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Match Medications to Your Needs

June 3, 2014 @ 6:48 am
posted by Dr Ginther

Are your bones still good enough and just need to be maintained?  Or have you fractured several times and need to rebuild your bones?  Are Steroid Inhalers supressing your Osteoblasts – the cells that build new bone?  (not good)  Or have your Osteoclasts – the cells that eat away bone – gone wild (even worse) now that you are post-menopausal or an older guy?

Different problems require different classes of medication.  Bisphosphonates, Hormone Replacement Therapy, Synthetic Estrogen Receptor Modifier – Evista, and RANK-Ligand Antibody – Prolia, are all Antiresorptives, which act in different ways.  They slow down the Osteoclasts that have gone wild and are eating up the bone.  The Anabolic, Forteo, stimulates the Osteoblasts that make new bone matrix.  Antiresorptive and Anabolic are radically diferent actions.

Briefly:

Bisphosphonates accumlate in bone, and disable or kill the Osteoclasts that gobble up that bone.

Modern Hormone Replacement Therapy re-establishes Estrogen control of the Osteoclasts – basically restoring a woman’s pre-menopausal state.

Evista re-establishes estrogen-like control over the Osteoclasts.  It also blocks Breast Cancer Risk by about 70%.

Prolia works like the hormone which Estrogen and Evista induce to control the Osteoclasts that otherwise will gobble up that bone.

Forteo is the only Anabolic.  It is the only one to significantly stimulate Osteoblasts and new bone formation.  It stimulates bone turnover and often stimulates bone healing (a good thing after a fracture).

Antiresorptive Bisphosphonates (Fosamax, alendronate, Actonel, Atelvia, Boniva, Ibandronate, and Reclast), and Antiresorptive Prolia, do not speed up bone healing, and can slow bone healing at times.

More details in coming posts.  (Some older posts about these medications do not have all the latest data.)

Choose the best medication for you by identifying the problems that need fixing.  A Complete Bone Health Evaluation will help identify the underlying problems.  That will help you choose the best osteoporosis medication for you.

Jay Ginther, MD

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