Osteoporosis ( II )

Osteoporosis ( II )

The Current Osteoporosis Treatment

A. Bisphosphonates

Currently, Bisphosphonate is the most frequently prescribed medication for osteoporosis. There are many different types of Bisphosphonate treatments in the market such as Alendronate, Risedronate, Ibandronate, Zoledronic Acid, etc. Bisphosphonate mimics pyrophosphate and acts as an antagonist, inhibiting activation of the enzyme that utilizes pyrophosphate. It also preferentially binds to calcium and promotes its storage in bones, strengthening bone health by increasing Bone Mineral Density (BMD). According to the National Osteoporosis Foundation (2018), some side effects have been observed in patients who were prescribed Bisphosphonates. Commonly, they complained of “joint or muscle pain, nausea, difficulty swallowing, heartburn, irritation of the esophagus and gastric ulcers.” (NOF, 2018) Moreover, Bisphosphonates are not recommended for patients with low calcium levels, because some reports have indicated that low calcium levels may exacerbate symptoms of the disease. (NOF, 2018) Also, Bisphosphonates are not recommended for patients with severe kidney disease, because it can worsen the kidney calcification, which may cause nephrocalcinosis. (NOF, 2018)

Moreover, Green et al. (2010) have found out that “prescribing of [oral] Bisphosphonates over a period of about five years was associated with a doubling of the risk of esophageal cancer.” (p. 545) Also, Shane (2010) claimed that long-term use of bisphosphonates can cause over-suppression of bone turnover, which can exacerbate the symptoms of osteoporosis. Moreover, Kennel & Drake (2009) have mentioned in their article, “this association was thought to be due to erosive esophagitis resulting from the suboptimal administration in patients who failed to maintain an upright posture for 30 to 60 minutes after ingesting medication with a full glass of water.” (p. 633). As they (Kennel & Drake, 2009) have argued in their article, the dropout rates from the medication treatment is higher among patients with osteoporosis, especially for those who are prescribed bisphosphonates. Because of its complicated ingestion, the improper intake of the medication resulted in the decrease in the efficacy of the drug.

Through literature reviews for the efficacy of Bisphosphonates for patients with osteoporosis, it is confirmed that bisphosphonates have many adverse effects that can even exacerbate the symptoms of osteoporosis. Moreover, as the medication ingestion method is very complicated to follow, high dropout rates are observed. Therefore, we see an urgent need in finding alternative treatment for osteoporosis with much fewer side-effects and an easier consumption method. For this reason, SAC would be highly recommended, as its efficacy has been proven in increasing BMD and decreasing bone turnover rates. Furthermore, as SAC only contains the small number of calcium carbonates that can trigger calcium homeostasis in the body, there are much fewer side effects as compared to other calcium supplements in the market.

B. SERMS (Estrogen Agonist/Antagonist)

Selective Estrogen Receptor Modulators (SERMS) are commonly prescribed for those who are suffering from postmenopausal osteoporosis, and it works by stimulating estrogenic action in bones. However, it is not recommended for women who were previously diagnosed with breast and uterine problems, because many researchers have shown the possible side effects of SERMS for those who have that medical history. There are many types of SERMS in the market. Raloxifene is the most prescribed medication for patients with postmenopausal osteoporosis. Bazedoxifene and Lasofoxifene are also commonly prescribed. While Raloxifene is specified for its efficacy to increase lowered serum estrogen level, its long-term use increases the risk of establishing endometrial cancer by two to three times. (Maximov, Lee & Jordan, 2013) Moreover, Bazedoxifene showed an increase in the risk of having venous thromboembolism. (Pickar & Komm, 2015) Since SERMS only targets repression of the serum estrogen level, it cannot control the entire homeostasis of calcium in the body. Therefore, it is necessary to find an alternative approach to reviving the underlying mechanism of the bone loss in postmenopausal women. For this reason, SAC can be a distinctive option to treat postmenopausal osteoporosis, while it triggers calcium homeostasis in the body. As it helps to balance the serum and intracellular calcium concentration, it can increase bone mineral density as well as the quality of bones.

C. Teriparatide (Recombinant PTH)

Teriparatide is the recombinant form of parathyroid hormonal treatment. There are few different teriparatide medications, and one of the well-known parathyroid hormone (PTH) medications is called Abaloparatide. It acts as an anabolic agent to initiate bone growth, and it is identical to the form of PTH. It is used to activate more osteoblasts than osteoclasts and, increases bone formation. This type of medication also manifests adverse side effects such as such as limb pain, nausea, dizziness, and headache. (Rizzoli et al., 2011) Moreover, as Bazaldua & Bruder (2004) have found in their research, “[PTH] causes osteosarcomas in rats, but the relevance to humans is unknown.” (p. 1983) Even though it has not been extensively studied whether PTH may cause osteosarcoma in humans, the potential carcinogenicity of the drug may question the safety of PTH medication for some patients. Furthermore, patients who are suffering from Paget’s disease of bone or open epiphysis or sudden elevation of serum alkaline phosphatase, as well as patients under radiation therapy involving bones, should not be prescribed Teriparatide since it can exacerbate the symptoms. (NOF, 2018) For this reason, it is crucial to investigate a treatment option that regulates both thyroid hormone (TH) and parathyroid hormone (PTH) to regulate bone absorption and resorption rates. Currently, PTH hormone only increases the bone absorption rate by forming osteoblasts; it cannot influence the bone turnover rate, which is required for improving the quality of bone. Therefore, SAC is recommended for the new form of osteoporosis treatment, because while it triggers ionized calcium to be circulated in the body and regulates bone absorption and reabsorption rates, it can treat the fundamental cause of osteoporosis.

D. Calcitonin

Primarily, calcitonin is produced by the thyroid gland, mainly by parafollicular cells that exist in the thyroid gland. Calcitonin reduces serum calcium, and it opposes the action of PTH. It is not commonly prescribed like any other osteoporosis medications. However, some physicians prescribe calcitonin to patients with Type II osteoporosis. It mainly acts to inhibit the activity of osteoclasts and for the minor effects, it inhibits tubular cells in the kidney and prohibits calcium and phosphate resorption by helping urine excretion. (Potts & Jüppner, 2008) However, as Carney (1997) has found, high calcitonin concentration in blood can increase urinary calcium and phosphate excretion, which causes hypocalcemia. Moreover, as the kidney becomes resistant to calcitonin, unregulated excretion of calcium would occur, especially to those patients who are suffering from thyroid tumors, which excrete excessive amounts of calcitonin. Also, Woo & Adachi (2001) have found that calcitonin showed “minimal changes in bone density.” (p. 469) Therefore, SAC could be an alternative option for osteoporosis treatment because as it increases both BMD and quality of bone by regulating bone turnover rate, it would be highly beneficial to treat patients who are suffering from the symptoms related to osteoporosis.