Although an increasing number of people are taking powerful new prescription drugs to treat osteoporosis, chances are the majority of patients are not getting the greatest effect from these medicines because they do not have an adequate calcium and vitamin D intake, according to a paper published in the March 2005 issue of The Journal of Women's Health.
John A. Sunyecz, M.D., president of MenopauseRx, Inc., who co-authored the paper, "Calcium's Role in Osteoporosis Drug Therapy," notes that many people being treated for osteoporosis mistakenly think their calcium and vitamin D intake is no longer important once prescription therapy begins. "People taking osteoporosis medications should remember that they do not contain calcium and have been proven most effective when taken with adequate calcium and vitamin D, usually achieved with the addition of supplements to the daily diet," he explains.
"This paper builds on previous research published last year that shows physicians are not taking the clinical information we know about these drugs and putting it into practice when treating patients. From 1994 to 2003 there was a five-fold increase in prescriptions for bisphosphonates, however during that same time period, the percentage of osteoporosis patients who were treated with calcium supplements decreased by nearly 50 percent."
Dr. Sunyecz also stresses the importance for physicians prescribing osteoporosis drugs to educate their patients about the necessity for calcium supplementation.
"Physicians need to take a more active role by prescribing calcium supplements along with the drugs and informing their patients that these drugs will only be effective if taken properly," he says.
The paper reviewed the clinical trials leading to the Food and Drug Administration (FDA) approval of the osteoporosis drugs, which fall into four categories: bisphosphonates (alendronate/Fosamax, risedronate/Actonel); recombinant human parathyroid hormone (PTH) (teriparatide/Forteo); calcitonin (Miacalcin); and selective estrogen receptor modulators (SERMs) (raloxifene/Evista). The osteoporosis drugs have been proven effective only when taken in conjunction with adequate calcium plus vitamin D.
Dr. Sunyecz observes that many patients he sees in his daily medical practice do not pay attention to achieving the target calcium level until he counsels them on its importance.
"Their assumption is 'I'm on this osteoporosis prescription now, so I no longer need to worry about calcium,'" he reports. "I believe this is occurring partly because the doctors who have prescribed the medication did not emphasize the need for calcium enough, and partly because patients are just jumping to the wrong conclusions."
To help patients understand how osteoporosis drugs work, Dr. Sunyecz explains, "Think of you body as a construction site with your bones as the unfinished frame, osteoporosis drugs as the tools and calcium as the raw material needed to build the structure. If your body doesn't have the raw material, the tools alone may be ineffective in building the structure."
Experts say that adult Americans should be consuming between 1,000 and 1,200 mg of calcium per day, and certain groups like teens, pregnant women and postmenopausal women require even more.
Many people find it difficult to obtain enough calcium through diet alone. In fact, 75 percent of Americans don't get enough calcium through diet. The average woman over 50 has a calcium intake of less than half the amount recommended for postmenopausal women, and people with osteoporosis who routinely have low calcium intakes are more likely to need a calcium supplement to achieve the most effective treatment.
In his recent report on Bone Health and Osteoporosis, the U.S. Surgeon General states that supplements may be helpful for people who don't get enough calcium in their diets. Os-Cal and TUMS, the two calcium supplements doctors recommend most, are excellent choices that require just one or two tablets with breakfast and dinner to meet the recommended amount of calcium.