Osteoporosis therapeutic approach

An alternative therapeutic approach to osteoporosis is through the use of calcitonin (798), a peptide hormone containing 32 amino acids (the sequence is species dependent) secreted by the thyroid gland, which stimulates the production of new bone. Synthetic calcitonins corresponding to human, eel, and salmon variants, and natural calcitonin extracted from pig thyroid, are all used in medicine - they have slightly different efficacies, side effects, and tolerance levels (799). 

However, convincing evidence questions the usefulness of this classification and these therapeutic approaches. Dietary restriction of calcium is now generally regarded as ineffective, and actually counterproductive, as it results in an increase in intestinal oxalate absorption and increased risk of stone formation. Further, patients with hypercalciuria are known to have reduced bone mineral density, and dietary calcium restriction may exacerbate a tendency to osteopenia and/or osteoporosis. ... 

Bisphosphonates such as etidronate are often coprescribed with calcium supplements in the treatment of osteoporosis. If these are ingested concomitantly, the bioavailability of both is significantly reduced with the possibility of therapeutic failure. This may be avoided by allowing a sufficiently long dosage interval a possible approach is to give etidronate for 2 weeks and calcium supplements for 10 weeks in a 12-week period. 

Miller E. Therapeutic options an evidence-based approach to prevention and treatment of osteoporosis. Int J Fertil Women s Med 2003 48 122-6. 

Biological products were developed traditionally, before recombinant proteins, as extracts or derivatives of the actual protein from the human body or nature. This approach continues today and Table 15 lists 18 such products, mostly blood derivatives for therapeutic use. Albumin is obtained for cardiovascular volume conditions. A fish protein is harvested for osteoporosis. Igs extracted from blood are available for immunodeficiency conditions, viral infections (hepatitis-B and vaccinia), hemolytic anemia in newborns, and idiopathic thrombocytopenic purpurea. Antihemophilic products are still derived from blood. An antiglobulin is produced for kidney transplant rejection. A collagen product and two botulinum toxin products are used for various facial wrinkle problems and cervical dystonia. A bacterial antigen is formulated to enhance immunity to treat a cancer. 

Teriparatide contains the first 34 amino acids in human parathyroid hormone and represents a novel approach to osteoporosis treatment. Although hyperparathyroidism leads to bone loss (see Fig. 88-3), therapeutic doses (for shorter periods of time) conversely improve BMD and rednce fractnre risk. Parathyroid hormone is currently the only approved osteoporosis medication that works by stimulating bone formation. Becanse of adverse effects and cost concerns, teriparatide is reserved for treating those at high risk of osteoporosis-related fracture who cannot or will not take or have failed bisphosphonate therapy. 

Bone health and the prevention of osteoporosis-related fractures are key elements in the strategy for managing patients undergoing menopause. A detailed knowledge of bone health and related diagnostic and therapeutic options falls within the domain of the g)mecologist as part of a mulfidisciplinary approach. 

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