Medicines to protect bones

In addition to lifestyle changes you can make to help keep your bones healthy, there are certain medicines that can be taken to stop bone loss. As with all medicines, these come with some side effects, but if you have been diagnosed with osteoporosis, your doctor may recommend one of these medicines to keep you from losing more of your bone strength and help prevent fractures.

Some of the same medicines that are used to treat osteoporosis have been shown to help lower the risk of breast cancer returning and, in some studies, even seemed to improve breast cancer survival. Doctors will learn more about how bone health medicines can benefit women with breast cancer as future studies are released.

Bisphosphonates for bone loss

The most common medicines given to people with low bone density are called bisphosphonates. These medicines slow the cells that break down bones to keep them from getting weaker.

Bisphosphanates can be taken as a pill or given by vein. The most common bisphosphonate pills are alendronate sodium (Fosamax) and risedronate sodium (Actonel), which are taken weekly, and ibandronate sodium (Boniva), which is taken monthly. These are known to cause heartburn and upset stomach after being taken. To prevent these side effects, you should:

• Take the pill with a full glass of water on an empty stomach
• Do not lie, bend down or eat for 30-60 minutes after you take your pill
• After the wait time has passed, eat a meal to settle your stomach

One way to do this is to take the pill when you wake up before your morning shower. You will be standing upright through the shower and your morning routine, then ready for breakfast once you are dressed.

You can also get bisphosphonates by vein if you are bothered by the side effects of the pill or they are not working. The two common bisphosphonates given by IV are each a form of zoledronic acid. Reclast is given once a year to women who are postmenopausal, and Zometa is given to women who have stage IV breast cancer in the bones.

Most bisphosphonates work similarly well. Ask your doctors how they chose the one for you. Cost and how likely you are to keep to the schedule of when to take it are important factors in this decision. If you don’t think you will remember to take a pill monthly, a form you take weekly may be better.

Bisphosphonates for breast cancer

Because bisphosphonates act on the bone, they have been studied as a possible way to stop breast cancer from recurring in bones. A 2015 meta-analysis brought together the findings of 26 previous trials. It found women who were given bisphosphonates showed a lower risk of recurrence of the bones over 10 years. But the greatest benefits were for women who had been through menopause when treatment began. They showed a lower risk for distant recurrence and death from breast cancer.

The reason bisphosphonates work better in postmenopausal women is not clear. More research is being done to determine the best treatment schedule for bisphosphonates in lowering risk of breast cancer recurrence. But your doctor may discuss bisphosphonates as a possible treatment option for you.

Other medicines for bone health

If bisphosphonates are not working, or your doctor thinks a different medicine may work better for you, you may be given one of these other treatments to help manage your bone health.

• Raloxifene (Evista) is a pill taken once a day that can prevent bone loss by acting like estrogen, which normally signals the bones to rebuild. It may cause hot flashes and, in rare cases, blood clots.
  • It is also approved to lessen the chance of developing breast cancer for postmenopausal women who are considered to have a high risk but who have not been diagnosed.
• Denosumab (Prolia, Xgeva, and biosimilar denosumab-bbdz [Jubbonti]) is part of a class of medicines called RANK ligand inhibitors. Denosumab stops the cells that break down bone tissue for women with a high risk for fracture because they take aromatase inhibitors. It is given by injection once every six months.
• Teriparatide (Forteo) is given to women who have already been through menopause and have very low bone density. It is the only medicine that has shown the ability to regrow some bone density.
• Calcitonin is a nasal spray derived from salmon that helps slow the breakdown of bone in postmenopausal women with osteoporosis.

A note on estrogen replacement therapy: You may know women who have been given hormone replacement therapy for menopausal symptoms or osteoporosis. Because estrogen causes certain types of breast cancer to grow, women who have had breast cancer are usually discouraged from using products meant to raise the levels of estrogen in the body.