Drug treatments to protect your bones This information is an extract from the booklet, Bone health. You may find the full booklet helpful. We can send you a copy free see page 5. Contents Bisphosphonates Calcium and vitamin D supplements Less commonly used drug treatments Specialist referral Bisphosphonates This group of drugs is used to prevent fractures due to osteoporosis. They may also be used to prevent bone loss caused by cancer treatments, such as some types of hormonal therapy, or to prevent or treat secondary cancer in the bone (bone metastases). Bisphosphonates work by reducing the activity of the osteoclasts (osteoclasts break down and remove old bone), which slows bone loss. Although bisphosphonates don t help replace lost bone, they can prevent further bone loss and this helps strengthen existing bone. Bisphosphonates may be prescribed alongside hormonal cancer treatments to protect your bones. Macmillan and Cancerbackup have merged. Together we provide free, high quality information for all. Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk Page 1 of 5
There are a number of different bisphosphonates including: alendronic acid (Fosamax ) ibandronic acid (Bonviva, Bondronat ) sodium clodronate (Bonefos, Loron 520 ) risedronate sodium (Actonel ) disodium pamidronate (Aredia ) zoledronic acid (Zometa, Aclasta ) disodium etidronate (Didronel ). Bisphosphonates are usually given as a tablet or capsule to treat bone loss and osteoporosis, but they may also be given by injection into a vein (intravenously) or as an infusion. Tablets or capsules should be taken on an empty stomach with a glass of water, usually first thing in the morning. You will be given instructions for taking them, which will include staying upright for 30 minutes after taking the tablet or capsule. This helps the drug move quickly into the stomach and reduces the risk of the drug staying in the throat or gullet where it can cause irritation. Side effects of bisphosphonates may include: indigestion a sore throat or inflamed gullet pains in the muscles and joints flu-like symptoms, which usually settle after the first dose. Osteonecrosis of the jaw is a very rare side effect of bisphosphonate treatment. It affects up to five people out of every one hundred (1 5%). If this does happen, healthy bone tissue in the jaw becomes damaged and dies. It happens more commonly in people who have teeth removed or other dental procedures while taking bisphosphonates. It s also more common when bisphosphonates are given by injection rather than as tablets or capsules. It can result in poor healing of the gums or loosening of the teeth. If possible, dental treatment should be avoided while taking bisphosphonates. Before taking them, you should have a dental check-up if you ve not seen a dentist for six months or if you have dentures that don t fit well. It s important to let your dentist know you re taking bisphosphonates. You should also let your doctor know if you need any dental treatment while taking them. Page 2 of 5 Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk
Calcium and vitamin D supplements If you re having cancer treatments that are known to increase your risk of osteoporosis, such as hormonal treatments, you may need to take calcium and vitamin D supplements. Your GP will usually organise for you to have a bone mineral density scan before deciding whether you need to take supplements. A bone mineral density scan is also known as a DXA (dual energy x-ray absorptiometry) scan. Special detectors measure how much radiation passes through the bones, usually in your spine and hips. This information is sent to a computer that records your bone density. Calcium tablets may be prescribed by your GP to be taken alongside bisphosphonate treatment. You can also buy both calcium and vitamin D supplements without a prescription from many chemists, but you should always check what dose to take with your GP. Less commonly used drug treatments Calcitonin (Miacalcic ) is a naturally occurring hormone that can help reduce the risk of fractures in the spine (but not the hip) in postmenopausal women who have osteoporosis. It s available as a nasal spray that s inhaled once a day or as an injection. Raloxifene (Evista ) is licensed for the prevention and treatment of osteoporosis in postmenopausal women. This drug mimics some of the helpful effects of oestrogen, reducing the breakdown of bone and the risk of fractures in the spine. Women with hormone-sensitive breast cancer being treated with tamoxifen shouldn t take raloxifene, because it may interfere with the tamoxifen. Raloxifene is taken daily as a tablet. Denosumab (Prolia ) is a new drug. It reduces the breakdown of bone in postmenopausal women who are at an increased risk of fractures due to osteoporosis. It s normally only used in specific circumstances. For example, when bisphosphonate drugs such as risedronate sodium or disodium etidronate can t be tolerated or are likely to cause too many side effects. Parathyroid hormone (PTH) is a naturally occurring hormone that s produced by the parathyroid glands (these are Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk Page 3 of 5
attached to the thyroid gland in the front of the neck). It stimulates bone formation and increases the absorption of calcium in the body. A synthetic preparation of PTH called teriparatide (Forsteo ) is available as a subcutaneous injection that s given daily for a maximum of 24 months. It s more likely to be used by people who have broken bones due to severe osteoporosis. Hormone Replacement Therapy (HRT) Oestrogen has a protective effect on bones. But some cancer treatments may lower the levels of oestrogen in the body. Young premenopausal women may benefit from the protective effect of HRT on bone health if: they have an early menopause due to cancer treatment they have a cancer other than breast cancer they don t already have risk factors for breast cancer, such as a family history. HRT may be given until a woman reaches the normal age of menopause (usually about 50) and sometimes for a few years afterwards. HRT is not recommended for elderly postmenopausal women because the risks of developing other health problems (such as heart problems, stroke and breast cancer) outweigh any benefits. If a man under 60 has a low testosterone level due to cancer treatment, testosterone replacement therapy can be given to get the testosterone level back to normal. This helps increase bone density, which may be reduced in men with low testosterone levels. In older men (over the age of 60), giving testosterone has little effect on bone density even if testosterone levels are low. There are a number of different types of hormone replacement therapies for both men and women. They can be given as tablets, injections, gels or patches applied to the skin. Specialist referral If your GP or hospital doctor feels you need specialist advice for the treatment or management of your osteoporosis, they may refer you to a hospital team that specialises in it. These teams include doctors, nurses and physiotherapists who work closely with occupational therapists and pain specialists. Page 4 of 5 Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk
More information and support If you have any questions about cancer, ask Macmillan. If you need support, ask Macmillan. Or if you just want someone to talk to, ask Macmillan. Our cancer support specialists are here for everyone living with cancer, whatever you need. Call free on 0808 808 00 00, Monday Friday, 9am 8pm www.macmillan.org.uk We make every effort to ensure that the information we provide is accurate but it should not be relied upon to reflect the current state of medical research, which is constantly changing. If you are concerned about your health, you should consult your doctor. Macmillan cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third party information such as information on websites to which we link. Macmillan Cancer Support 2010. Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED IN JULY 2011 Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk Page 5 of 5