Drugs for Bone Disorders

Drugs used to treat disorders affecting bone formation, replacement, and repair

Common drugs

    Bisphosphonates

  • Alendronic acid

  • Etidronate

  • Ibandronic acid

  • Risedronate

    Calcium and vitamin D

  • Calcitriol

  • Calcium carbonate

  • Ergocalciferol

  • Vitamin D

    Oestrogen and compounds with oestrogen-like effects

  • Conjugated oestrogens

  • Estradiol

  • Raloxifene

  • Tibolone

    Other drugs for bone disorders

  • Calcitonin

  • Parathyroid hormone

  • Teriparatide

  • Strontium ranelate

The body constantly breaks down and rebuilds bone. Disorders can develop if the balance between breakdown and renewal is upset. Drugs that affect bone turnover are used to treat disorders in which either too much bone is broken down or bone grows abnormally. For example, in osteoporosis, bone is broken down faster than it is replaced; in Paget’s disease of the bone, there is abnormal bone formation.

What are the types?

Drugs used to treat bone disorders include bisphosphonates; calcium and vitamin D; oestrogens and compounds with oestrogen-like effects; certain hormones involved in bone breakdown and rebuilding, such as calcitonin and parathyroid hormone, and synthetic variants of such hormones, such as teriparatide; and strontium ranelate.

Bisphosphonates

These drugs have re-placed hormone replacement therapy as the first-line treatment for osteoporosis; they are also used to treat Paget’s disease. The drugs work by reducing abnormally high rates of bone breakdown and renewal and are usually taken orally. Side effects may include nausea, diarrhoea, and indigestion.

Calcium and vitamin D

These substances are essential for maintaining healthy bone. Supplements may be used to treat bone disorders. Postmenopausal women require a daily calcium intake of about 1,200–1,500 mg, much of which can be obtained in the diet. Calcium supplements may cause constipation. Vitamin D helps the body to absorb calcium from food. Deficiency is rare but can cause rickets in children and osteomalacia in adults. Taken at the recommended dose, vitamin D supplements usually cause no side effects.

Oestrogen and compounds with oestrogen-like effects

The sex hormone oestrogen and compounds with oestrogen-like effects slow the breakdown of bone and may be used to prevent osteoporosis or to slow its progress. However, oestrogens, either alone or with progestogens, and tibolone are no longer usually recommended as the first-line treatment for the prevention or treatment of osteoporosis. Raloxifene is used for the prevention and treatment of osteoporosis after the menopause. Side effects include hot flushes, leg cramps, rashes, and breast discomfort. There is also a risk of thromboembolism.

Other drugs

Calcitonin and parathyroid hormone help regulate bone turnover in the body. As medication, calcitonin may be used to treat Paget’s disease and to reduce the risk of osteoporotic fractures in some postmenopausal women. It may be given as a nasal spray or by injection. Side effects may include irritation at the injection site, gastrointestinal disturbances, and hot flushes.

Parathyroid hormone and teriparatide are given by injection and may be used to treat osteoporosis in some women at a high risk of fractures; teriparatide may also be used to treat some men at risk of osteoporotic fractures. Possible side effects of both drugs include gastrointestinal disturbances, palpitations, and irritation at the site of injection.

Strontium ranelate stimulates bone formation and reduces bone breakdown. It may be used to treat osteoporosis in some women for whom other treatments are not suitable. Possible side effects include gastrointestinal disturbances, headache, and venous thromboembolism. Very rarely, it may cause a life-threatening allergic reaction; if you develop a rash while taking strontium ranelate, you should stop using the drug and consult your doctor immediately.

Warning

If you are taking strontium ranelate and develop a rash, particularly if it is accompanied by fever and swollen glands, you should stop taking the drug and consult your doctor immediately.

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

The subjects, conditions and treatments covered in this encyclopaedia are for information only and may not be covered by your insurance product should you make a claim.

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