Injection, infusion and medication: Demystifying osteoporosis treatments

Dear Dr. Roach: I have had osteoporosis for a while and recently had a bone density test that again confirmed that I have it. I am not really interested in taking an oral prescription such as Fosamax, because of the many negative side effects. I would like to find out more about the injection, Prolia. I also understand that there is an infusion, Reclast, that is done once a year. I am concerned about the strength of something that is done only once a year and any side effects since I tend to be sensitive and don’t take a lot of medication.

I have also heard that the bone that is produced after taking these medications tends to be brittle and breaks easily. If that is true, how is that helpful? A nurse told me that her 88-year-old mother, who had been very active and healthy, just turned the wrong way and broke her back. She said that at 69 years old it isn’t a huge issue, but at 80 it may be. That is why I am considering a treatment plan currently. — D.B.

Dear D.B.: Osteoporosis is decreased bone mass, abnormal bone architecture and bone fragility. Having it puts men and women at higher risk of fracture. Many conditions predispose a person to developing osteoporosis, but older age and being female by themselves are significant risk factors, enough to warrant screening.

Alendronate (Fosamax) is a type of medicine called a bisphosphonate. Zoledronic acid (Reclast) is an injectable form of the same class of medicine. It is certainly true that medicines like these have the potential for side effects. However, doing nothing is not a good choice. Without treatment or prevention, 15% of women and 5% of men will develop a hip fracture by age 80. Hip fractures have a profound effect on quality of life.

The bone density test is a very good screening test, but decisions to treat should be based on an overall picture of the person, including risk factors, such as that given by the FRAX score. People at high risk of fracture get much more benefit than harm from medication for osteoporosis, when used properly.

Long-term use of these drugs can lead to brittle bones and atypical fractures. Experts can avoid this risk by using these medications appropriately, i.e., for only as long as necessary and by changing medications if needed. The long-term safety record of oral bisphosphonates like alendronate is well-established when used properly. It is the best firstline treatment for most men and women with age-related osteoporosis.

Denosumab (Prolia) works similarly, but because the gains in bone strength are lost quickly after stopping Prolia, it’s not my first choice.

Dear Dr. Roach: Ihada problem with swollen legs. As a last resort, my cardiologist stopped my terazosin. I didn’t take it one night. Guess what — the next morning like a miracle my legs were back to normal. I am 92 years old, and everything is functioning just fine. — M.W.

Dear M.W.: Terazosin (Hytrin) is in a class of medicines called alpha blockers. They are most used in men with symptoms from a large prostate, but also can be used for high blood pressure. Although, the newest alpha blockers have less blood pressure effect. Dizziness on standing and swollen legs are among their most common side effects.

All medicines can cause side effects, but you should never stop a medicine without physician advice. There are other choices for both blood pressure and prostate symptoms.