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P&S Journal

P&S Journal: Fall 1996, Vol.16, No.3
Clinical Advances
Expanded Clinic Targets Osteoporosis

Osteoporosis is a devastating disease: It affects an estimated 25 million Americans, mainly women, resulting in some 1.3 million fractures a year in individuals over age 45. Osteoporosis-related hip fractures are especially damaging, resulting in up to 20 percent excess mortality in the first year following the fracture. Half of all individuals who suffer a hip fracture due to osteoporosis never return to an independent mode of living. The cost of health care for osteoporosis-related fractures is estimated at $10 billion a year.



Normal Bone
In an effort to help change these distressing statistics, CPMC has expanded its osteoporosis program to provide individualized screening, nutrition counseling, referral to physical therapy, and treatment with a variety of medications. The new Osteoporosis Prevention and Treatment Center supports state-of-the-art bone density technology, patient care, research, clinical trials, and education programs for both patients and health care professionals.

Clinical trials are under way at CPMC for two new drugs, raloxifene and tiludronate. Raloxifene is chemically related to tamoxifen and has some estrogen-like effects. Like estrogen, it helps slow bone loss. It also lowers LDL cholesterol, although, unlike estrogen, it does not raise HDL levels. Importantly, it also does not stimulate breast tissue, leading researchers to speculate it may pose less risk for breast cancer and possibly afford breast protection. In addition, raloxifene does not stimulate the uterus and therefore does not produce menstrual-like bleeding. The drug's effectiveness against osteoporosis is now being tested on approximately 10,000 subjects in medical centers around the world.

Tiludronate, another drug with promise for the treatment of osteoporosis, is also being tested in a multi-center trial now in its third of five years. Tiludronate is similar in action to the anti-osteoporosis drug alendronate but is used cyclically rather than daily.



Osteoporotic Bone
The development and testing of these new medications marks a turning point in the treatment of osteoporosis: Until recently, only a few limited treatment choices existed for osteoporosis. Estrogen was considered the therapy of choice, but some women either could not take it because of pre-existing conditions or objected to it because of its possible cancer risk, side effects, or other concerns. Two other medications-parenterally administered salmon calcitonin and cyclic etidronate-did not have clearly proven roles in reducing the likelihood of fractures. Beginning in 1995, however, the U.S. Food and Drug Administration approved two new medications-orally administered alendronate and intranasal calcitonin.

Current drug therapies are aimed at helping women who already have osteoporosis, says Dr. Ethel Siris, professor of clinical medicine and director of the osteoporosis program. "But, a fracture is just the first symptom of a process of bone loss that goes on in all women after menopause. The extent of a woman's risk of fracture depends in part on how much bone she has at age 30, when she has her peak bone mass, as well as on the rate at which she loses bone after menopause." Future therapies will aim to build peak bone mass and slow bone loss. "The real work in osteoporosis research lies in preventing it from ever developing," says Dr. Siris.


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