Generic Name

Brand Name

Dosage

Side-effects

Comments

alendronate

Fosamax

70 mg once weekly or 10 mg each morning, 30 minutes before eating with a glass of water for the treatment of osteoporosis, 35 mg once weekly or 5 mg daily as a prevention dose

An oral solution is available for those patients who have difficulty in swallowing the Fosamax tablet. The liquid has a raspberry flavor to it and requires taking a 75 ml bottle of Fosamax once a week.

Most important concern is regarding irritation of the esophagus.  The patient is asked to sit up or stand up immediately after taking the Fosamax and definitely not to lie down back in bed until after they have finished their breakfast

Fosamax is very difficult to absorb, and thus if any food or other pills are taken with it, not much of the medication will get absorbed into the body.  This is the reason it has to be taken on an empty stomach with water and with a 30 minute waiting period for absorption without being allowed to attach to other food substances or medications

calcitonin

Calcimar (injection)

Miacalcin nasal spray

Dose varies 100 I.U. to 200 I.U. daily or at intervals during the week given as S.Q. injection

200 I.U. with one spray in one nostril daily

Reactions at the injection site, GI symptoms with nausea, vomiting or diarrhea, flushed feeling, rash

There may be local irritation in the nostril and even ulceration.  Once again a patient may have GI problems with nausea, vomiting, diarrhea, flushing or rash

The injectable calcitonin not only works for osteoporosis treatment but particularly is effective for bone pain after a compression fracture.

This medicine does block resorption of bone, although it is not as strong as alendronate.  It is an alternative treatment however, in those patients who have esophageal problems and cannot tolerate alendronate

raloxifene

Evista

60 mg once daily by mouth

Leg cramps, hot flashes, potential for deep vein thrombosis which could then evolve into pulmonary embolus if unrecognized or untreated

This is an excellent alternative in women who cannot tolerate estrogens or have a strong family history of breast cancer or problems particularly with vaginal bleeding on estrogens.  Would avoid Evista in a woman with a history of clotting problem.  Also should not be used in pregnancy.  If a patient is going to be immobilized such as when admitted to the hospital, Evista should be stopped because of the potential for thrombosis with the patient at rest

conjugated estrogens

Prempro, Premphase (combined with progesterone)

Premarin w/o progesterone

Usually .625 mg daily with 2.5 mg of progesterone

May be taken daily in various dosages 0.3 mg up to 2.5 mg with usual dose at .625 mg daily.  May take it for 21 days of the month and then rest or take it on a daily basis with the addition of progesterone tabs for 10 days per month or a smaller dose on a daily basis

Breast pain, vaginal bleeding, weight changes, possible increased risk for uterine cancer if uterus still in place unless progesterone is used with this, possible increased clotting problems and deep vein thrombosis

Estrogen is still a wonderful way to treat postmenopausal osteoporosis in those women who can tolerate it.  It also has beneficial effects from a cardiovascular standpoint with lowering of the cholesterol and the LDL cholesterol (bad cholesterol).  When used for osteoporosis, it should be combined with an adequate dosage of calcium and vitamin D.

5mg once daily with water or 30mg once weekly with water