Review of the best according to the editors. About the selection criteria. The the material is subjective, is not advertising and is not serves as a guide to the purchase. Before purchase is needed consultation with a specialist.
“Love your bones” – under this motto the World Organization Health (WHO) has been spending October 20 for over 20 years World Osteoporosis Day, and our country is participating in this initiative since 2005. According to research companies, every year the global market for osteoporosis grows by 4%. So, in Russia from different forms of osteoporosis suffers more than 14 million people.
In our country, drugs that are used to treat osteoporosis, occupy no more than 7% of all expenses for treatment, and the main costs are the treatment of fractures according to compulsory medical insurance. Usually this price consists of being in the hospital and, and about 15% more – this social payments. This is a very poor indicator. It is known that medicines for osteoporosis prevent fractures, and their use improves the quality of life. If a person was hospitalized with a fracture, it simply means that either osteoporosis was not treated correctly, or he was not diagnosed. We will deal with this important problem.
- What is osteoporosis?
- Why does osteoporosis develop?
- How to treat osteoporosis?
- Overview of Osteoporosis Drugs
- Why is calcium needed?
- Calcium and phosphorus – twin brothers
- Calcium Magnesium Chelate
- Calcium D3 Nycomed (calcium carbonate + cholecalciferol – Vitamin D3)
- “Real” medicines
- Tevabon (alendronic acid)
- Bonviva (ibandronic acid)
- Risendros (Risedronic Acid)
- Aklast, Resorb, Veroclast (zoledronic acid)
- Ossein-hydroxyapatites: Osteogenon
- Means that affect hormonal metabolism
- Tibolon (Livial)
- Raloxifene (Evista)
- Monoclonal antibodies: denosumab (Exgiva, Prolia)
- Teriparatide (Forsteo)
What is osteoporosis?
Osteoporosis is a complex problem not only in endocrinology, gerontology, but also internal diseases in general. In the literal translating the word “osteoporosis” can be interpreted as excessive porosity, airiness of bone tissue. The main disadvantage of this bone is a violation of its structure, a decrease in the mass of mineral bone tissue substances and various defects as the result of excessive porosity.
It is known that bone, especially the end sections of long tubular heavily loaded bones are structured with optimal efficiency in terms of material resistance. Everyone knows photographs of the direction and intersection of bone beams in tibia, which resemble the arches of Gothic temples. Location on the beams of the connective tissue base of inorganic calcium compounds (hydroxyapatite) and attached to normal bone at the same time elasticity, strength, hardness and resistance to kink.
In the event of osteoporosis, imperfection of deposition in bones of calcium salts leads not only to high fragility bone matrix, but also dramatically increases the risk of fractures for all sorts of trifles, and even without any reason at all. Sometimes enough for a fracture and just the mass of a limb without any load. Consider what the different types are most often associated with. osteoporosis.
Why does osteoporosis develop?
Of course, the most known osteoporosis in women who have reached the age of menopause. There is even a special, postmenopausal a form of osteoporosis that is rightly considered female a disease. Up to 80% of all forms of bone density reduction it is in this form, and the fault is the age and decreased ovarian function (unmodifiable risk factors).
In women who have not reached menopause, estrogens protect bone tissue, and along the way help a woman have a fairly low level “bad cholesterol.” That is why ischemic cases are so rare. strokes in women aged 40 to 50 years, and only then after the onset of menopause, they are compared in the frequency of development strokes with men. In men over 40, the phenomenon cardiovascular disasters such as heart attack, stroke – to Unfortunately, not uncommon. Therefore, men “recoup” on women after 50 years. A modern woman, aged 50, is at risk the fracture is three times higher than a typical man of the same age. And in osteoporosis is to blame. As a result, vertebral fractures occur, and also a typical distal radial bone fracture.
In old age, a special senile form occurs osteoporosis, in which fractures of the femoral neck are already occurring, and proximal sections of both the humerus and the tibia. it occurs because senile osteoporosis is a condition in which violates the structure and density of several species bone tissue, unlike menopausal. There are secondary forms of osteoporosis, which are, of course, associated with pathology endocrine and nervous systems.
We list some known diseases that may result in be osteoporosis. This is a hyperfunction of the adrenal cortex, or a disease Itsenko-Cushing, hyperfunction of the parathyroid glands, thyrotoxicosis, type 1 diabetes, rheumatism and rheumatoid arthritis, systemic red lupus and ankylosing spondylitis.
Clinically significant forms of osteoporosis occur due to operations on the stomach, which is accompanied by its resection, or removal of part of the organ. And the larger the volume of resected tissue, the less calcium enters the bloodstream, and from there it enters the bones. So calcium deficiency causes fractures.
The causes of osteoporosis include chronic hepatic and renal failure, blood diseases such as thalassemia. Myeloma, a condition after removal of ovaries in women and obstructive chronic processes in lungs, long-lasting chronic alcoholism and imperfect osteogenesis, some hereditary diseases such as syndrome Ehlers-Danlos “rubber man”, Marfan and Fanconi syndromes. They lead to a violation of bone density and increased the content of homocysteine, which is manifested by homocystinuria.
The correct diagnosis of osteoporosis is very important, and, to Unfortunately, very often they start looking for its cause only after the appearance of diagnosed complications of osteoporosis – the presence of bone fractures that occurred either spontaneously or with exposure to very little physical impact. Therefore in If you or your loved ones have the following complaints, then you need to do an assessment of bone density tissue. These are the “red flags”, in the presence of which the risk is increased osteoporosis:
- various back pains that cannot be stopped with medication, associated with awkward movement or weight lifting;
- significant back fatigue after walking;
- the need to often lie down and rest during the day;
- the presence of vertebral fractures;
- limb deformities;
- pronounced local tenderness in the bones with pressure.
Very important risk factors are also:
- calcium and vitamin D deficiency that can be determined laboratory;
- long-term use of corticosteroid hormones;
- chronic alcoholism and long smoking history;
- low physical activity and a long stay in motionless condition (immobilization after injury);
- age over 65 years;
- gender, and increased family risk osteoporosis.
In men, an increased risk factor for bone density deficiency tissue can be considered low testosterone.
How to treat osteoporosis?
Before prescribing medicines for osteoporosis various types, it is necessary to accurately diagnose. Certainly it will be completely superfluous to prescribe expensive drugs from osteoporosis if the patient has an alimentary calcium deficiency and vitamin deficiency ergocalciferol, or vitamin D3.
First of all, you need to make sure that the patient is not has a deficiency of calcium and vitamin D in the diet that this calcium absorbed, and its concentration in the blood is sufficient for normal osteogenesis, or bone development. But about these preparations will be described in the next section, but here I would like would list some non-drug treatments and prevention of osteoporosis.
So, high-grade protein nutrition is extremely important, since protein is part of glycosaminoglycans – organic parts of normal bone tissue. And with protein deficiency it’s impossible building strong bone tissue.
The second very important point is a complete cessation of smoking and a sharp reduced alcohol consumption. For normal functioning bones it is very important their full blood supply, along with muscles and bundles. This is facilitated by walking, swimming and various physical activity (water aerobics). It should be remembered that Jumping, running and traumatic forms are strictly contraindicated. sports.
As a treatment and prevention of vertebral fractures with osteoporosis, wearing semi-rigid corsets is shown, but as possible shorter courses. Proven to be long and excessive corset abuse, fear of being left without a corset, habit of it causes reflex weakness of the back muscles, and, as a result – increased risk of vertebral fractures.
Patients with severe forms of osteoporosis should not resort at the services of manual therapy specialists, since their manipulation is proven to increase the risk of vertebral fractures.
The patient must comply with the set of measures that is aimed to reduce the risk of falls and injuries. This is prevention and treatment of dizziness, fainting, prevention of progressive vision loss. Timely treatment of cataracts and glaucoma in the elderly, complete vision correction. Important a factor is the availability of comfortable and stable shoes that have low heel. Anti-icing trailers are very important in winter devices, it is important not to neglect simple caution, and not to leave the house once again without the need for strong icing.
Overview of Osteoporosis Drugs
|Nomination||a place||Name of product||price|
|Medications||1||Calcium Magnesium Chelate||1 840 rub.|
|2||Calcium D3 Nycomed (calcium carbonate + cholecalciferol – Vitamin D3)||448 rub|
|Bisphosphonates||1||Tevabon (alendronic acid)||844 rub|
|2||Bonviva (ibandronic acid)||1 383 rub.|
|3||Risendros (Risedronic Acid)||2 004 rub.|
|4||Aklast, Resorb, Veroclast (zoledronic acid)||17 638 rub.|
|OSEIN-HYDROXYAPATITIS||1||Ossein-hydroxyapatites: Osteogenon||613 rub|
|Means that affect hormonal metabolism||1||Tibolon (Livial)||2 435 rub.|
|Monoclonal antibodies: denosumab (Exgiva, Prolia)||1||Teriparatide (Forsteo)||26 990 rub.|
Now you can go to the drugs, and the first of they will be calcium and vitamin D3 preparations which are over-the-counter, and relate to food additives and vitamin and mineral complexes. They may well be assigned and healthy people in critical periods of increased consumption calcium, for example, during pregnancy. But first, a little reminder calcium metabolism.
Why is calcium needed?
First of all, muscle contraction is impossible without calcium. Neither one muscle fiber will not contract without being involved in the process of ionized calcium, including the myocardium. And this means that life and movement without calcium are impossible.
Calcium is paramount in the mechanisms of normal blood coagulation, without calcium conversion of prothrombin into thrombin, thrombus and fibrin formation is impossible to stop bleeding.
But still, almost 99% of calcium in bound form (as hydroxyapatite) is indeed enclosed in bones and teeth. About 1% of all calcium circulates in the blood. In turn from of this part, 50% is ionized calcium, that is, free, active form having a valence of 2+. And the remaining tiny part (0.5%) is associated with various proteins, and with acid residues. This part can also be called calcium salts. It is a salt of lactic acid (lactate), calcium bicarbonate, phosphate and citrate. Ionized part blood calcium is called free, and only it can be taken in calculation, because it is used by the body for various goals.
After circulation in the body, calcium is lost, leaves our the body through the kidneys with urine. In order for an adult maintain a balance between calcium intake and its departure from organism, approximately in terms of mineral substance, it is necessary, in an average of one gram of calcium every day. For these purposes, in addition to a complete diet, in some cases the use of tablets containing calcium.
Calcium and phosphorus – twin brothers
However, it is not so simple: calcium metabolism is very strong interconnected with phosphorus metabolism. There is even a concept phosphorus-calcium metabolism. Phosphorus and Calcium Regulate Each Other by the mechanism of negative feedback. Higher concentration calcium in the blood means less phosphate and vice versa.
This mechanism is regulated by parathyroid (parathyroid) glands, as well as the thyroid gland. The processes are as follows:
- when the blood calcium level is low, it is “felt” parathyroid glands. They release parathyroid hormone into the bloodstream, and he “requires” activation of the work of those very special bone cells – osteoclasts – bone crushers, and bone tissue by them intensely collapses. As a result, the level of calcium in the blood rises, but there is an increased risk of osteoporosis;
- if, on the contrary, the concentration of calcium in the blood is too high, then the thyroid gland reacts. She secrets to the blood calcitonin, and vice versa, stimulates bone formation. Calcium leaves the blood and rushes to the bones.
In addition, of great importance in the metabolism of calcium, and, therefore, phosphorus also plays an active form of vitamin D. It is with the help of vitamin D that calcium absorption from food in the gastrointestinal tract, as well as vitamin D helps to absorb calcium back from primary urine and not get lost in vain to this useful ion.
Therefore, when answering the question, what are the best calcium tablets, they should take into account the content of phosphates, as well as vitamin D. The best calcium tablets will never be “just calcium “. So, in the Soviet Union, children with a preventive purpose fed calcium gluconate, but there were no vitamins or phosphates, nor any other ingredients. Vitamin D intake was tormented, it was necessary to swallow fish oil. Modern pharmaceutical industry produces a large number vitamins and mineral complexes, as well as calcium preparations in pills. We list the most useful and active of them.
Calcium Magnesium Chelate
Popularity Rating: 4.9
Opens a list of drugs to increase imported calcium American drug Calcium Magnesium Chelate. It is called so because that chelating compounds of calcium and magnesium in terms of chemistry, have a special structure. These are complex compounds. Metal ions in in this case, calcium and magnesium are called complexing agents, and around it are coordinated additional molecular units, which are called ligands.
Chelated compounds are often used in medicine as times for the introduction into the body of various trace elements. Complexes very well absorbed, compared to just with metal salts, for example, fairly ancient calcium gluconate.
In addition to chelate complexes of calcium and magnesium, the drug contains phosphorus, vitamin D3, and as a source of biologically active fiber – 2 milligrams of alfalfa per capsule.
The drug is sold in capsules, 150 pcs. in a bottle, releases his company Natures Sunshine Products, USA, and the cost of the bottle is 1633 rub. Take this drug one capsule 2 times per day, respectively, it will be enough for 75 days of admission, more than 2 months. Accordingly, the cost of a monthly intake varies in an average of about 750 rubles.
Advantage can be considered as easy digestibility. organism, and the disadvantage is a rather high price and not always can be purchased at pharmacies.
Calcium D3 Nycomed (calcium carbonate + cholecalciferol – Vitamin D3)
Popularity Rating: 4.8
The next popular calcium pill is Calcium D3 Nycomed. Despite the fact that it contains calcium in inorganic form, i.e. in the form of a carbonate or compound calcium with weak carbonic acid, tablets have vitamin D3, which regulates the exchange of calcium and phosphorus. Tablets are available with orange and mint flavor, these are chewable tablets. In terms of per elemental calcium, each tablet contains 500 mg of it.
Therefore, for adults, 1 tablet is indicated for prevention 2 times per day. In pregnant women as well as in high-risk patients osteoporosis dose may be increased. Tablets cannot be used with children under 3 years old, because they simply can choke on them, therefore for the prevention of rickets, other drugs must be used. So, it may be Aquadetrim in drops containing vitamin D and others facilities.
The Takeda company produces the drug, and one pack of 60 monthly chewable tablets 330 rub It’s over two times cheaper than the previous one. a drug.
Popularity Rating: 4.7
Continues the list of calcium preparations German drug Rockaltrol. Its main active ingredient is calcitriol. it a special type of vitamin D3, active form. His task is to improve the intake of calcium from food into the body, it increases it suction. In addition, this compound reduces the secretion of calcium in urine, and allows you to save it in the body. Calcitriol also helps to reduce the secretion of parathyroid hormones, this another mechanism for maintaining calcium in blood plasma.
Interestingly, the formula of this substance does not contain calcium, and, strictly speaking, this is not a mineral supplement, but a real drug for increased calcium in blood plasma, not containing this element itself. Rockaltrol is also an expensive drug, and one pack of 250 capsules mg No. 30, calculated for a monthly intake, costs, on average, in retail 650 rubles.
Of course, there are a very large number of calcium preparations. But their reception allows you to make up for an existing deficit, or prevent calcium and phosphorus deficiency. And if with this level mineral metabolism is normal, but the patient still there is diagnosed osteoporosis, what drugs treated in modern medicine? We pass to medicinal means.
Improving the quality of life in the elderly with osteoporosis, and especially fracture prevention is a costly expense. therefore knowing how old people are treated for osteoporosis, we can judge the welfare of the population in the country. If there is no such country problems like osteoporosis, then this does not mean its high level of medicine. It’s just that most people, for example, die young from infections and malnutrition.
Which patients need serious treatment for osteoporosis? Before total, this is a woman after reaching the menopause, men older than 50 years with spontaneous fractures or caused by minimal trauma, including vertebral fractures, which come to light by chance. These are densitometry data (definition bone density), osteopenia, and related laboratory criteria. The main purpose of applying all of the following drugs for osteoporosis is a reduction and elimination of risk spontaneous bone fractures, i.e. elimination of complications osteoporosis.
For the treatment of various forms of osteoporosis are used:
- various forms of bisphosphonates;
- monoclonal antibodies;
- organic strontium salts;
- hormones and receptor agonists.
Integrin antagonists may also be used according to indications. ossein-hydroxyapatite compounds, anabolic steroids, ipriflavone and other drugs. Let’s consider some of them. with proven effectiveness.
Healthy bone tissue is known to be composed of mature cells – osteocytes, young and immature osteoblast cells, and cells osteoclasts. The latter destroy the old bone, and often their excessive activity leads to symptoms osteoporosis. The first group of serious drugs representatives who are able to reduce the symptoms of this severe diseases, and improve the quality of life – these are bisphosphonates.
Their role is to shorten the life of osteoclasts, or induce them apoptosis. Accordingly, the number of destroyed osteoclasts, or resorbable bone tissue, and balance moves towards the newly formed bone mass. Speaking easier, drugs from this group do not contribute to renewal, and reduce bone destruction. And the first of the representatives bisphosphonates, which is the most inexpensive, will be tevabon.
Tevabon (alendronic acid)
Popularity Rating: 4.9
It, in addition to the calcitriol precursor known to us, contains separately aledronic acid. This is a special compound that interferes with the destruction of bone tissue, affecting osteoclasts, and already refers exclusively to the treatment of osteoporosis. Aledronic acid inhibits bone destruction, promotes increase their strength, and this drug must be prescribed to a doctor, because there is a risk of adverse reactions.
Tevabon is a product that is sold in two dosage forms: tablets and capsules. The tablets contain aledronic acid (70 mg per tablet), and they must be applied orally once a week, on an empty stomach before breakfast. Therefore pills significantly less than capsules. The capsule contains alfacalcidol, and it must be used one capsule per day in the evening every day.
So, a set of 28 capsules of alfacalcidol and 4 tablets of aledronic acid, calculated for a month of use, will cost 1200 rubles. The drug is made by the Israeli company Teva, and he has highest monthly treatment cost (of all listed above means). But since this is a special medicinal means, and not a vitamin or supplement, then it stands “apart”, and this fact can not be taken into account. The drug has many side effects. effects: headache, insomnia, anemia, change blood pressure, abdominal pain, dry mouth, and so on. Tevabon is not intended for prevention, but only for treatment, and under the supervision of a doctor.
Bonviva (ibandronic acid)
Popularity Rating: 4.8
Bonviva is ibandronic acid, which is also relate to bone resorption inhibitors. In one tablet the preparation contains 150 mg of this acid in the form of sodium salt, the drug is intended for the treatment of postmenopausal osteoporosis.
Also ibandronic acid is available in syringes, in an amount of 3 mg of active substance in 3 ml. One 3 ml syringe, ready for equipped and dressed, will cost, on average, from 3900 to 4350 rub. Releases ibandronic acid in ampoules Romanian company Rompharm, this medicine is called Vivanate.
Bonviva is a tablet form of release, and it is available Swiss company hoffmann La Roche. The cost of the drug is from 800 rubles to 1900 rubles. in pharmacies of different ownership for the end August 2019 It’s important to understand that there’s only one in the package a tablet, and one tablet just costs about 2000 rubles. Saves Russian patients only that it is a tablet applied orally only once a month, and intravenous Vivanate is administered only once every 3 months. AND only this allows you to somehow save. After all, the treatment of osteoporosis is this is mainly the lot of the elderly, senior citizens, and in our country in the vast majority are low-income people.
Such a high price is explained by the good activity of ibandronic acid, and it cannot lead to an overdose, and does not affect long-term changes in the number of osteoclasts. Combination of large therapeutic range for doses with high activity allows doctors use Bonviva as a flexible regimen, with various dosages, and rarely used. High efficiency ibandronic acid is proved by the fact that after 3 years treatment of bone structure in women during menopause did not differ from the bone structure of healthy women.
Ibandronic acid is indicated, primarily for the treatment of women with postmenopausal osteoporosis. However, when applying all without exclusion of drugs from this group, you first need to make sure that patient no calcium deficiency. Hypocalcemia is contraindication to treatment, and its fact when prescribing bisphosphonates – This is a gross miscalculation, an expensive diagnostic error. Not Bonviva is also indicated during pregnancy, during the period of chest feeding, to persons under the age of 18 years, if there is severe impaired renal function. There are a large number of side effects. effects that will not be described here. This is the task of the attending physician – explain everything to the patient before prescribing the drug, and conduct monitoring side effects, deal with them. Medicine also may interact with other means.
Risendros (Risedronic Acid)
Popularity Rating: 4.7
This medicine is manufactured by Zentiva in Czech Republic. 35 mg of risedronate are in one tablet sodium. The effect of the drug is also associated with suppression of functions. osteoclasts, active risedronic acid binds to hydroxyapatites. It is necessary to treat the patient for a long time, and the maximum therapeutic effect develops after six months, and this medicine is valid for another six months due to the peculiar cumulation. The tablet is administered orally, once a week, and Risendros is indicated not only for the treatment of postmenopausal osteoporosis in women, but also for the treatment of density deficiency bone tissue associated with prolonged use of corticosteroids hormones.
Therefore, this medicine can be used not only in women, but also in men. It is important that the pill must be taken exactly in the same day of the week. The drug is contraindicated, in the same way, at low calcium levels, a severe decrease in the filtration capacity of the kidneys, in case of pregnancy, breastfeeding, and in children.
It should be said that, of course, pregnancy is an ability fertile, that is, a healthy woman to childbearing in “the very process. “But menopause, in which osteoporosis develops – this is age-related hypofunction of the ovaries when they cease to secrete the necessary amount of estrogen. Therefore, the state of pregnancy and menopause is the opposite, and cannot fit in the same woman at the same time.
But since these drugs cause bone disorders embryo tissue, then manufacturers are simply required to indicate pregnancy and childhood as contraindications, although in children Moreover, there can be no age-related menopause, since it corresponds to the age of 50 years.
This drug, although not cheap, is also not so expensive. One a package of 12 tablets, designed for 3 months of admission, costs in retail from 2400 to 3400 rubles.
The advantage of this drug can be considered high activity and a rather rare schedule of appointments – once a week. Some consider it a plus, and others, more forgetful – a minus.
However, you must strictly follow the instructions. In patients possible dysfunction of the esophagus in the form of its erosive-ulcerative lesions and especially in those who have been diagnosed esophageal strictures or achalasia of the cardia.
In addition, after taking the pill, the patient should be within 30 minutes to be upright so that it is acid like could leave the esophagus faster, otherwise use funds will be contraindicated. In case of an overdose of this agent a decrease in blood calcium levels is possible, but from side effects most commonly constipation, headache, muscle and eye pain, urticaria and allergic reactions.
Aklast, Resorb, Veroclast (zoledronic acid)
Popularity Rating: 4.6
These medications for osteoporosis are “severe artillery “of all bisphosphonates, and contain zoledronic acid. Aklast is a highly selective drug that acts only on mineralized bone tissue, and its activity due to the high affinity of the active substance to the active parts of a particular enzyme that is located in osteoclasts and is associated with their activity.
Therefore, zoledronic acid only reduces resorption. And here bone formation, effect on the degree of mineralization, and the mechanical properties of Aklasta are negligible. These bone properties remain unchanged, and this is very important.
The use of zoledronic acid in patients with osteoporosis, according to to all canons of evidence-based medicine and statistics, reduces risk fractures, for example, vertebrae – after 3 years of treatment by 70%, and this really amazing result. You need to use this tool, in addition to menopausal osteoporosis, for the prevention of new fractures, if the patient has already had a hip fracture.
Aklast is prescribed for osteoporosis in men, for prevention and treatment of hormonal forms of osteoporosis, as well as in the presence of Paget’s disease, its bone form. Aklast’s drug is dripping intravenously, in an amount of 100 ml. Accordingly, in the sale of Aklast also comes in plastic bottles of this volume. Wherein the cost of one bottle is quite high: from 16500 to 20,000 rubles. FROM on the other hand, this is the cost of annual treatment, so the cost monthly treatment in case of minimum prices may even cost less than 1400 rub.
The drug Aklast is a highly effective medicine of the European its qualities are produced by the Swiss company Frezenius, and Novartis Pharma This remedy is also contraindicated, like other bisphosphonates during pregnancy, lactation, breast feeding, with a low concentration of calcium in the blood plasma and with pronounced decrease in the concentration ability of the kidneys when creatinine clearance drops less than 30 ml per minute.
Aklast can cause various side effects. It’s short bouts of fever, muscle pain, flu-like syndrome, joint pain and headache. Usually when properly prescribed these side effects lasted no longer than 3 to 5 days. Besides treatment, Aklast and analogues are also used for prevention postmenopausal osteoporosis, and then patients may have side effects such as anxiety and headache.
Osteogenon already belongs to the classification of metabolic corrections cartilage and bone tissue, it contains calcium and phosphorus in the form phosphate hydroxide, or in the form of hydroxyapatite. It is in this form he is in bone tissue. Also present in the preparation ossein, or a special protein consisting of peptides. He reduces destruction of bone tissue, and stimulates its reproduction, or osteogenesis. Thus, osteogenon does not affect osteoclasts, like bisphosphonates, but his task is to give “food” for osteoblasts. Therefore, it is shown not only for prevention calcium deficiency, but also with different forms of osteoporosis: primary and secondary. For example, when a patient is treated for a long time glucocorticosteroids. Osteogenon is necessary for prevention, two tablets per day, and with osteoporosis (for doctor’s prescription) up to 8 tablets per day. Of course, there are contraindications, therefore this drug should be prescribed a doctor.
Osteogenon also refers to high calcium preparations price range, but compared with Aklast – these are real “flowers.” A pack of 40 tablets, on average, costs 660 rubles. it French company Pierre Fabre. One pack is enough for 20 days, and a monthly course with a preventive purpose will cost about 1000 rubles. However, despite its high cost, – this is the only existing drug that refers to ossein-hydroxyapatite compound and is available in our country.
Means that affect hormonal metabolism
The purpose of these funds is the prerogative of either an andrologist, or gynecologist-endocrinologist. Amplification or hormonal production ovaries, or increased sensitivity of estrogen receptors almost always used in young people who are still by age, have not reached menopause, but already have a hormone deficiency associated with a lack of estrogen production. Consider just two drugs that are used in the data categories.
Popularity Rating: 4.9
Livial is used for successful therapy of menopause syndrome, and against the background of treatment with this agent does not occur the resumption of regular bleeding, the so-called bleeding cancel. The product has a pronounced estrogen and progesterone property. This replacement of ovarian function is very useful for menopausal symptoms as well as for prevention osteoporosis, when there is laboratory proven failure estrogen. Only one year after the end of the last natural menstruation, you can start treatment with this tool. Otherwise a possible side effect such as frequent bleeding, and the shorter the period after the last menstruation before treatment, the this risk is higher. Livial take 1 tablet daily, on the packaging is marked accordingly, it shows in what day is it necessary to use the drug.
The drug is contraindicated in pregnant and lactating women, in case of hormone-dependent tumors, in the presence of a history of thrombosis, thrombotic conditions and thromboembolism, as well as in the presence of vaginal bleeding.
Livial has side effects such as pain below the abdomen and in the mammary glands, enhancing hair growth on the face and body, weight gain, as well as discomfort in the vagina. Exist and other side effects, such as swelling, joint pain, and depression. Therefore, before his appointment, a full inspection.
Apply Livial after regular menopause “age” is necessary only if the patient has these symptoms very painfully reduce the quality of life. Releases medicine pharmaceutical company Organon, the Netherlands. Cost one pack of 28 tablets for a monthly course, is from 2300 to 3400 rubles. Spanish analogue of Wellledien, manufactured by Leon Pharma is several times cheaper: its price, an average of 900 rubles for the same package.
Popularity Rating: 4.8
Evista, manufactured by the German company Daiichi Sankyo Europe GmbH. This is a different approach to hormone therapy. Preparations of this class do not increase the amount of hormones in a woman’s body, they just alter estrogen receptors in the body and increase them sensitivity. At the same time, receptors associated with reproductive tissues, for example with uterine epithelium, are not only not activated, but also suppressed. And estrogen receptors that are not related to female genitalia intensified. This effect on different receptors is called selective, or selective. Therefore in If you use Evista along with calcium preparations, then therapy with this medicine leads to an increase in bone density tissue, especially the spine and femurs. it prevents the occurrence of compression fractures of the vertebral bodies and the neck of the thigh.
Raloxifene is indicated for women in menopause as a means prevention of osteoporosis. It can also be applied after removal. uterus. The second indication for the appointment is a warning unpleasant symptoms of menopause, as well as prevention of the risk of development breast cancer after extinction of ovarian function in the presence of high risk. In men, this remedy is used to treat gynecomastia, and since this medicine is antiestrogen drug, then it is also in demand among bodybuilders – bodybuilders.
Take raloxifene 60 mg daily, 1 tablet per day. The duration of the course is determined by the doctor. Means completely contraindicated for pregnant and lactating women, children, with high the risk of thrombosis in allergic reactions. In the treatment of Evista her can not be combined with estrogenic drugs, and such side effects, like small cramps of the calf muscles, peripheral edema. The cost of Evista is about 2000 rubles. per pack of 28 tablets for a monthly course application.
Monoclonal antibodies: denosumab (Exgiva, Prolia)
In the treatment of metabolic diseases, which include and osteoporosis, one of the most effective medications considered synthetic monoclonal antibodies. They are used to treat severe forms of psoriasis, bronchial asthma, malignant neoplasms. To create this tool that blocks an unnecessary substance, and comes up to it, “like a key to a lock”, and to multiply molecules in identical copies, not only is required modern chemical industry, but also genetic engineering production. Exjiva also belongs to such preparations. Her task is stop the destruction of the affected areas of bone tissue.
Therefore, it is used not only in severe forms osteoporosis, but also with malignant bone tumors, for example with osteosarcomas. Monoclonal antibodies block synthesis of special substances that destroy bones. Effectiveness of this 75% of the drug, that is, a clinically pronounced confirmed effect appears in three out of every four people if the drug appointed and accepted within one month, no less.
Exjiva is a solution for subcutaneous administration, and is available in bottles. Each vial contains 120 mg of denosumab, 1.7 ml Such a volume should be introduced once a month.
The introduction of such a serious drug requires prior training of the patient and medical personnel, injection is carried out in Shoulder, thigh or abdomen, mandatory with medication calcium and vitamin D.
The most common side effects may be hypocalcemia, a drop in plasma phosphates, hyperhidrosis (sweating), diarrhea, loosening and loss of teeth, up to osteonecrosis of the jaw. But, however, if the medicine is prescribed according to indications and under control, then it is effective and prevents the development of complications from bone tissue, including osteoporosis. Packaging cost Exgives, in which there are three bottles, is 45,900 rubles, for a course of three months.
Popularity Rating: 4.7
This drug refers to parathyroid hormone analogues glands, also obtained recombinantly. For his man produce “manual Escherichia coli” living and “working” on genetic engineering plants. This hormone stimulates the formation of bone tissue, directly affecting osteoblasts and increasing the seizure name calcium from the blood.
The administration of teriparatide is required once a day, it is proven reduces the risk of osteoporosis complications menopausal form. Forsteo is also used in primary forms osteoporosis in men, which is caused by endocrine pathology – hypogonadism. It can also be used with steroid forms osteoporosis.
The drug is administered subcutaneously, an injection is made in the thigh or stomach, daily, 20 micrograms. Special training required patient for self-injection. Necessary inform him of various side effects, among which may be anemia, depression, dizziness, and increased levels cholesterol, drop in blood pressure and shortness of breath, others symptoms. It must be remembered that the drug may interact with some other medicines, so treatment should controlled by a doctor.
Teriparatide is sold in pharmacies with one syringe. One syringe the pen is not intended for one injection at all, but for use it within one month, more precisely, 28 days. Cost of one such a syringe, that is, a monthly course, averages 25,000 rub, releases Forsteo firm Eli Lilly.
In conclusion, it should be recalled once again that osteoporosis in Russia is a very serious problem, especially in the fall income level of the population for the sixth consecutive year. Now at risk almost 40 million people for fractures in osteoporosis in our country, or more than a quarter of the country’s population, and the tendency to increase. Treatment and rehabilitation of fractures cost as a result much more expensive than prevention, and especially non-medication way, on the principles of a healthy lifestyle and the right nutrition.
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