Preparations for osteoporosis with menopause

Osteoporosis - a disease of the bones, in which, due to the formation of voids, they lose strength, fragility and fragility appear, and bone mass decreases. Women are susceptible to this disease twice as often as men. In a high-risk zone, there are women during menopause. Studies have shown that only in the first 5 years after the onset of menopause, the bone mass of the spine is reduced by 3%. This is due to the fact that the production of the hormone estrogen significantly decreases with climax, which increases the rate of formation of the so-called osteoclasts (cells that remove bone tissue).

In the reproductive age of women, there is a balance between osteoclasts and osteoblasts (cells that create new bone tissue). Violation of this balance leads to the appearance of osteoporosis. As a consequence, the calcium is "washed out" from the bones of the body, which makes it rarefied, porous. The disease manifests itself in frequent fractures, back pain due to deformity of the joints. Preparations for osteoporosis in menopause are intended to play a role in preventing fractures.

Bisphosphonates in the treatment of osteoporosis in menopause

The paramount task of medicine is to correct the synthesis of osteoclasts and osteoblasts in the bone tissues of the female body. It helps to solve its pharmacology, which has introduced a group of drugs called bisphosphonates into medicinal medicinal practice. By action they are similar to natural pyrophosphates, which take part in the regulation of metabolic processes in bone tissue. Bisphosphonates inhibit the production of osteoclasts, put a barrier between them and osteoblasts, and also have antitumor and analgesic effects.

On the pharmacological market, bisphosphonates are already about 60 years old and are deservedly recognized in the field of osteoporosis treatment in women during menopause and its prevention. They are well tolerated by patients, they have few side effects. The form of release is mainly in tablets, but a newer generation of bisphosphonates is available in powders for the preparation of injections. The chemical composition of bisphosphonates is simple and nitrogen-containing, the efficiency of the latter is much higher. The most commonly used nitrogen-containing bisphosphonates include alendronate, risedronate, ibandronate, zoledronic acid. The duration of bisphosphonate administration is very long (3-5 years).

[1], [2], [3], [4], [5],

Bisphosphonates in the form of tablets

Alendronate - a drug in the form of tablets of 10 mg and 70 mg, has proven high efficacy, 50% reduces the risk of local and 90% of multiple fractures. Pharmacodynamics of the drug is to suppress osteoclasts in the bone, which will restore balance between the withdrawal of bone tissue and the formation of a new, increasing density, and hence the strength of the bone. Pharmacokinetics indicates a low bioavailability of the drug, so it is taken in the morning on an empty stomach and washed down with a large amount of water (a glass and a half). After taking alendronate, you should eat nothing for at least an hour and do not lie down horizontally. For treatment, you need to take a pill 70 mg once a week, or 10 mg daily. If the frequency of admission is once a week, you must adhere to the same day. From the body the drug is unchanged. Contraindicated in pregnant women, with increased sensitivity to compound preparations, renal failure. It is necessary to be cautious about taking the drug with a lack of vitamin D and diseases of the gastrointestinal tract. Possible adverse reactions in the form of nausea, vomiting, heartburn, allergic reactions, ailments, general weakness. Overdose can include diarrhea, nausea, the formation of ulcers and erosions in the gastrointestinal tract.

With the simultaneous reception of alendronate with calcium preparations, the absorption of alendronic acid, which is in its composition, decreases. Non-steroidal anti-inflammatory drugs, including acetylsalicylic acid, can enhance the negative effects of alendronic acid on the gastrointestinal tract.

The drug should be stored for no more than 2 years in a dry place at a temperature not exceeding 25 ° C.

Risendronate - is a tablet, packaged in 35 mg and 75 mg, covered with an orange coating. Suppresses osteoclasts, increases bone mass, strengthens the skeleton, thus reducing the risk of fractures in postmenopausal women. A tablet with a dosage of 35 mg is taken once a week, adhering to the same day, 75 mg - two days in a row on a tablet on the same days every month. To grind a tablet it is not necessary, to drink entirely in the morning for half an hour before meal, washing down with a plenty of water, after reception to not lay down minutes 30. The maximum concentration of a preparation in an organism occurs in an hour after reception. Half of the absorbed dose is excreted in the urine within 24 hours. The unabsorbed drug is excreted unchanged with feces. Risendronate can have side effects in the form of headache, nausea, diarrhea, depression, insomnia, allergic reactions. Contraindicated in pregnant women, children and adolescents under 18 years of age, with renal insufficiency, if it is impossible to accept a vertical position. Overdose can cause hypocalcemia - a low calcium content in the blood. Studies of the reaction with simultaneous reception with other medications have not been conducted, but it is assumed that preparations and foods containing aluminum, magnesium, iron, calcium can reduce the absorption of risendronic acid. Shelf life of the drug is 3 years, at a temperature of no higher than 25 ° C in a dry place. It is released by prescription.

[6], [7], [8]

Bisphosphonates with other forms of release

Admission of the above described bisphosphonates requires the patient punctuality in taking medications, so it is not always brought to the clinical efficacy. At present, new highly effective bisphosphonates have appeared on the market of medical preparations, which are less accepted and have different ways of administration, i.e. Different forms of release. These include ibandronate and zoledronic acid.

Ibandronate - in the form of tablets of 150 mg is taken once a month according to a scheme similar to that of alendronate and rizendronate, and in the form of intravenous injections - every three months, a dose of 3 mg.

Zoledronic acid - white powder or porous mass in a vial, weight 4 mg. The contents of the vial are dissolved in 5 ml of water for injection, the resulting liquid is diluted with glucose solution (5%) or 100 ml sodium chloride (0.9%). The injection is done once a year (5 mg) from a freshly prepared preparation and has minimal negative consequences, because is similar to the mineral component of bone tissue. Contraindicated for pregnant, lactating women, with renal failure. Side effects are similar to those that are inherent in other bisphosphonates, and are observed in a third of patients. But there are also special features, after the injection for three days, symptoms of the flu-like condition may occur: fever, chills, bone pain. When interacting with other drugs, no significant reactions were noted, except with caution used simultaneously with diuretics. Shelf life of the drug is 2 years, stored in a dark place at a temperature of no more than 25 ° C.

For the treatment of osteoporosis in menopause, a combination of bisphosphonates and vitamin D is also successfully used . These drugs include fosavans and calcium remains. In addition to alendronic acid, they include calcium. The regimen is similar to that of alendronate.

[9], [10], [11],

Other drugs in the treatment of osteoporosis with menopause

Strontium ranelat - corrects metabolism in the bone and cartilage tissues, restoring the balance between the synthesis and excretion of bone tissue from the bone in favor of the first. The form of the product is a powder of 2 mg, for dissolving in 250 ml of water and drink once a day at night, but not earlier than 2 hours after calcium and vitamin D, in combination with which it is prescribed. Shelf life of the prepared solution is no more than a day. Has contraindications for pregnant women, nursing mothers, patients with renal insufficiency, venous thromboembolism, recumbent patients and temporarily recumbent after surgical intervention. Side effects include nausea, vomiting, skin rashes, muscle pain. If the instructions for taking the drug in combination with food are violated, the absorption of strontium ranelate decreases. When taking the recommended dose, symptoms of an overdose were not observed.

Denosumab is a biological preparation, an antibody that is produced by the immune system and is used to suppress osteoclasts. It is administered subcutaneously and is convenient in use, because it is pricked every six months. A good tolerability of the drug was noted.

Salmon calcitonin is a hormone that regulates the exchange of calcium in the body, blocking its passage into the blood from the bone tissue. In passing, an analgesic effect on the patient's body was also established. It is available in the form of a solution for injection. Can be administered either subcutaneously or intramuscularly. It has the property of rapidly absorbed into the blood, reaching a maximum concentration in an hour and a half. It is excreted from the body by the kidneys. Has contraindications in case of intolerance of the components of the drug. There have been cases of a decrease in the level of calcium in the blood. Not recommended for use with pregnant women and with lactation. The dose of the drug is determined by the doctor depending on the severity of the disease and ranges from 50 to 100, sometimes up to 400 ME (the international unit of action of the substance) per day. Duration of treatment from two weeks to six months. There may be side effects in the form of nausea, headache, diarrhea, reduced visual acuity, joint and muscle pain. Ampoules for injections are stored for no more than three years.

Estrogen-gestagen - their action is aimed at replacing the lack of estrogen during menopause, and this is accompanied by an increase in bone mineral density. However, the drug is effective only at the time of taking, after stopping its reception, all the indicators return to the previous level.

Recently, for the treatment of osteoporosis with menopause there are also homeopathic remedies, consisting of not less than 5 components. However, they are not sufficiently researched to give clear recommendations on their application, and very costly.

As you can see, the pharmacological market for treating osteoporosis with climax is quite extensive, but most drugs are aimed at a very long reception, which often leads to interruption of treatment. Women are encouraged by the appearance of new dosage forms (in the form of injections), which make it possible not to strain in tracking the intervals of taking the drug, but do 1-2 injections per year.