Modern Hormone Replacement Therapy (HRT) is safe in most women through their 60′s. 20 years ago, when Progesterone was included in the formulation, HRT was associated with heart problems. Estrogen alone in modern HRT avoids this issue, at least until age 70. Recent studies have shown that modern HRT actually decreases heart disease deaths in women in their 50′s.
Modern HRT is most commonly used to treat menopausal symptoms. However, human estrogen is what naturally preserves bone in a pre-menopausal woman. Restoring human estrogen will also preserve bone in a post-menopausal women. You can postpone Osteoclasts Gone Wild eating away your bones!
A delicate balance between bone formation and bone resorption is needed for Healthy Bone. This balance is naturally present until menopause in a woman or “Low T” in a man. The main players are OsteoBlasts, OsteoClasts, and OsteoCytes.
OsteoBlasts are cells that build bone by producing bone matrix (Anabolic). OsteoClasts are cells that resorb or take away bone (Resorptive). Both live on the surface of bone. OsteoCytes live inside bone and control the balance of formation and resorption through the hormone Osteoprotegrin (OPG). OPG supresses the number and activity of OsteoClasts.
Estradiol is the hormone that tells the OsteoCytes to make enough OPG to keep the Osteoclasts under control. Women make Estradiol from Estrogen. Men make Estradiol from Testosterone. Women after menopause (about age 50) and men after about age 70 no longer make enough Estradiol to produce enough OPG. Then it is Osteoclasts Gone Wild.
Modern Hormone Replacement Therapy (HRT) is an obvious possibility in a woman. Estrogen is back on board. Prolia (Denosumab in osteoporosis dose), and Evista (Raloxifene), are two novel osteoporosis medications designed to bring unruly OsteoClasts under control. They both mimic the natural process, but in different ways. We will address each in coming posts.
Take Back Control with whatever medication works best for you.
Jay Ginther, MD
The biggest problem with oral Bisphosphonates is GI upset, especially Gastro-Esophogeal Reflux Disease (GERD). Another problem is that you must take them on an empty stomach – then eat nothing for 30 to 60 minutes. Atelvia attempts to evade those issues with enteric coating. Atelvia is Risedronate (Actonel) which does not disolve until in the small intestines. It can be taken with food. This is definitely more convenient.
Published studies show Atelvia to be as effective in decreasing fracture rates as daily Actonel (the orginal dosing of Risedronate). That is good.
The enteric coating should make GERD much less common than with regular Actonel. Surprisingly, there are no published studies to back up that obvious supposition. Nor are there any studies about other GI problems common with regular bisphosphonates. Fortunately, we do have some samples for patients to try in order to determine if they have any GI problems with Atelvia, before getting a paid-for prescription.
Atelvia is still new enough on the market that we have no long term experience. It may acquire the niche market for an oral Bisphosphonate without GERD.
Having an additional osteoporosis medication option is good.
Jay Ginther, MD