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Physicians Update
New Drug Offers Another Option for Long-Term Osteoporosis Treatment in Postmenopausal Women
Bisphosphonates — including drugs like risedronate, ibandronate, zoledronic acid and alendronate, which slow or stop the natural process that dissolves bone tissue — represent the first-line treatment for osteoporosis. Evidence of side effects such as increased risks for fractures, osteonecrosis of the jaw and esophageal cancer, however, has raised concerns about using these drugs long term. Prolia, a twice-a-year subcutaneous injection approved by the Food and Drug Administration last June, represents another treatment option for postmenopausal women with osteoporosis who are at high risk for fractures and have failed bisphosphonates or can no longer tolerate them. It is not indicated for use in premenopausal women or in men.
“Many of the people who started on bisphosphonates 10 years ago are still on them,“ says Aurelia Nattiv, M.D., director of the UCLA Osteoporosis Center. “Because of the potential side effects associated with these medications, it is now recommended that patients who have been on bisphosphonates for a long time discuss the advantages and disadvantages of remaining on the drug, and consider a “drug holiday” period with physician follow-up and monitoring.
Denosumab, the first “biologic therapy” to be approved for osteoporosis treatment, works by inactivating the body’s bone-breakdown mechanism. While results of clinical studies indicated that postmenopausal women taking denosumab over a three-year period had fewer fractures and increased bone density, the new drug also has potential side effects, including increased risk for skin sensitivity, rashes or infections and, less commonly, muscle and bone pain, high cholesterol and urinary bladder infections. Additionally, hypocalcemia (low serum-calcium levels in the blood) must be treated before patients can begin taking denosumab.
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