Estrogen agonists/antagonists have a mechanism of action similar to estrogen when it comes to protection of bone, but without some of the side effects of hormonal therapy.
Evista is known to build bone mass, similar to estrogen. Unlike estrogen, it does not increase the risk of breast or uterine cancer. However, it does increase the risk of blood clots.
Evista belongs to a drug class called selective estrogen receptor modulators (SERMs); SERMs are FDA-approved for the prevention and treatment of osteoporosis in postmenopausal women, as well as reduce the risk of invasive breast cancer in postmenopausal women at risk or with osteoporosis.
SERMs act like estrogen, but without the potential side effects. Evista helps to protect bone density but does not affect the uterine lining – meaning it does not cause uterine cancer. It was also shown to lower LDL cholesterol.
As discussed, those taking Evista are at increased risk of blood clots, including deep vein thrombosis and pulmonary embolism – but this side effect affects less than 1% of women without a prior history of blood clots. The most notable side effect is hot flashes.
Forteo is a synthetic form of parathyroid hormone (PTH). PTH is responsible for regulating calcium metabolism in the body. Thus, Forteo increases bone density and causes new bone to grow. It is the only FDA-approved medication that is approved to rebuild new bone.
Forteo is given only to men with osteoporosis, or to women who are postmenopausal. It is given via injection. The downside to this medication is that the injection is daily, as opposed to some of the other medications, which are much less frequent. Long-term studies have not been performed, so it can only be prescribed for up to 24 months.
Side effects include itching and redness at the injection site, heartburn, depression, and leg cramps.
Hormonal Replacement Therapy (HRT)
The use of HRT to treat osteoporosis has been studied vastly, from observational studies, case-control studies, randomized clinical trials, and meta-analyses. The same conclusion has been met – HRT is highly effective at decreasing the risk of fractures (in some research, a reduction in fracture risk up to 25%!) and discontinuing HRT shows a loss of the anti-fracture efficacy as well as a decreased risk of colon cancer.
However, the studies also indicate that there are other health risks associated with HRT. For example, the use of HRT increases the risk of endometrial cancer. It also increases the risk of cardiovascular events such as unstable angina (USA), venous thromboembolism, and thromboembolic stroke. It can also increase the risk of myocardial infarction, ovarian cancer, and overall cognitive function.
HRT should be considered if other treatment modalities are not tolerated or are contraindicated, and then at the lowest dose possible.
Natural/Herbal Remedies for Osteoporosis
Drugs from your doctor aren’t your only options. From supplements to herbal remedies, talk to a medical professional if the following strategies are right for your lifestyle and your current bone health status.
Take Omega 3s
Omega-3 fatty acids are healthy fats the may improve bone health, especially when combined with foods that are also high in calcium. Omega-3s are also linked to a wide range of additional health benefits, such as improved cardiovascular health, better cognition, and enhanced mood.
Look for Herbal Options
Herbal medicine has been used for centuries to treat maladies such as osteoporosis. One promising area is in the realm of traditional Chinese medicine (TCM).
In a report published in the Journal of Traditional and Complementary Medicine, researchers did a review of current studies done on TCM, specifically looking at the safety benefits of TCM herbs compared to modern drugs that have potentially negative side effects.
“Many medicinal herbs used in Traditional Chinese Medicine, known as kidney tonics, have been tested for their effects on bone metabolism in the laboratory and clinically,” notes the study. Three specific herbs were tested successfully:
- Herba epimedii (淫羊藿, Yín Yáng Huò)
- Fructus ligustri lucidi (女貞子, Nǚ Zhēn Zi)
- Fructus psoraleae (補骨脂, Bǔ Gǔ Zhī)
“Bone mineral density protection was obvious among those women with the onset of menopause beyond ten years,” concludes the report. “A general protective trend was observed among all women under trial. [...] Our study supports more research and trials in this area, while we are looking for safe and effective agents to keep the bone metabolism in a balanced state.”
Meanwhile, a recent study from the University of British Columbia found that another TCM herb called red sage helps block an enzyme that leads to the breakdown of bones during osteoporosis.
Talk to your doctor if TCM could be an appropriate option for you.