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Kuo Internal Medicine


Dr Wilbur Kuo

Health Topic: Osteoporosis

by Dr. Wilbur Kuo, MD
March 15, 2016

What medications are used to treat osteoporosis?

oral bisphosphonates
- such as fosamax, actonel, and boniva
- Most are given once a week; boniva is once a month
- Have to take on an empty stomach, first thing in morning, with 8 oz water, and stay upright without eating for 30-60 minutes after
- Can cause stomach inflammation (gastritis)
- Can't use if have chronic kidney disease or esophageal disorders
- Rare risk of jaw necrosis mostly in patients with cancer. Stop medication if you get bone pains

IV bisphosphonates
- such as reclast or IV boniva
- Given if patient can't tolerate pills
- Reclast is given once a year through a 15 minute infusion
- Boniva is every 3 months
- Cannot be given to patients with kidney problems
- can cause flu-like sxs for 1-3 days

- nasal spray
- helps with vertebral fracture pain
- Taken once a day, alternating nostrils every day

- used for severe osteoporosis: t-score less than -3.5 or t-score less than -2.5 accompanied by fracture
- Given as an injection every day
- Give for 2 years then follow with a bisphosphonate

Prolia or Xgeva
- used in osteoporosis patients with a fracture, people with kidney disease, or in patients intolerant of oral bisphosphonate
- Given as injection every 6 mos
- Watch for signs of infection

Evista, an estrogen receptor modulator
- for postmenopausal women w/no fx, can't tolerate bisphosphonates, and/or have an increased risk of breast ca
- doesn't work as well as fosamax

Hormone replacement therapy
- no longer first line due to risk of breast cancer, stroke, blood clots, and heart disease

More later...

As always, consult your physician before diagnosis yourself or making treatment changes 


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