Zoledronic acid (Reclast) is an injectable bisphosphonate given once a year as an intravenous infusion. (It can also be given biannually to prevent osteoporosis in postmenopausal women.) The infusion can produce flu symptoms immediately after administration, Dr. Lyles says.
Bisphosphonates increase the risk of two rare complications—spontaneous femur fractures and osteonecrosis (bone death) in the jaw.
These complications occur in between one in 10,000 and one in 100,000 patients, Dr. Lyles says, usually after using the medications for two years. Doctors usually stop prescribing these medications after five years.
Raloxifene (Evista) can reduce the risk of spinal fractures by 50%. The drug doesn't, however, appear to prevent fractures not in the spine.
Intended for use in postmenopausal women, it may decrease the risk of breast cancer and heart disease, but it also raises the risk of blood clots. It typically isn't the first line of defense for osteoporosis, Dr. Lyles says.
Denosumab (Prolia) is the newest osteoporosis drug on the market.
This medication prevents bone breakdown as well as bisphosphonates, but through a different mechanism, Dr. Lyles says. It is given by injection (not infusion) twice a year.
Side effects can include back and muscle pain, eczema, and skin infections. Unlike bisphosphonates, however, denosumab has not been associated with osteonecrosis of the jaw.
Friday, September 30, 2011