Osteoporosis Drug

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No Bones About It: These Drugs Work

And a new medication promises to revolutionize treatment for osteoporosis

By Colette Bouchez

HealthScoutNews Reporter

SUNDAY, June 23 (HealthScoutNews) -- For women who suffer with osteoporosis,

the news is good: A new medication promises to revolutionize treatment for

the bone-thinning disease, particularly in women with the most severe

problems.

The drug, a synthetic version of human parathyroid hormone called PTH, works

by helping the body build new bone -- even after dramatic loss has occurred.

" Unlike other treatments for osteoporosis, which can help stop bone loss,

parathyroid hormone actually helps the body build new bone, so that a woman

has a chance to put back what her skeleton has lost over time to

osteoporosis, " says endocrinologist Dr. Loren Wisner Greene, co-director of

the Bone Density Center at New York University Medical Center.

Although most of us stop growing in height in our late teens, our skeleton

actually remains a work in progress for most of our lives, continually

breaking down and re-building bone mass at a fairly steady rate.

When osteoporosis sets in, however, bone loss begins to occur faster than

the rebuilding process can take place. And that means instead of being

strong and solid, bones become porous, filled with little holes or craters.

As the disease progresses, there is less bone " mass " and more bone

" holes " -- turning a strong skeleton into one that can be weak and

vulnerable.

For women, who comprise the vast majority of osteoporosis patients, the

problems generally become extremely apparent after menopause, a time when

levels of the hormone estrogen drop dramatically.

Why is this important?

Estrogen helps to regulate factors involved in bone formation, Wisner Greene

says. When estrogen levels fall, so does the production of new bone cells,

she adds.

For women who start out with less bone mass to begin with, even a tiny loss

can spell trouble.

" The end result can be weaker bones, and a dramatically increased risk of

fracture, particularly of the hip, spine and wrist, " says Wisner Greene.

There are 10 million Americans who have osteoporosis, 8 million of whom are

women. According to the National Osteoporosis Foundation, another 34 million

women have low bone density, which is a precursor to osteoporosis.

Although there are a variety of medications available to treat osteoporosis,

they all work in pretty much the same way -- to stop the bone loss.

PTH, however, stimulates new bone cell production. The results, according to

endocrinologist Dr. , are nothing short of astounding.

" This drug is remarkable in the fact that while all of the other

[osteoporosis] drugs are designed to inhibit bone loss, this is completely

different in that it stimulates the bone forming cell, the osteoblast, " says

, the director of the endocrinology, diabetes and metabolism division

at Cedars-Sinai Medical Center in Los Angeles.

When combined with drugs that stop bone loss, like Fosamax (aldendronate),

parathyroid hormone becomes the ultimate way to increase skeletal strength,

says.

" I'm planning on putting every single one of my patients on this medicine as

soon as it becomes available. I feel that strongly about it, " says .

As good as it sounds, there are some caveats to consider. First, the drug

must be injected daily, which could be problematic for some women.

More important, however, while human trials as long as 20 months showed no

serious side effects, a rat study found parathyroid hormone has the

potential for causing an extremely rare but life-threatening form of bone

cancer.

Although the rats received doses far above the human equivalent and were

treated with the drug for an entire lifetime, the Food and Drug

Administration was concerned enough to request that the manufacturer, Eli

Lilly, conduct studies on larger animals using dosages equal to that

proposed for humans.

Those results are expected soon and all indications are the drug will be

considered safe enough to get the FDA's nod of approval.

Until then, Wisner Greene says another new treatment option is Evista

(raloxifene), a medication known as a SERM -- short for " selective estrogen

receptor modulator. "

Often referred to as a " designer estrogen, " SERMs work on a variety of

diseases " by offering the benefits of estrogen without the side effects of

estrogen replacement therapy, such as increased risk of breast and uterine

cancer, " says Wisner Greene. In osteoporosis, Evista works much like

estrogen to help ensure that bone production is not outpaced by bone loss.

Also available are drugs known as bisphosphonates -- medications such as

Fosamax, Didrocal (Etidronate) and Actonel (risedronate). They work

specifically to slow down bone loss. Although they can be hard on the

gastrointestinal tract, a new intravenous form is being tested, with a

one-time treatment offering protection for up to a year.

A third alternative is the drug Miacalcin (calcitronin), a synthetic version

of a hormone made in the thyroid gland that is involved in the breaking down

of old bone cells. Available as a nasal spray, it also works to reduce the

rate of bone loss.

Finally, for those who wish to take a more natural approach, boosting

vitamin D intake along with 1,500 mg of calcium daily is the way to go.

What can also help: Weight-bearing exercises such as brisk walking, which

can increase the production of new bone.

What To Do

For more information on all treatments for osteoporosis, visit Osteoporosis

Online. For a quick way to calculate your calcium intake, check out the

Calcium Calculator.

To learn more about parathyroid hormone and osteoporosis, see this page at

Massachusetts General Hospital's Web site.

Copyright © 2002 ScoutNews, LLC. All rights reserved.

SOURCES: Loren Wisner Greene, M.D., co-director, Bone Density Center, New

York University Medical Center, New York City; S. , M.D.,

director, division of endocrinology, diabetes and metabolism, Cedars-Sinai

Medical Center, Los Angeles

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