Medications that prevent bone loss and breakdown and Prevention of osteoporosis due to long-term corticosteroids

Osteoporosis results when the rate of bone resorption exceeds the rate of bone rebuilding. Antiresorptive medications decreases resorption, thus keeping the balance in favor of bone rebuilding and increasing bone density.

Updated: June 16, 2022

Antiresorptive agents can be used, which decrease the removal of calcium from bones. The bone in your body is constantly being built and removed  which is an essential part of maintaining the normal calcium level in the blood and serves to repair tiny cracks in the bones that occur with normal daily activity.

Medications that prevent bone loss and breakdown:

Osteoporosis results when the rate of bone resorption exceeds the rate of bone rebuilding. Antiresorptive medications decreases resorption, thus keeping the balance in favor of bone rebuilding and increasing bone density. HRT is one example of an antiresorptive agent. Others include alendronate (Fosamax), raloxifene (Evista), risedronate (Actonel), ibandronate (Boniva), calcitonin (Calcimar), zoledronate (Reclast), and denosumab (Prolia).

Bisphosphonates:

Bisphosphonates slow down bone loss and reduce fracture risk especially in the hip, wrist, and spine in people with osteoporosis and can improve the T-score. Food, calcium, iron supplements, vitamins with minerals, or antacids containing calcium, magnesium, or aluminum can reduce the absorption of oral bisphosphonates, thereby resulting in loss of effectiveness.
To reduce side effects and to enhance absorption of the medicine, all bisphosphonates should be taken orally in the morning, on an empty stomach, 30 minutes before breakfast, and with at least 240 ml of plane water.

Selective estrogen receptor modulators (SERMs):

Raloxifene or Evista is a SERMs that work like estrogen in some tissues but as an antiestrogen in other tissues. It  can act like estrogen on bone but as an antiestrogen on the lining of the uterus where the effects of estrogen can promote cancer. These can reduce the risk of spine fractures in women after menopause.

Calcitonin (Calcimar, Miacalcin):

This helps prevent spinal fracture in postmenopausal women, and it can help manage pain if a fracture occurs. Calcitonin has been shown to increase bone density and strength in the spine only.
Calcitonin is not as effective in increasing bone density and strengthening bone as estrogen and the other antiresorptive agents, particularly bisphosphonates. Therefore, calcitonin is not the first choice of treatment in women with established osteoporosis.But it is a helpful alternative treatment for patients who cannot tolerate other medications.
Common side effects of either injected or nasal spray calcitonin are nausea and flushing. Patients using Miacalcin Nasal Spray can develop nasal irritation, a runny nose, or nosebleeds. Injectable calcitonin can cause local skin redness at the site of injection, skin rash, and flushing.

Teriparatide (Forteo):

This is a parathyroid hormone for people with a high risk of fracture, as it  helps to regulate calcium metabolism and stimulates bone formation.  It reduces spinal fractures in women with known osteoporosis. Usually after a 2year course of teriparatide the patient is switched to bisphosphonate therapy to maintain bone density.

Denosumab (Prolia):

This is an injectable antibody that blocks a chemical messenger that plays a role in promoting bone thinning by the bone cells that are responsible for bone resorption. Prolia strengthens bone by increasing its density and reduces fractures. Prolia can be injected under the skin twice a year. Denosumab is used for the treatment of postmenopausal women with osteoporosis at high risk for fracture. Denosumab can cause increased risk of infections and hypocalcemia.

Prevention of osteoporosis due to long-term corticosteroids:

The long-term use of corticosteroids such as prednisone, cortisone, and prednisolone can lead to osteoporosis. Corticosteroids decreases calcium absorption from the intestines and increases loss of calcium through the kidneys in urine which increases calcium loss from the bones. Patients should follow the following steps to prevent bone loss while on long-term corticosteroids.

  • An adequate calcium and vitamin D should be taken daily.
  • Alendronate, risedronate, and zoledronate, can be used for the prevention and treatment of corticosteroid-induced osteoporosis.
  • DXA bone density scan as well as blood testing for calcium, kidney function, and vitamin D should be done prior to beginning therapy and monitoring for osteoporosis during therapy.


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