You Can Prevent Osteoporosis: page 3
Hormone-replacement therapy. HRT has long been considered the best therapy for preventing and treating osteoporosis. It reduces the risk of both hip and forearm fractures by half and the risk of spinal fractures by up to 75 percent. Drawback: long-term use seems to increase the risk of breast cancer and blood clotting.
Raloxifene. This first example of a new class of drugs called selective estrogen receptor modulators (SERMs) was introduced in 1997. It has been approved for prevention of osteoporosis, but not treatment, although new data showing that it reduces the risk of spinal fracture by about half might soon change that. There are no data yet on how well it reduces hip fractures. Raloxifene works like estrogen, but doesn't increase and may reduce breast-cancer risk. Drawback: it can cause blood clots and may cause hot flashes. A new generation of SERMs, which should be available as early as next year, might work even better.
Alendronate. This powerful treatment, available since 1995, can reduce spine, hip and wrist fractures by up to 50 percent. Drawback: the drug must be taken on an empty stomach, with a large glass of water, first thing in the morning, at least 30 minutes before eating, and you must remain upright to avoid heartburn. The next class of similar drugs, known as biphosphonates, is expected within about a year, perhaps with fewer side effects.
Calcitonin nasal spray. Inhaling this synthetic version of a salmon hormone once a day can reduce the risk of spinal fractures by about 40 percent, though for unknown reasons it doesn't work as well on other bones. Introduced in 1995, this is the only drug that actually reduces the persistent long-term pain of existing spinal fractures. Drawbacks: nasal irritation and bleeding.
Even with these new drugs, plain old-fashioned prevention works best. So drink your milk, eat your dark leafy greens and heft some weight now so your bones won't be unbearable in the future.
Who Should Get a Bone Scan?
Osteoporosis experts recommend that the following women receive a bone-mineral-density test:
- Postmenopausal women under 65 with one or more risk factors, including use of glucocorticosteroids, thyroid problems, eating disorders, amenhorrea (cessation of menstruation) that lasted three months or more, smoking, family history of osteoporosis, being very thin, alcoholism, lifelong low calcium intake
- Premenopausal women with any of these risk factors should ask a doctor's advice about getting a scan
- Postmenopausal women who have suffered bone fractures
- All women over 65
Part 3 of 3
Newsweek, Spring/Summer, 1999
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