Scientific Statements:

• Bisphosphonates Linked to Bone, Joint and/or Muscle Pain
• Osteonecrosis of the Jaw

Osteoporosis Medications:

• Medications for Prevention and Treatment
• Bone Remodeling Cycle
• Antiresorptive Medications—Bisphosphonates
• Alendronate (Fosamax®)
• Ibandronate (Boniva®)
• Risedronate (Actonel®)
• Zoledronic Acid (Reclast®)
• Other Antiresorptive Medications
• Calcitonin (Fortical® and Miacalcin®)
• Denosumab (Prolia™) - Approved June 2010
• Estrogen Therapy (ET) and Hormone Therapy (HT) (Multiple brand names available)
• Raloxifene (Evista®)
• Bone Forming (Anabolic) Medications
• Teriparatide (Fortéo®)
• Response to Treatment
• Adverse Events
• Additional Information

Although there is no cure for osteoporosis, there are steps you can take to prevent, slow or stop its progress. In some cases you may even be able to improve bone density and reverse the disorder to some degree. Getting enough calcium and vitamin D as well as appropriate exercise are essential to the bone health of everyone, including people treated with an osteoporosis medication.

Medications Approved to Prevent and/or Treat Osteoporosis

*Estrogen is also available in various vaginal preparations, in a vaginal ring, as a cream, by injection and as an oral tablet taken sublingually (under the tongue).

Medications for Prevention and Treatment

To prevent and treat osteoporosis, the U.S. Food and Drug Administration (FDA) has approved medications to slow or stop bone loss and reduce the risk of fractures (broken bones). One medication works by rebuilding bone.

The best way to determine whether you have osteoporosis is with a bone mineral density (BMD) test. The T-score result on a BMD test falls into three categories: normal density, low density and osteoporosis. The chart on "Bone Mineral Density (BMD) Results and Treatment" indicates when you should speak with your healthcare provider about possible treatment with an osteoporosis medication.

People at high risk for fractures that are caused by osteoporosis should always speak with their healthcare provider about treatment. Individuals at highest risk are those who have had previous fractures of the spine (vertebral fractures) or hip. Almost all people with these types of fractures need treatment for osteoporosis.

Some other serious risk factors to consider when making a treatment decision include:

• History of a previous fracture as an adult (in any bone in the body)
• Family history of osteoporosis or fractures
• Being very thin
• Taking certain medications (such as steroids)
• Smoking (currently)

Bone Mineral Density (BMD) Results and Treatment

* To help understand osteopenia, NOF has presented the T-scores differently than in its clinical guidelines.

Special Note: All medications have potential side effects. When making a decision about taking a medication, NOF encourages you to discuss your treatment options with your healthcare provider and to look at both the risks and benefits of taking or not taking a medication.

The "Staying Power" toolkit can help you keep on track with your treatment plan.

Bone Remodeling Cycle

Bone is living, growing tissue that constantly forms new bone while replacing older bone. Bone continuously renews and changes through a process called remodeling. The bone remodeling cycle consists of two distinct stages: (1) bone resorption (breakdown or removal) and (2) bone formation. During resorption, special cells (osteoclasts) on the bone's surface dissolve bone tissue and create small cavities. During formation, other cells (osteoblasts) fill the cavities with new bone tissue.

Usually, bone resorption and bone formation take place in close sequence and remain balanced. An imbalance in the bone remodeling cycle occurs with menopause and with aging in both genders, and it can occur with other conditions. An imbalance can result in bone loss that eventually leads to osteoporosis and fractures.

Bisphosphonates, calcitonin, estrogen, estrogen agonists/antagonists and RANK ligand (RANKL) inhibitors (denosumab) are antiresorptive medications. They slow the bone loss that occurs in the breakdown part of the remodeling cycle. When people first start taking these medications, they stop losing bone as quickly as before, but still make new bone at a normal pace. Therefore, bone density may increase. The goal of treatment with antiresorptive medications is to prevent bone loss and lower the risk of breaking bones.

Teriparatide, a form of parathyroid hormone, is the first osteoporosis medication to increase the rate of bone formation in the bone remodeling cycle and is in a distinct category of osteoporosis medications called anabolic drugs. This is currently the only osteoporosis medication in the U.S. that rebuilds bone. The goal of treatment with teriparatide is to build bone and lower the risk of breaking bones.

Special Note: Information about the FDA approved osteoporosis medications is intended solely for general information and should NOT be relied upon for any particular diagnosis, treatment or care. This information does not imply an endorsement by NOF of any particular medication or manufacturer.

For more detailed information on the actions, administration and possible side effects for each of the following medications, please consult the package insert, available online and at pharmacies.

Antiresorptive Medications—Bisphosphonates

Alendronate Sodium or Alendronate Sodium plus Vitamin D₃
(Brand name Fosamax® and Fosamax Plus D™; Fosamax® is also available in generic form)

Alendronate is approved for the prevention and treatment of osteoporosis in postmenopausal women and for treatment of osteoporosis in men. It also is approved for the treatment of glucocorticoid-induced osteoporosis in men and women as a result of long-term use of steroid medications (examples are prednisone and cortisone). Alendronate reduces bone loss, increases bone density and reduces the risk of spine, hip and other fractures by about 50 percent over two to four years.

For prevention, alendronate is taken daily as a 5 mg tablet or weekly as a 35 mg tablet. For treatment, it is taken daily as a 10 mg tablet or weekly as a 70 mg tablet with or without vitamin D₃. The weekly dose with vitamin D contains either 2,800 IU or 5,600 IU of vitamin D₃. Alendronate also is available in an oral solution taken weekly.

The alendronate tablet needs to be taken first thing in the morning after waking up and on an empty stomach. It is swallowed whole with 6 to 8 ounces of plain water (no other liquid), at 30 minutes before having anything to eat or drink. Patients must remain upright (sitting, standing or walking) during this 30-minute period.

The oral solution is also taken first thing in the morning on an empty stomach. Patients need to drink the entire bottle of solution followed by at least 2 ounces of plain water. After drinking the solution, patients must remain upright (sitting, standing or walking) for at least 30 minutes with no food or drink during this time.

Alendronate with either 2,800 IU or 5,600 IU of vitamin D₃ provides another option for a source of vitamin D. Weekly alendronate with 2,800 IU of vitamin D₃ is the equivalent of taking 400 IU daily, while weekly alendronate with 5,600 IU of vitamin D₃ is the equivalent of taking 800 IU daily. Vitamin D₃ (also called cholecalciferol) is the preferred form of vitamin D for bone health.

Ibandronate Sodium
(Brand name Boniva®)

Ibandronate is approved for the prevention and treatment of osteoporosis in postmenopausal women. Ibandronate reduces the incidence of spine fractures by about 50 percent over three years. Data do not yet confirm that ibandronate can reduce the risk of hip and other non-spine fractures. However, ibandronate increases bone density substantially throughout the skeleton.

For both prevention and treatment, ibandronate is taken once monthly as a 150 mg tablet. For treatment, it is also available as an intravenous (IV) dose of 3mg given every three months. Although the FDA has approved a daily dose, it is not available in the U.S.

Oral ibandronate needs to be taken on the same day each month, first thing in the morning after waking up and on an empty stomach. It is swallowed whole with 6 to 8 ounces of plain water (no other liquid), at least 60 minutes before having anything to eat or drink. Patients must remain upright (sitting, standing or walking) during this 60-minute period.

A healthcare professional administers the IV dose in a doctor's office or other outpatient setting. It takes less than a minute to infuse. Patients need to have a blood test (serum creatinine) to confirm that kidney function is normal prior to each IV dose.

Risedronate Sodium or Risedronate Sodium with Calcium Carbonate
(Brand name Actonel® and Actonel® with Calcium)

Risedronate is approved for the prevention and treatment of osteoporosis in postmenopausal women, and in 2006 was approved for the treatment of osteoporosis in men. It also is approved for the prevention and treatment of glucocorticoid-induced osteoporosis in men and women as a result of long-term use of steroid medications (examples are prednisone and cortisone). Risedronate slows bone loss, increases bone density and reduces the risk of spine and non-spine fractures by 35 to 45 percent over three years.

For both prevention and treatment, risedronate is taken daily as a 5 mg tablet, weekly as a 35 mg tablet that is available with or without separate calcium carbonate tablets, or twice monthly as a 75 mg tablet (on two consecutive days) or monthly as a 150mg tablet.

The risedronate tablet needs to be taken first thing in the morning after waking up and on an empty stomach. It is swallowed whole with 6 to 8 ounces of plain water (no other liquid), at least 30 minutes before having anything to eat or drink. Patients must remain upright (sitting, standing or walking) during this 30-minute period.

Weekly risedronate with calcium carbonate offers another way to get calcium. The once weekly risedronate tablet comes with six individual tablets that contain 500 mg of calcium in the form of calcium carbonate. One calcium tablet is taken daily except on the day of the week when risedronate is taken. If calcium is taken with the risedronate tablet, it will prevent the absorption of risedronate and the desired effect will not occur. Calcium carbonate supplements should be taken with food to be well absorbed.

Zoledronic Acid
(Brand name Reclast®)

Zoledronic acid is approved for the prevention and treatment of osteoporosis in postmenopausal women. It is also approved to increase bone mass in men with osteoporosis and for the prevention of new clinical fractures in patients who have recently had a low-trauma hip fracture. In 2009, it was approved for the prevention and treatment of glucocorticoid-induced osteoporosis in men and women as a result of long-term use of steroid medications (examples are prednisone and cortisone).

Zoledronic acid is given once a year as an intravenous (IV) infusion to treat osteoporosis. It is also given every two years as an IV infusion to prevent osteoporosis. Although the FDA approved zoledronic acid in 2007 to treat osteoporosis, the medication was already available under the name Zometa® for use in cancer patients with certain bone conditions. The FDA first approved zoledronic acid in 2001.

Zoledronic acid increases bone density and reduces fractures in the hip, spine and non-spine areas (such as the wrists and arms). In one major study, zoledronic acid reduced the risk of spine fractures by 70 percent and hip fractures by 41 percent.

A healthcare professional gives zoledronic acid as an intravenous (IV) dose of 5 mg in a doctor's office or other outpatient setting. It takes 15 minutes for the yearly infusion. Patients need to have two blood tests prior to each IV dose. One is a test for creatinine to confirm that kidney function is normal. The other is a test for calcium to confirm that the blood calcium level is normal.

Side Effects of Bisphosphonates
Side effects for all the bisphosphonates (alendronate, ibandronate, risedronate and zoledronic acid) may include bone, joint or muscle pain. Side effects of the oral tablets may include nausea, difficulty swallowing, heartburn, irritation of the esophagus (tube connecting the throat to the stomach) and gastric ulcer. Side effects that can occur shortly after receiving an IV bisphosphonate include flu-like symptoms, fever, pain in muscles or joints, and headache. These generally stop within two to three days and usually do not happen with future infusions.

Inflammation of the eye (called uveitis) is a rare side effect of all bisphosphonates. Bisphosphonates are not recommended for people with severe kidney disease or low blood calcium.People with certain problems of the esophagus may not be able to take the oral tablets.

There have been rare reports of osteonecrosis (death of bone cells or tissue) of the jaw(ONJ) with bisphosphonate medications. Of the cases reported to date in 2007, nearly 95 percent were in cancer patients receiving an intravenous bisphosphonate, pamidronate (Aredia®) or zoledronate (Zometa®), typically given every three to four weeks. Although quite unusual, patients being treated with the bisphosphonate pills, alendronate (Fosamax®), ibandronate (Boniva®) and risedronate (Actonel®), for osteoporosis prevention or treatment have also been reported to have developed ONJ.

There have been recent reports of unusual fractures of the upper femur (thigh bone) in people taking bisphosphonate medicines. NOF is currently awaiting the outcome of a task force of leading experts who are evaluating the latest research related to these unusual fractures. If you have been taking bisphosphonate medicines for several years or longer and have an unusual ache or pain in your hip or thigh bone, it's important to tell your healthcare provider. There have been rare reports of people having an ache or pain, sometimes for several weeks or even months, before having an unusual break in the thigh bone.

Patients taking the oral bisphosphonate tablets should stop taking the drug and contact their healthcare provider immediately when experiencing chest pain, new or worsening heartburn or difficulty or painful swallowing. It is important that patients report these or other side effects to their healthcare provider.

Click here for NOF's statement on osteonecrosis of the jaw.

Other Antiresorptive Medications

Calcitonin-Salmon
(Brand names Fortical® and Miacalcin®; Miacalcin® nasal spray is also available in generic form)

Calcitonin is approved for the treatment of osteoporosis in postmenopausal women who are at least five years beyond menopause. It is a naturally occurring hormone involved in calcium regulation and bone metabolism. Calcitonin slows bone loss and increases bone density in the spine. It reduces the risk of spine fractures but has not been shown to decrease the risk of non-spine fractures.

Calcitonin is available as an injection (dosage varies) or nasal spray (200 IU daily). An oral form of the drug is also being tested in clinical trials.

Side Effects
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. The primary side effects with nasal calcitonin are a runny nose, headache, back pain and nosebleed (epitasis).

Denosumab
(Brand name Prolia™)

In June 2010, Denosumab was approved by the FDA for the treatment of osteoporosis in postmenopausal women at high risk of fracture or breaking a bone. According to the package insert, being at high risk of fracture means that you meet one or more of the following conditions:

• you have already broken a bone from osteoporosis
• you have several risk factors for breaking a bone
• you have not been able to take other osteoporosis medicines due to side effects
• you have not received enough benefit from other osteoporosis medicines

Denosumab is a RANK ligand (RANKL) inhibitor/human monoclonal antibody. A healthcare professional gives denosumab by injection every six months. Patients need to have a blood test before each dose to confirm that blood calcium level is normal. As for all people with osteoporosis, it is very important to get enough calcium, vitamin D and exercise every day.

In clinical trials, denosumab significantly reduced the incidence of new spine fractures by 68 percent, reduced the incidence of hip fractures by 40 percent and reduced the incidence of all non-spine fractures by 20 percent over three years.

Side Effects
Denosumab may lower the calcium levels in the blood. If blood calcium levels are low before receiving denosumab, the low calcium level must be corrected before giving the medicine or it will get worse. Signs of low calcium levels include spasms, twitches or cramps in the muscles; or numbness and tingling in the fingers, toes or around the mouth. If any of these symptoms are seen while on this medicine, patients should contact their healthcare provider. Most patients with low calcium levels, however, do not show these signs.

People who have weak immune systems or take other medicines that affect the immune system may have an increased chance of having serious infections with denosumab. Even patients who have no immune system problems may be at higher risk of certain infections such as those of the skin. Patients should contact their healthcare provider right away if signs of infection occur. These signs may include fever, chills, red and swollen skin, skin that is hot or sore to the touch, severe pains in the abdomen, or pain or burning when passing urine or passing urine more frequently and in small amounts.

Denosumab may also cause skin rashes. Call your healthcare provider if you notice any abnormal skin-related symptoms. Denosumab has caused osteonecrosis of the jaw (ONJ) when used to treat patients with cancer although at this time, these have not been seen in patients with osteoporosis. Patients should practice good dental care during treatment and should have an examination of the mouth by a doctor or dentist before starting the medicine.

Side effects can include back pain and musculoskeletal pain in the arms and legs.

Estrogen Therapy (ET) and Hormone Therapy (HT)
(Multiple brand names available)

Estrogen therapy (ET) and estrogen with progesterone hormone therapy (HT) are approved for the prevention of osteoporosis in postmenopausal women. ET and HT reduce bone loss, increase bone density in both the spine and hip, and reduce the risk of hip, spine and other fractures in postmenopausal women. ET and HT are commonly available as a tablet or skin (transdermal) patch and in other forms. Estrogen and hormone medications come in a wide variety of doses.

Side Effects
When estrogen is taken alone, it can increase a woman's risk of developing cancer of the uterine lining (endometrial cancer). To reduce this risk, physicians prescribe the hormone progesterone in combination with estrogen (hormone therapy or HT) for those women who have a uterus. Estrogen therapy (ET) is prescribed for women who have had hysterectomies. ET and HT relieve menopausal symptoms and benefit bone health. Side effects may include vaginal bleeding, breast tenderness and gallbladder disease.

The Woman's Health Initiative (WHI) study confirmed that one type of HT, Prempro® (administered to women who on average were more than ten years past menopause), reduced the risk of hip and other fractures, as well as colon cancer. However, it was associated with a modest increase in the risk of breast cancer, strokes, heart attacks, venous blood clots and cognitive (mental) decline. Although ET was associated with a similar increase in the risk of strokes, venous blood clots and cognitive decline, it did not increase the risk of breast cancer or heart attacks.

Because of side effects, the FDA recommends that women consider other medications for the prevention of osteoporosis. According to the FDA, estrogen should not be prescribed for the prevention of postmenopausal osteoporosis unless a woman is at significant risk of osteoporosis and cannot take non-estrogen medications. The FDA also recommends prescribing the lowest possible dose of ET/HT for the shortest period of time.

Raloxifene
(Brand name Evista®)

Raloxifene is approved for the prevention and treatment of osteoporosis in postmenopausal women. Raloxifene is in a class of drugs called estrogen agonists/antagonists, also known as Selective Estrogen Receptors Modulators (SERMs), that have been developed to provide the beneficial effects of estrogens without their potential disadvantages. Raloxifene increases bone density and reduces the risk of spine fractures. There are no data showing that raloxifene reduces the risk of hip and other non-spine fractures.

For both prevention and treatment, raloxifene is taken daily as a 60 mg tablet with or without meals.

Raloxifene appears to decrease the risk of estrogen-dependent breast cancer by 65 percent over eight years.

Side Effects
While side effects are not common, they include hot flashes, leg cramps and deep vein thrombosis (blood clots), the latter of which is also associated with estrogen therapy. Other side effects include swelling and flu-like symptoms. Raloxifene is not associated with diseases of the uterus or ovaries and does not affect cognitive (mental) function.

Raloxifene should not be given to women at increased risk for stroke. These women include those who have had previous strokes, transient ischemic attacks (TIAs), atrial fibrillation (a type of serious irregular heart beat) or uncontrolled hypertension (high blood pressure).

Bone Forming (Anabolic) Medications

Teriparatide - Parathyroid Hormone (PTH) (1-34)
(Brand name Fortéo®)

Teriparatide, a type of parathyroid hormone, is approved for the treatment of osteoporosis in postmenopausal women and in men who are at high risk for a fracture. It is also approved for the treatment of osteoporosis in men and women who are at high risk of breaking a bone as a result of taking steroid medicines for a long time. This medication rebuilds bone and significantly increases bone mineral density, especially in the spine.

In clinical studies of postmenopausal women using teriparatide, fractures were reduced in the spine and throughout the skeleton. In men, bone mineral density (BMD) increased, but the study was too small to evaluate fracture reduction.

Good candidates for teriparatide include those who have had an osteoporosis related fracture and those with very low bone mineral density (T-scores lower than -3.0). Teriparatide may be an option for patients who continue to lose bone mass during treatment with other osteoporosis medications.

Teriparatide is self-administered as a daily injection from a pre-loaded pen containing a one month supply of medication. It can be taken for a maximum of two years. At the end of two years, to retain the benefits of treatment with teriparatide, most experts recommend that patients start an antiresorptive medication.

Side Effects
Side effects include leg cramps and dizziness. Modest elevations in serum and urine calcium can occur, but there is no documented increase in the risk of kidney stones.

In animal studies, very high doses of teriparatide that were given for a long period of time increased the incidence of rat osteosarcoma. Although common in rats, this type of tumor is extremely rare in adult humans. For this reason, the FDA approved its use for up to two years only. Teriparatide should not be used in people who may be at increased risk for this tumor. This includes patients with Paget’s disease, children with growing bone, persons with unexplained serum alkaline phosphatase elevations and those who have had radiation treatment involving the skeleton. It also should not be given to people with metabolic bone diseases such as hyperparathyroidism and those who have had cancer metastases to bone.

Response to Treatment

To be effective, an osteoporosis medication must be taken as prescribed. It is important to stay with the plan on which you and your healthcare provider have agreed. Most people cannot feel their bones getting stronger (or weaker) in response to treatment with a medication. So if you decide that a particular treatment plan is not right for you, discuss your concerns with your healthcare provider before stopping or interrupting treatment. For your medication to work, you need to exercise regularly and continue to get enough calcium and vitamin D.

With the antiresorptive medications (bisphosphonates, calcitonin, estrogen and estrogen agonists/antagonists), the goal of treatment is to prevent further bone loss and to reduce the risk of fractures. Fractures can cause deformities, disabilities and serious, as well as life threatening complications. A patient has a favorable response to treatment when bone mineral density either remains stable or improves and no fractures occur.

With the one anabolic medication, teriparatide (Forteo®), the goal of treatment is to rebuild bone, increase bone mass, repair microscopic defects in bone and reduce the risk of fractures. A patient has a favorable response to treatment when both bone quantity and quality improve and there is a substantial increase in bone strength.

Monitoring Treatment

Most healthcare providers repeat the bone mineral density (BMD) test every one to two years to monitor the effectiveness of treatment with an osteoporosis medication. BMD tests and blood and urine tests for bone remodeling are the only widely available monitoring tools. At the current time, there is no easy way to measure improvement in bone quality.

How Long to Treat

There are currently no conclusive research findings to suggest how long an osteoporosis drug remains safe and effective, except for teriparatide (Forteo®). Teriparatide can be taken for no more than two years according to the FDA. It is uncertain how long any of the osteoporosis medications remain effective after they are stopped.

Past Experience and Studies

Past experience with bisphosphonates (Actonel®, Boniva® and Fosamax®) suggests that upon discontinuation of any of these drugs, the benefits may continue for several years or longer. This is because the drugs remain in the bone for a long time. Eventually, however, the beneficial effect begins to lessen, bone remodeling rates increase and bone loss may occur.

One study found that alendronate (Fosamax®) continued to have a beneficial effect on bone mineral density for up to 10 years in postmenopausal women taking the medication. Biopsies of bone tissue in women on alendronate for 10 years show that bone tissue looks healthy and normal. Other studies show that treating with alendronate for more than five years improves bone strength and reduces clinical fractures of the spine.

Another study suggested that women who discontinued taking alendronate after five years of treatment did not significantly increase their fracture risk for up to an additional five years. Women who stopped alendronate after five years had the same rate of non-spine fractures as women who continued using the drug for 10 years. However, the study found that women at very high risk of spine fractures may benefit by continuing to take alendronate beyond five years.

Drug Free Holiday

When a patient has a good response to treatment with an osteoporosis medication, some healthcare providers will consider a drug free holiday. This means stopping the medication for a period of time and continuing to monitor bone mineral density. Some healthcare providers consider a drug free holiday after five years when there has been a good response to treatment. Others view it as an option when bone mineral density tests are performed two years apart, and the test results are similar and show a good response to treatment. Although some healthcare providers give drug free holidays, there are few research findings that support (or not support) this practice.

In the absence of clinical studies on duration of treatment, healthcare providers and patients should discuss options to determine the best course of action. NOF encourages all healthcare professionals to evaluate a patient on the basis of clinical risk factors, such as the presence or absence of fractures, BMD status, age, weight, smoking and alcohol use. Length of treatment should be individualized and based on the person's medical and fracture history, as well as the initial and most recent bone mineral density test results.

Nutrition and Exercise

To protect bone health, it is important that all persons have a nutritionally balanced diet, which includes calcium rich foods and vitamin D. Adults 50 and older need 1,200 mg of calcium and 800-1,000 IU of vitamin D daily. Adults under 50 need 1,000 mg of calcium and 400–800 IU of vitamin D daily. Because of the importance of vitamin D to bone health, healthcare providers may recommend a lab test for vitamin D for patients with osteoporosis. Based on the test results, healthcare providers may recommend additional vitamin D supplementation. A program of appropriate weight-bearing and resistance exercises further helps to promote bone health.

Adverse Events

When a patient has a serious reaction or problem with a drug, either the patient or patient's healthcare provider should notify the FDA to report the problem. The toll free number for the FDA is 1-800-332-1088. To complete a report online, visit the FDA Web site at www.fda.gov/medwatch. Patients also may want to notify the pharmaceutical manufacturer of the adverse event. See the chart below for the phone numbers of the pharmaceutical manufacturers and the date each medication was approved by the FDA as an osteoporosis medication.

Additional Information

For additional medication information, the following Web sites may be helpful to you:

• DrugDigest: www.drugdigest.org
• Food and Drug Administration: www.fda.gov
• MedlinePlus: www.nlm.nih.gov/medlineplus/druginformation.html
• Physicians' Desk Reference (PDR): www.pdrhealth.com

To help you keep track of your prescription medications, over-the-counter medicines and dietary supplements, the FDA has developed a form for you. It is called "My Medicine Record." You can use it to share information with your healthcare providers. Take it with you every time you visit your doctor, pharmacy or hospital. The record can be printed from the FDA Web site at www.fda.gov/cder/consumerinfo/my_medicine_record.htm

Older adults and caregivers can get help to avoid medication problems and recognize and manage common side effects. You can obtain this information from the MUST for Seniors™ program. The Web site is www.mustforseniors.org. MUST stands for "Medication Use Safety Training." It is sponsored by the National Council on Patient Information and Education (NCPIE).

To receive the latest scientific information on osteoporosis and ideas on how to better cope with this disease, please consider joining the NOF Family. New members of the National Osteoporosis Foundation ($30) receive our quarterly newsletter, The Osteoporosis Report, and a copy of our 74-page comprehensive patient handbook, Boning Up on Osteoporosis. Several levels of health professional memberships are also available. Join on-line today!

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