Preventing osteoporosis: Beyond estrogen
September 27, 1999
Web posted at: 11:38 a.m. EDT (1538 GMT)
By William Hazzard, M.D.
Hormone replacement therapy is a double-edged sword for Pat Snyder. She says she often thinks about taking estrogen because it will help keep her bones strong to ward off osteoporosis and the two hip surgeries that her late mother endured. But equally on Snyder's mind are reports that estrogen could encourage the development of breast cancer, a disease that also afflicted her mother, who died from complications of ulcer surgery.
Snyder's decision is as emotional as it is mental. The 61-year-old San Francisco administrative assistant says that she's deeply affected by her mother's experience. At the same time, she reads up on the latest research and tries to stay informed about the benefits of taking estrogen and alternatives.
In the United States and Canada, approximately 4,000 women reach menopause every day, according to the North American Menopause Society. Like Snyder, many women grapple with the decision of whether to take estrogen, hoping that it may help offset osteoporosis and heart disease. But reports that breast and uterine cancers develop in some women who take estrogen may deter them.
But now, women may have more options as researchers develop new medications designed to prevent and treat osteoporosis. Called selective estrogen receptor modulators (SERM), the new medications behave like estrogens in the bone (and possibly the heart) but act like "anti-estrogens" on the breast and uterus. Researchers have found that these medications carry fewer side effects than estrogen. Some SERMs are still being developed while others are likely to reach the market soon.
Raloxifene, a SERM, received a lot of attention in the last year, when researchers reported that it could possibly prevent breast cancer. Just last month, results of a study published in the Journal of the American Medical Association showed that raloxifene was able to reduce the risk of spinal fractures by up to 50 percent. The researchers also found that raloxifene, which is currently approved to prevent osteoporosis, reduced bone loss in the spine and hip, without cancer-like changes in the breast or uterus.
Alendronate is another alternative to estrogen treatment. This SERM directly inhibits the bone from losing minerals, which keeps bones strong. Studies have shown that alendronate increases bone density of the hip and spine and reduces spinal fractures. Unfortunately, alendronate carries side effects that may preclude some people from using the medication. Side effects include abdominal pain, heartburn and flatulence. Other side effects include musculoskeletal pain and headaches. Because of the medication's corrosive nature, people who take this drug must take steps to prevent the esophagus from becoming inflamed. In addition, alendronate's effectiveness in preventing osteoporosis in men has not yet been determined.
Calcitonin, in the form of a nasal spray, may offer an effective alternative for people unable to use SERMs. The hormone calcitonin inhibits the body from taking minerals from the bone, which is how osteoporosis usually develops. However, calcitonin appears less effective than estrogen or alendronate in preventing fractures.
Back to basics
Medications, of any type, can only go part way in preventing osteoporosis, with diet and lifestyle playing central roles, according to the National Osteoporosis Foundation. A diet rich in calcium and vitamin D -- obtained from consuming dairy products, canned sardines and broccoli -- can help supply the body with the material it needs to maintain strong bones. And weight-bearing exercise -- walking, jogging and stair-climbing -- also keeps bones strong. Health experts also recommend people stop smoking and limit alcohol. Perhaps the best approach is for people to speak to their doctors to come up with a plan that works.
Dr. William Hazzard is a professor of medicine at the University of Washington School of Medicine and manager of the Geriatric and Extended Care Service Line at the Veterans' Administration Puget Sound Health Care System in Seattle. He has founded three programs in gerontology and geriatric medicine located at the University of Washington, Johns Hopkins University in Baltimore and Wake Forest University in Winston-Salem, North Carolina. He is the chief editor of the textbook "Principles of Geriatric Medicine and Gerontology," and he is the author of 75 chapters in books and over 140 peer-reviewed articles.
Copyright 1999 WebMD, Inc. All rights reserved.
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