Can You Simplify the Osteoporosis Medications?

Karen recently asked for clarification about the myriad of medications for osteoporosis. While I’m not an MD and can’t give medical advice, I offered this summary of the leading medications.

What the Medications Do

Osteoporosis medications are used to address bone remodeling. This process begins in our mid-30s when osteoclasts (bone-breaking cells) start to exceed osteoblasts (bone-building cells). Four of the most common medications are:

• Forteo - stimulates bone formation.

• Prolina - reduces bone resorption by targeting osteoclasts.

• Fosamax - inhibits bone resorption, leading to increased bone mineral density.

• Evista - acts like estrogen to maintain bone density.

 How These Medications Work

While all three medications are used to treat osteoporosis, they differ in the way they work. Given the patient's history and risk factors, some medications may be more appropriate than others. Also, these medications only appear to work for a certain period or may be associated with other risks if taken too long, so a physician may switch a patient to a different medication after a few years. Here is a quick summary:

 Forteo (teriparatide) is a parathyroid hormone used as an anabolic (bone-building) agent. It stimulates new bone growth by increasing osteoblast activity and is typically prescribed for individuals at high risk of fractures, often for postmenopausal women and men with osteoporosis. It is administered via a daily injection.

 Prolia (denosumab)  is a monoclonal antibody that works by inhibiting a protein called RANKL, which is involved in osteoclasts' formation, function, and survival (cells that break down bone). By reducing osteoclast activity, Prolia helps decrease bone resorption and increase bone density. It is administered via injection every six months and is used in both men and women with osteoporosis at high risk of fractures.

Fosamax (alendronate) is a bisphosphonate that inhibits osteoclast-mediated bone resorption, increasing bone mineral density. It is commonly prescribed for the prevention and treatment of osteoporosis in postmenopausal women and men and for the treatment of glucocorticoid-induced osteoporosis (long-term use of steroids for conditions like asthma). Fosamax is taken daily as a pill but can’t be tolerated by people with GERD (e.g., acid reflux), which is common in older adults.

Evista (raloxifene): This selective estrogen receptor modulator (SERM) mimics estrogen's beneficial effects on bone density without some of the risks associated with estrogen therapy. It helps reduce bone resorption and is primarily used for preventing and treating osteoporosis in postmenopausal women. It is often prescribed for postmenopausal women who are at increased risk of breast cancer. It is taken orally every day.

Think Beyond the Medication

While there are many considerations for prescribing medication for osteoporosis, lifestyle factors like nutrition and exercise play a key role in reducing the risk and slowing the progression of this disease. I am working with a team of physicians through the American College of Lifestyle Medicine to provide more educational resources to MDs and patients about non-medical treatments for osteoporosis.

Does Benadryl Cause Dementia?

I recently gave a presentation about reducing the risk of dementia and received a question from Linda about Benadryl, the active ingredient in many over-the-counter sleep aids. Linda’s question was this:

I heard that Benadryl causes dementia. Is that true?

What the Research Says

There is some research suggesting a potential link between the long-term use of anticholinergic medications, including Benadryl (diphenhydramine), and an increased risk of dementia in older adults. Anticholinergic drugs block the action of acetylcholine, a neurotransmitter in the brain, and this blockade has been associated with cognitive impairment.

A study published in JAMA Internal Medicine in 2015 found an association between the use of anticholinergic medications and an increased risk of dementia. However, it's essential to note that this association does not establish a direct causal relationship. The study observed an association, but causation remains uncertain. Additionally, individual responses to medications can vary, and other factors may contribute to the development of dementia.

A 2018 study analyzed the link between antihistamines (which also contain Benadryl) and did not find an association with dementia. There was an increased risk of dementia in patients taking antidepressant, urological, and anti-Parkinson drugs.

These are just two studies. We need more research into the link between anticholinergic drugs and neurological disease.

Other Side Effects of Benadryl

I’m not a fan of over-the-counter sleep aids with Benadryl because one proven side effect is dizziness. This greatly increases the risk of falls, especially if you get up in the middle of the night and are feeling light-headed. My top advice is to avoid these over-the-counter medicines if at all possible.

However, I’m not a medical professional so I always advise individuals to consult with their healthcare providers about supplements.