Featuring Dr. John Wade, MD, FRCPC, Rheumatologist

Duration: 4 minutes
Osteoporosis Treatment and Side Effects
So the class of medications that are recommended for osteoporosis right now are drugs called ôbisphosphonates,ö and there are a number of bisphosphonates available on the market at the present time.

The common ones are a drug called ôalendronateö û this is typically given once a week; similarly, another drug in the same class, ôrisedronate,ö typically given once a week or once a month; and there's also another medication I see in the same group, ôzoledronic acid,ö which is given by intravenous once a year. They're all fairly effective in terms of reducing factors [inaudible] factors of the spine by anywhere from 50 to 70 percent.

And they're all relatively safe in terms of the side effect profile, but there are some concerns, and it depends whether you take them by mouth or by intravenous what those concerns are. With the oral bisphosphonates, whether it be alendronate or risedronate, the biggest concern is some GI irritation or some heartburn, what we call ôsephagitis.ö Those are the things that relatively are rare, but something one needs to be aware of, and may be reasons you can't take the drug.

There is a new formulation coming out which we're excited about, one of these medications now that's available on some markets, where you can take these medications with food, whereas traditionally you need to take these medications with a glass of water first thing in the morning and not take breakfast or food for anywhere from 30 minutes to up to two hours. So that's an advance of the last period of time.

The intravenous drug, zoledronic acid, is easy in the sense that you can get it once a year; there are no problems with absorption or GI irritability. The concern with zoledronic acid is you have to go to an infusion center and have a nurse or doctor start an intravenous and infuse you, generally over 15 minutes.

So over the last few years, we've recognized that there are some potential long-term concerns of bisphosphonates, whether you take them by mouth or intravenously. We don't really know the definitive answer as to what that risk is, but the two concerns that you'll often read about are the risk of osteonecrosis of the jaw û and that's something that your dentist may actually bring up an issue with you when you're on these medications.

Although it's probably true that there maybe is an association with taking these medications, the risk is extremely low, and probably something that most patients do not need to be concerned about.

There are, in addition to osteonecrosis of the jaw, some unusual fractures that can happen in the leg, called ôatypical fractures,ö and these have been observed over the last couple of years. There's a great controversy about how come these are, but certainly it's given those of us who treat patients with osteoporosis some feeling that we should limit the use of these medications to perhaps five years or ten years.

Different experts will give advice about how long patients should be on these medications, but most of us certainly are suggesting that you reevaluate after five years or ten years, and perhaps consider a drug holiday for anywhere from one to four years off these medications.

There are other medications, including hormone therapy, selective estrogen receptor modulators, or ôSERMsö we call them, calcitonin, which are either effective treatments for osteoporosis. And those are medications you may want to talk to your doctor and pharmacist about.

It's important for individuals to recognize that medications have side effects. Those side effects can be severe, and so one needs to realize that if they're gonna start a medication, they need to discuss with their doctor and their pharmacist whether that medication is right for them.

If you have questions about osteoporosis, contact a local rheumatologist.

Presenter: Dr. John Wade, Rheumatologist, Vancouver, BC

Local Practitioners: Rheumatologist