Bisphosphonates for osteoporosis treatment in women

May 10 2007

A class of drugs called bisphosphonates has become the new mainstay treatment for postmenopausal women diagnosed with osteoporosis in the post-hormone-replacement era.

Taking just one pill a week, or even one a month, may prevent, slow or stop the breakdown and progress of this bone-thinning condition, according to the May issue of Mayo Clinic Women's HealthSource.

An estimated 10 million Americans, mostly women, have osteoporosis, where bones become weak and highly prone to fractures. Millions more have low bone density (osteopenia), which can increase the risk of fractures.

Bone -- a living tissue -- is constantly remodeling, with old bone breaking down and new bone replacing it. Bisphosphonates work by slowing the breakdown and reabsorption of old bone, an ongoing process that accelerates as estrogen levels fall during the first few years after menopause. By slowing the process, bisphosphonates help preserve bone density and reduce the risk of fractures.

Estrogen once was commonly prescribed to reduce bone loss. But when the landmark Women's Health Initiative Study, released in 2002, showed that long-term estrogen use increased the risk of breast cancer, heart attacks, strokes and blood clots, hormone therapy fell out of favor.

Bisphosphonates have filled the void and perform as well as estrogen in preventing bone loss. Bisphosphonates available to treat osteoporosis include alendronate (Fosamax), ibandronate (Boniva) and risedronate (Actonel).

Patients should talk with a doctor about the best ways to prevent and treat osteoporosis. Bisphosphonates have potential side effects, most commonly heartburn and abdominal pain caused by irritation of the esophagus or stomach. Even when taking medications, patients should take steps to protect bones, including consuming adequate calcium and vitamin D; engaging in regular weight-bearing exercise such as walking and weight training; and avoiding smoking and excessive use of alcohol.