral compression fractures (VCF) affect nearly a quarter of all older American women. Researchers hope that an advanced medical device may help relieve pain and restore mobility better than conventional methods.

In the July issue of the American Journal of Roentgenology, Dr. Lucia Flors and colleagues report on an innovative method called vesselplasty that was tested on 29 patients previously treated with medicines and physical therapy for painful VCF at the Hospital Universitario Doctor Peset in Valencia, Spain.
During the minimally invasive procedure, doctors utilized a new device called the Vessel-X bone Filling Container System to create a cavity—and a container—into which bone cement is injected to stabilize broken bones, improve posture, and prevent further fractures. With standard versions of the therapy, referred to as vertebroplasty and kyphoplasty, the cement leaked out from the targeted area in up to 70 percent of cases.

“Theoretically, this technique solves the problem of leakage of cement from the vertebral body because most of the cement is contained by the expandable artificial vessel,” Dr. Flors’ group wrote.

Preliminary outcome data on 29 patients with 37 fractures show reduced pain scores in all treated patients, improved mobility in 93 percent, and reduced analgesic use in 62 percent. Asymptomatic leakage of cement occurred in 2.7 percent of the cases and the technique appeared to be as effective in treating new fractures as in older ones.

Most patients had fractures related to osteoporosis (73 percent). Other VCF were caused by trauma (13.5 percent), myeloma (8 percent), and cancer that had spread from other organs (5.4 percent).

Further investigation will determine long-term effectiveness and safety. The Container System device is yet to be approved in the United States.

Despite recent research questioning the effectiveness of vertebroplasty and kyphoplasty, pain specialists point to several large studies that demonstrate their short- and long-term clinical benefit for treating painful VCF.

Novel Therapy for Back Pain The Saturday Evening Post

During the 1990s, scientists in Amgen’s genomic drug discovery program identified a previously unexplored protein found throughout the body’s skeleton. Further research showed that the RANK Ligand protein is a key regulator of cells called osteoclasts that break down bone.

Currently under FDA review, Amgen’s drug denosumab (dmab for short) inhibits the protein, blocking the formation of osteoclasts, and boosting bone density.

“We have a family of different kinds of drugs we can use for osteoporosis, but none of those drugs are perfect, and many of the patients who begin any one of the current therapies frequently discontinue it,” Dr. Ethel S. Siris, Director of the Toni Stabile Osteoporosis Center at Columbia University Medical Center, New York-Presbyterian Hospital, and a past President of the National Osteoporosis Foundation told the Post.

“I’m excited about denosumab’s potential to offer great benefit, given its robust reduction in fracture risk at all sites measured and its twice-yearly administration.”

Osteoporosis: New Science, New Therapies The Saturday Evening Post