WEAPONS TO FIGHT BONE LOSS GROWING

Women have more weapons than ever before to fight osteoporosis, and they are using them to prevent or offset the effects of the bone-thinning disease, local experts say.

"Women are more knowledgeable about osteoporosis and its effects, and there's more awareness of the methods for preventing and treating it," said Barbara Crowell, services manager at St. Francis Medical Center's Womencare unit.

Osteoporosis, a disease that afflicts an estimated 10 million Americans and costs $13.8 billion annually, generally occurs in post menopausal women and causes loss of bone density. That loss can cause stooping and fractures as bones become brittle.

Amy Thompson, a staff pharmacist at Healing Arts Pharmacy, said she has seen a large increase in the number of prescriptions for drugs used to prevent osteoporosis in the past five years.

Reasons for that increase, Thompson said, include a growing awareness among women of the effects of osteoporosis, better testing to determine bone density and, perhaps most important, more drugs being available that build bone density.

There are now four drugs approved by the Food and Drug Administration to fight osteoporosis: raloxifene, alendronate, estrogen and calcitonin. And many of these have other benefits besides fighting osteoporosis.

Raloxifene was the subject of a study published in Wednesday's Journal of the American Medical Association. The study found that in addition to preventing osteoporosis, raloxifene also can reduce the risk of spinal fractures by up to 50 percent in women who already have the bone-thinning disease.

"Women even who have fractures, who have lost inches, who are beginning to get some curvature can do something about it right now to reduce their risk of fractures in the future," lead researcher Dr. Bruce Ettinger of Kaiser Permanente Medical Care Program in Oakland, Calif., said. Ettinger's study was funded by Eli Lilly & Co. of Indianapolis, which sells raloxifene as Evista.

The news comes only a month after data from the same women showed that raloxifene appears to lower the risk of breast cancer by 70 percent. That is a major advantage for post menopausal women who want the bone-strengthening benefits of estrogen but fear the slightly increased risk of breast cancer from long-term use.

Raloxifene was approved by the FDA in 1997. It, like other osteoporosis drugs, adds bone mineral density early in treatment and thereafter slows the loss of bone mineral.

Ettinger said the four approved osteoporosis drugs should not be considered competitors, because their benefits and limitations are so different. For example, he said:

-- Alendronate, marketed as Fosamax, is the strongest bone builder and is the only drug shown to protect against both spine and hip fractures. But it offers no other health benefits and causes many women stomach upset.

-- Estrogen is almost equal to alendronate as a bone builder, and research suggests it also protects against heart disease and even mental decline for women past menopause. It relieves menopause's hot flashes and night sweats but commonly causes breast tenderness and a resumption of menstrual bleeding.

-- Raloxifene has about two-thirds the bone-building power of alendronate but does not relieve menopausal symptoms and may worsen some such as leg swelling. But it seems to lower "bad" cholesterol levels.

-- Calcitonin, marketed as Calcimar, is the least powerful of the bone-boosters but is offered in an easy-to-take nasal spray.

Thompson said each of these drugs cost about $60 to $65 per month, except estrogen, which costs about $23 per month. Those prices do not take into account insurance or Medicare copayments.

Ettinger said: "In making a choice of which of the drugs a woman is going to use, she needs to think about what else is in the package. Is it agreeable? Is it acceptable? Is it easy to use? Is it something that can be continued long term?"

Some women, for example, may want to take estrogen in early menopause, then switch to raloxifene, he said.

Not every older woman needs a drug. Women should have their bone density tested or check whether they are losing height, experts say. More than an inch of lost height since young adulthood indicates osteoporosis, Ettinger said.

Crowell at Womencare said women are heeding the warnings about osteoporosis, and more are having bone density screenings.

"Until the last three years, we did about 15 screenings per month," Crowell said. "Now we do 150 per month."

She recommends a bone density screening when women enter menopause, whether menopause is brought on by a hysterectomy or naturally.

"You lose the most bone structure during the first 10 years of menopause," Crowell said. "So it's critical to find out whether you are losing bone mass to know if you need to be on a drug therapy."

With osteoporosis, which makes bones more brittle and more susceptible to fractures, it is much more effective to prevent bone loss than try to treat weak bones and fractures later in life, Crowell said.

The screenings are non-invasive, she said. The initial screening is usually an ultrasound of the wrist or heel. If a problem shows up from that, the patient is referred for a more thorough screening involving the hip and spine.

The screenings are generally covered by insurance, Medicare or Medicaid, she said.

"We do have medications that can be used to treat osteoporosis now," Crowell said. "That makes it even more important to learn what your bone density is and begin treatment as soon as possible if it's needed."

The Associated Press contributed to this report.