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Medication Options H ealthPLACE/HOPE Program COPYRIGHT © 2002 Highmark Inc. All Rights Reserved. These materials may not be copied or otherwise reproduced in any manner.
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Medication Options Are You A Candidate for Medications? Postmenopausal women with vertebral or hip fractures Bone mineral density (BMD) T-scores below -2 in the absence of risk factors BMD T-scores below -1.5 if other risk factors are present Women over age 70 with multiple risk factors H ealthPLACE/HOPE Program
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Medication Options Medication Options for the Prevention and Treatment of Osteoporosis Hormone Replacement Therapy (HRT)/ Estrogen Replacement Therapy (ERT) Selective Estrogen Receptor Modulators (SERMs) Bisphosphonates Calcitonin-Salmon H ealthPLACE/HOPE Program
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Medication Options Hormone Replacement Therapy (HRT) vs. Estrogen Replacement Therapy (ERT) HRT is a combination of synthetic progesterone (progestin) and estrogen ERT is prescribed if you no longer have your uterus Both can help your body absorb more calcium and prevent bone loss that can occur after menopause H ealthPLACE/HOPE Program
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Medication Options HRT/ERT Generic Name: Estrogen Brand Name(s): Estroderm ®, Premarin ®, Estrace ®, Ogen ®, Premphase ®, Prempro ®, Estratab ® Function: prevention & management Availability: oral tablets and skin patches Dose: varies depending on brand name Side Effects: menstrual bleeding, breast tenderness, mood disturbances, weight gain H ealthPLACE/HOPE Program
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Medication Options HRT/ERT Concerns: breast cancer, endometrial cancer, deep vein thrombosis, heart disease and stroke Take with adequate calcium and vitamin D Benefits: improves bone density and reduces fractures (50-80% decrease in vertebral fractures and a 25% decreases in non-vertebral fractures within 5 years of use), reduces risk of colon cancer, increases cholesterol levels, reduces menopausal symptoms and possibly decreases memory loss H ealthPLACE/HOPE Program
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Medication Options Forms of HRT/ERT Pill - taken cyclic (sequential) or continuous –combination pill available –metabolized or broken down Patch - changed 1-2 times a week –combination patch available –absorbed slowly and directly into the bloodstream Vaginal ring - changed every 3 months Cream - applied 1-3 times weekly HealthPLACE/HOPE
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Medication Options Women’s Health Initiative “ Findings from the WHI study are based on a single HRT product, Prempro® and should not be applied to other HRT products” – National Osteoporosis Foundation News Release, July 2002 Study showed increase risk of: –Breast cancer –Heart attacks –Strokes –Blood clots (lungs and veins) Study also showed: –37% reduced risk of colon cancer –34% reduction in risk of hip fracture –23% reduction in other osteoporosis fractures H ealthPLACE/HOPE Program
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Medication Options Selective Estrogen Replacement Modulators (SERMs) Generic Name: Raloxifene Brand Name: Evista ® Function: prevention & treatment Availability: oral tablets Dose: 60mg daily, with or without meals Side Effects: hot flashes, leg cramps, vaginal discharge Concerns: deep vein thrombosis H ealthPLACE/HOPE Program
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Medication Options SERMs (Evista®) Take with adequate calcium and vitamin D Benefits: improves bone density, reduces risk of vertebral fracture by 40-50% and risk of breast cancer, and can reduce serum cholesterol levels Produces estrogen-like effects on bone without stimulating breast and uterine tissues (so that the risk of breast or uterine cancer is not increased) Option for women who are unwilling to use HRT, have contraindications to using HRT (breast cancer), or conditions that prevent use of bisphosphonates H ealthPLACE/HOPE Program
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Medication Options Bisphosphonates Generic Name: Alendronate Brand Name: Fosamax ® Function: prevention and treatment (approved for men) Availability: oral tablets Dose: – 5 mg daily or 35 mg weekly - prevention – 10 mg daily or 70 mg weekly - treatment Side Effects: irritation of the esophagus, stomach pain, chest pain, heartburn and nausea H ealthPLACE/HOPE Program
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Medication Options Bisphosphonates (Fosamax ®) Concerns: esophageal disorders, low levels of calcium, severe kidney disease, allergy to Fosamax®, use of aspirin & NSAIDs Taken along with adequate calcium and vitamin D Benefits: improves bone density and reduces fractures by 50% in patients with osteoporosis Option for women who are unwilling/unable to use HRT or Evista®; option for men and may be first choice for those with previous fracture or high risk of fracture Instructions: take with plain water and remain upright for at least 30 minutes before first food, beverage and medication of the day H ealthPLACE/HOPE Program
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Medication Options Bisphosphonates Generic Name: Risendronate Brand Name: Actonel ® Function: prevention and treatment Availability: oral tablets Dose: 5 mg daily or 35 mg weekly - prevention and treatment Side Effects: irritation of the esophagus, stomach pain, chest pain, heartburn and nausea H ealthPLACE/HOPE Program
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Medication Options Bisphosphonates (Actonel ®) Concerns: esophageal disorders, low levels of calcium, severe kidney disease, allergy to Actonel ®, use of aspirin & NSAIDs Taken along with adequate calcium & vitamin D Benefits: improves bone density and reduces fractures of both hip and spine Option for women who are unwilling/unable to use HRT or Evista®; option for men and may be first choice for those with previous fracture or high risk of fracture Instructions: take with plain water and remain upright for at least 30 minutes before first food, beverage and medication of the day H ealthPLACE/HOPE Program
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Medication Options Calcitonin-Salmon Generic Name: Calcitonin Brand Name: Miacalcin ® Function: treatment Availability: intranasal (most commonly used) and injectable Dose: 200 IU per spray each day alternative nostrils; can be administered with meals or medications Side Effects: runny nose, nasal crusting, nosebleed, nasal ulceration and nausea; transient and usually disappear with continued therapy H ealthPLACE/HOPE Program
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Medication Options Calcitonin-Salmon (Miacalcin ® ) Take with adequate calcium and vitamin D Benefits: improves bone density in the hip and especially in the spine (improved by 40%), but not as effectively as HRT, SERMs or bisphosphates. Relieves pain of recent spinal fractures and reduces need for analgesics Option for women and men who are unwilling to accept or have contraindications to the use of HRT or bisphosphonates No drug interactions or contraindications (except allergy) H ealthPLACE/HOPE Program
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Medication Options Combination Therapy Positive evidence for combination of bisphosphonates and ERT for individuals with severe osteoporosis Miacalcin ® may be beneficial as an add-on for pain relief of recent spinal fractures Take with adequate calcium and vitamin D H ealthPLACE/HOPE Program
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Medication Options Future Therapies Parathyroid hormone treatment (Forteo®) - stimulates bone formation, increase bone mass dramatically and reduce the risk of vertebral fractures (National Osteoporosis Foundation News Release) Yearly IV treatment (Zometa®) - produces effects on bone turnover and bone density as great as those achieved with daily oral dosing with bisphosphonates with proven efficacy against fractures (NEJM 2002; 346:653-61) H ealthPLACE/HOPE Program
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