I. Fosamax Fact File :

Fosamax was introduced by Merck Pharmaceuticals.

Merck & Co., Inc. is a global research-driven pharmaceutical company dedicated to putting patients first. Established in 1891, Merck discovers, develops, manufactures and markets vaccines and medicines in over 20 therapeutic categories.

II. Fosamax Medication :

Generic Fosamax is used for:

• The treatment or prevention of osteoporosis (thinning of bone) in women after menopause. It reduces the chance of having a hip or spinal fracture (break).
• Treatment to increase bone mass in men with osteoporosis.

Fosamax medication are for treatment and prevention of osteoporosis.

Improvement in bone density may be seen as early as 3 months after you start taking Fosamax medication.

For Generic Fosamax to continue to work, you need to keep taking this medication.

Generic Fosamax is not a hormone.

Osteoporosis: Information of Fosamax

Osteoporosis means porous bones. Bones affected by osteoporosis are less dense than normal bones. They are also more likely to break, even as a result of a minor bump or fall, or even without an injury.

Osteoporosis is around four times more common in women than men, and most common in women who have been through the menopause.

Diagram 1: Osteoporosis

What is Osteoporosis?
The inside of a bone consists of a strong mesh made of protein and minerals (particularly calcium). This mesh is living tissue that is constantly being renewed by a process called bone turnover. Old, worn out bone is broken down and absorbed by the body while, at the same time, new bone tissue is created from fresh protein and minerals.

Diagram 2: The structure of Bone

In children and young people, more new bone is created than is broken down. This makes bones bigger and more dense.

The bones are at their strongest when the peak bone mass is reached, and this usually occurs in a person's mid-twenties. Peak bone mass is then maintained for about ten years, with roughly equal amounts of bone creation and breakdown. After the age of about 35, bone loss begins to overtake creation as part of the normal aging process. With osteoporosis, the process happens much more quickly, leading to premature bone weakness.

As well as bones, such as the wrist or hip, breaking more easily than usual, osteoporosis can result in small fractures of the bones in the spine. This can cause a curved back and a loss of height.

Low levels of oestrogen
The female hormone oestrogen reduces the amount of bone that is broken down and so helps to protect against osteoporosis. In women, the ovaries make oestrogen from puberty to the menopause. Any condition that reduces the number of years that a woman produces oestrogen tends to increase the risk of osteoporosis.
These risks include:

• having an early menopause (before the age of 45),
• an early hysterectomy (before the age of 45, especially if both ovaries are removed),
• missing periods for six months or more as a result of over-exercising or over-dieting (especially due to anorexia)

Other risk factors of Osteoporosis
Men who have low levels of the male hormone, testosterone, are also at a higher risk of osteoporosis.
For both men and women, the following factors also increase the risk of developing osteoporosis:

• long-term use of corticosteroid tablets (medicines sometimes used for conditions such as severe allergies),
• a family history of broken hips,
• digestive disorders that affect absorption of nutrients, such as Crohn's disease or ulcerative colitis,
• long-term immobility,
• heavy drinking or smoking,
• very low body weight

Symptoms of Osteoporosis

Osteoporosis has been called the "silent disease". Most people affected are unaware that their bones are thinning until they experience a break, or notice more gradual signs such as height loss, or curvature of the spine (sometimes known as "dowager's hump").

The bones most likely to break as a result of osteoporosis are the hip, wrist and the vertebrae of the spine.

Prevention of Osteoporosis

People who reach a high peak bone density when they are young are less likely to develop osteoporosis. Bone density can be boosted by a healthy diet and regular exercise, particularly in people under 35. This means prevention needs to begin at a young age.

i. Diet : A varied, well-balanced diet is important to build and maintain healthy bones. A combination of bread and cereals, fruit and vegetables, milk and diary products, and protein (from meat, fish, eggs, pulses, nuts and seeds) should provide the nutrients that your body needs.

Foods rich in calcium are especially valuable for healthy bones. Good sources include milk and diary products, such as cheese and yogurt.

The body needs vitamin D to absorb calcium properly. About 15-20 minutes of daylight on the face and arms during the summer months will enable the body to store enough vitamin D for the rest of the year; you don't need to sunbathe. Vitamin D is also available in foods such as margarine and oily fish.

ii. Exercise : Weight-bearing exercise helps to promote bone formation and bone health. Good exercises include running, skipping, aerobics, tennis, weight-training and brisk walking. Ideally, try to do this type of activity three times a week for at least 20 minutes.

If you are not used to exercising, build up your exercise routine gradually - increasing frequency before intensity. Talk to your doctor before you start if you have a health problem that affects your heart or breathing.

iii. Lifestyle : Smoking can have a harmful effect on bone and can also cause an early menopause. If you smoke, try to give up. You should also be careful not to drink too much alcohol.

Treatment for osteoporosis

Now there are a number of effective treatments that can help prevent fractures and increase bone density. These include:

• Hormone replacement therapy (HRT)
  This prescription-only treatment aims to restore oestrogen to a pre-menopausal level. In the short term, it is taken to relieve menopausal symptoms such as hot flushes, night sweats, and vaginal dryness. Small doses over several years also reduce osteoporosis. HRT also helps reduce the risk of heart disease. Some women may experience breast tenderness and nausea as side effects of the treatment.
• Bisphosphonates are non-hormonal medicines, which work by blocking the break down of bone. There are three bisphosphonates available in the UK namely, alendronate (Generic Fosamax), etidronate (Didronel) and risedronate (Actonel).
• A type of medicine called selective oestrogen–receptor modulator or SERM is a synthetic hormone replacement, which works by copying the effects of oestrogen on the bones. This type of drug reduces the risk of osteoporosis and heart disease, but appears to not increase the risk of breast or endometrial cancers. The SERM currently available in the UK for osteoporosis is raloxifene (Evista).
• Vitamin D and calcium supplements are an effective treatment to reduce bone loss in the elderly.
• Calcitriol is an active form of vitamin D given to post-menopausal women who have osteoporosis in the spine. Calcitriol improves the absorption of calcium from the gut.
• Calcitonin is a hormone made by the thyroid gland (a hormone-producing gland in the neck), which blocks the action of the cells that are responsible for breaking down bone. It is only available in injection form.
• Testosterone can be used to treat men who are deficient in this hormone and can increase their bone density. It is available in injection or implants form.

Side effects of Osteoporosis Medications

HRT can also increase the risk of developing breast cancer and uterine cancer, but the risk remains low. Side effects of estrogen therapy may include vaginal bleeding, breast tenderness, mood disturbances and gallbladder disease.

Side effects for alendronate and risedronate are uncommon but may include abdominal or musculoskeletal pain, nausea, heartburn, or irritation of the esophagus.

While side effects of raloxifene were not common, those reported included hot flashes and deep vein thrombosis, the latter of which is also associated with estrogen therapy.

Side effects for nasal Calcitonin are not common but may include nasal irritation, backache, bloody nose, and headaches.

While it does not affect other organs or systems in the body, injectable Calcitonin may cause an allergic reaction and unpleasant side effects including flushing of the face and hands, urinary frequency, nausea and a skin rash.

III. Useful links

http://www.cdc.gov/

http://www.fda.gov/

http://www.fda.gov/cder/ogd/

http://www.nih.gov/

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

http://www.health.gov.on.ca/

National Library of Medicine

World Health Organization

http://www.mayoclinic.com/index.cfm

MedicineNet.com

Drugdigest.org

Healthsquare.com

Pharmacy sites

http://www.merck.com

http://www.hsforum.com/stories/storyReader$1509 ,

http://www.hsforum.com/stories/storyReader$1516

http://www.hsforum.com/stories/storyReader$1504,

http://www.people.vcu.edu/~urdesai/atc.htm#Process%20of%20clotting

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