"The awareness of it really came about 15 to 20 years ago," says Murray Favus, MD, director of the Bone Program and the Clinical Research Center at the University of Chicago Medical Center, who holds appointments in endocrinology and nephrology.
"It's certainly the frontline drug," Favus
"We recommend people should keep good oral health, but they don't need to stay away from the drug," Favus
Other bisphosphonates include risedronic acid (Actonel), also a widely used oral drug taken monthly, and ibandronic acid (Boniva), which is taken once per month or four times per year intravenously.
Zoledronic acid (Reclast) is given once per year intravenously and can last for 12 months following one infusion.
Originally developed in 2001 to treat bone cancer, it was thought for years to be an effective treatment for osteoporosis.
Approved by the FDA
in 2007, the drug can be administered intravenously in only 15 minutes, is well tolerated, and "reduces hip and spine fractures as well as anything available on the market now," according to Favus
Individuals on Reclast do not need to take anything other than calcium and vitamin D supplements, he
adds, which are the building blocks for all these treatments.
"SERMs are important options, especially for those who may not respond to bisphosphonates," Favus
Also referred to as estrogen agonists/antagonists, the drugs work like estrogen on the bone, while at other sites, such as the breast, the drug acts as an antiestrogen.
"This means they don't stimulate breast tissue nor do they stimulate the lining of the uterus.
They have even been shown to reduce the rates of new breast cancers," Favus
One SERM approved by the FDA
in 2007 is raloxifene (Evista).
The daily drug, taken orally, has been shown in clinical studies to reduce spinal fractures, but data do not support a reduction in hip fractures.
"That's a concern, and so the doctor has to look carefully at the needs of the individual patient in terms of selecting a drug," Favus
But most important to Favus
"is that we may soon have another very effective drug."
Murray Favus, MD, of the University of Chicago Medical Center, would like to see strontium ranelate given a trial in the United States but doubts it will happen because of expensive trial costs that could lead to companies sharing profits.