Osteoporosis is a skeletal disorder characterized by compromised bone strength, leading to bone fragility with increased vulnerability to fracture. 8 out of the 10 million persons with osteoporosis are women.
Some things to know:
- Women can lose up to 20% of their bone density 5-7 years into menopause if loss is not tempered by estrogen supplementation or administration of another bone-resorbtion mitigator. In other words, you need to take something to control the bones breaking down. 20-25% of women are genetically susceptible to loss.
- Approximately half of women older than 50 years will have an ostroporosis-related fracture in their lifetime. Over 2 million osteoporotic fractures in one year (2005 data) were responsible for an estimated $19 billion in costs, not to mention the devastating effects of immobility on the effected individual. This figure is expected to rise to more than 3 million fractures by the year 2025, and probably more since so many women discontinued estrogen therapy secondary to the “great estrogen scare” of 2002-2005 that caused so many women to discontinue what may have been the only medication (estrogen) that stood between them and fragile, fracture-prone bone. (Turned out than the “causes breast cancer” scare of that study was false, secondary to misinterpretation of data.)
- Osteoporotic fractures are most likely to occur in the hip, spine, and wrists, resulting in increased morbidity, healthcare costs, and mortality. Fortunately, highly effective therapies such as estrogen, estrogen-receptor modulators (“SERMs”), and parathyroid hormone (Forteo™) are available, but compliance with therapy is frequently poor owing to perceived adverse effects of medication, inconvenient dosing regimens, or both. It’s important to know the true facts.
For those with bone density issues either leery of estrogen (the “gold standard” for reducing bone loss), not wishing to use a bisphosphonate (Fosamax™, etc), or desiring “dual therapy” to more robustly increase bone mineral density, there is a relatively “new kid on the block.” It’s name is Dinosumab.
Facts About Dinosumab
Dinosumab (trade name Prolia™), is a member of a group of compounds that are “RANK-L inhibitors,” and is an FDA-approved anti-resorbtive agent that will meet the goals of many post-menopausal women. RANK-L is a receptor activator factor that promotes bone resorbtion cells (osteoclasts). Dinosumab and other similar drugs still “in the pipeline” inhibit the formation, function and survival of osteoclasts (bone-breakdown cells), resulting in decreased bone resorbtion and therefore increased bone mineral density (“BMD.”) Multiple placebo-controlled trials have proven Dinosumab superior even to bisphosphonates in prevention of bone resorbtion, resulting in fewer fragility fractures of vertebra, wrist and hip. Important to note however is that, unlike bisphosphonates, which confer bone resorbtion protection for a few/several years after discontinuation (thus the several years on, years-off therapeutic regimen presently recommended), Dinosumab does not bestow long-term protection after discontinuation.
Dinosumab is given as a single injection, 60 mg. just under the skin, every six months, and is tolerated well in most, making it a relatively easy therapeutic regimen. Because of its expense, it is probably not indicated for primary prevention in women not osteoporotic (estrogen or a bisphosphonate are probably best for that.) However, for women with severe osteopenia or borderline to moderate osteoporosis, Dinosumab, especially if combined with estrogen therapy) is probably the best therapeutic regimen available short of parathyroid hormone, which is the gold standard for the treatment of severe osteoporosis, especially in an individual at risk for fracture.
Concluding, it is of course important to remember that we are speaking here of loss-prevention. Bone formation is equally important. For that, don’t skimp on your calcium, vitamin D, and weight-bearing exercise.