Fighting fractures with a bone-building drug

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Study links drug to decreased risk of bone fractures in postmenopausal women with osteoporosis

  Make no bones about it: bone loss and fractures related to osteoporosis can cause severe pain and even disability. A new drug that increases bone formation, reducing the risk of fracture, may be an improved treatment option for women living with osteoporosis, according to a recent study in the New England Journal of Medicine.

“This study suggests that the drug romosozumab prevents osteoporosis fractures in postmenopausal women better than the more commonly used drug alendronate,” said Ajay Zachariah, MD, a family medicine physician at Seton Family of Doctors at Round Rock. “While it may be too early to definitively say romosozumab is a superior drug, the findings offer hope to many women looking for treatment options.”

Seton is part of Ascension, the largest nonprofit health system in the U.S. and the world’s largest Catholic health system.

Romosozumab and alendronate are marketed as Evenity and Fosamax, respectively, by their makers. In a two-year study, more than 4,000 postmenopausal women at high risk for bone fractures randomly received romosozumab or alendronate. In year two, all women received alendronate.

Researchers found that women who first received romosozumab had a 48 percent lower risk of new vertebral fractures than those who received only alendronate.

It’s unclear whether romosozumab alone is a better treatment option, or if the effectiveness comes from the two-pronged approach of both romosozumab and alendronate. So more studies are needed to determine whether patients who take only romosozumab will experience similar results.

Zachariah also points out that a small number of patients taking romosozumab experienced more serious cardiovascular events than those taking alendronate. While cause and effect can’t be proven, any serious side effects need further investigation, he said.

Choosing the right osteoporosis drug for you

Having options of when and how you take medications can help you and your doctor decide the best treatment plan for you.

Alendronate, a commonly used osteoporosis medication, works to block or slow bone loss. It is taken once a week, by mouth.

Romosozumab is a manufactured antibody that binds to proteins that cause bones to weaken, resulting in increased bone mineral density, according to the study. It is given much like an insulin injection, but only once a month.

Some patients may prefer a small injection once a month to a once-per-week pill. It’s important to talk to your doctor about the pros and cons of any new treatment, Zachariah said.

Greater risk for women

Osteoporosis weakens your bones causing them to easily break.  While both men and women can get osteoporosis, it is more common in women, according to the Centers for Disease Control and Prevention.

There are many causes of osteoporosis, including vitamin D deficiency, kidney disease, alcoholism and genetic disorders. For women, the drop in estrogen levels after menopause is the biggest culprit.

“Estrogen affects the cells that maintain a woman’s bones, keeping them strong,” Zachariah said. “Without estrogen, the bones do not get their regular signal to keep themselves strong and they start to become brittle,” he said.

Because men’s bone strength does not rely on estrogen the way women’s does, men are less likely to develop osteoporosis as they age.

The danger of broken bones later in life

Broken bones are common in children and they typically bounce back, restored to normal function after the break heals. But as your bones age, broken bones can be more devastating.

Weakened bones can be at risk even during day-to-day routines. Zachariah says vertebral and hip fractures are the most notable risks associated with osteoporosis and can greatly impact quality of life.

Bone fractures in the spine can over time cause kyphosis, also known as a hunched back. The rounded back can cause loss of height making daily activities more difficult. Hip fractures can cause severe pain and disability, often leaving patients wheelchair-bound or unable to get out of bed.

Reducing your risk

A healthy lifestyle can help lower your risk of osteoporosis and should go hand-in-hand with any treatment plan. To help keep osteoporosis at bay, Zachariah says:

  • Talk to your doctor about adding calcium or vitamin D supplements to your diet.
  • Do regular weight-bearing exercise. Start small and work your way up.
  • Don’t smoke and limit alcohol consumption.