Are infusions an effective treatment option for osteoporosis?

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Infusion therapy is a method of administering medications, fluids, and other products to a person. A doctor will inject the medication into the body either through a needle or a catheter, which is a tube.

Intravenous therapy is one of the most common forms of therapy. This method involves injecting the medication directly into the bloodstream via a person’s vein.

Other forms of infusion or injectable therapies include:

• Epidural: This method involves injecting medication into the epidural space of the spine.
• Intramuscular: This method involves injecting medication into a specific muscle or group of muscles.
• Subcutaneous: This method involves injecting medication into the subcutaneous tissue, the fatty layer of tissue beneath the skin.

The most common type of infusion therapy for osteoporosis is bisphosphonates. Examples of intravenous bisphosphonates include zoledronic acid (Reclast) and ibandronate (Boniva).

Infusion therapy allows for the direct injection of medication into the bloodstream and the cardiovascular system. In this way, the medication bypasses potential barriers to absorption and can reach the target cells quickly.

Bisphosphonates are a class of drugs that can help treat osteoporosis in all individuals. Their effectiveness relates to their ability to inhibit bone resorption.

These drugs are available in a variety of formulations. Zoledronic acid and ibandronate are examples of bisphosphonates that people can receive through infusion therapy.

These bisphosphonates work by inhibiting farnesyl pyrophosphate synthase. This molecule promotes the attachment of osteoclasts to bones. Osteoclasts are molecules in the body that are responsible for bone resorption, which is the process where osteoclasts break down and remove bone.

By inhibiting farnesyl pyrophosphate synthase, bisphosphonates are able to prevent this process and maintain bone mass and bone mineral density.

Evidence suggests that a person should receive intravenous zoledronic acid once per year or once every 2 years. For females who are experiencing menopause, it is advisable to administer intravenous ibandronate every 3 months.

According to the Bone Health & Osteoporosis Foundation, side effects for all bisphosphonates can include bone, joint, or muscle pain.

Adverse effects of zoledronic acid may include:

• low levels of calcium in the blood
• secondary hyperparathyroidism, a condition where the parathyroid glands create too much parathyroid hormone
• musculoskeletal pain
• atypical femur fractures
• osteonecrosis of the jaw
• atrial fibrillation
• ocular inflammation

A small number of individuals who receive intravenous bisphosphonate therapy may also experience:

• flu-like symptoms
• fever
• headache

Other treatment options available to help treat osteoporosis may include:

Denosumab

Denosumab is a bone anti-resorptive drug. This means that it stops the action of osteoclasts and, therefore, bone resorption, similar to bisphosphonates. A doctor will administer denosumab via subcutaneous injection either in the upper arm, upper thigh, or abdomen.

Hormone replacement therapy (HRT)

HRT is a type of medication that mimics the female hormones estrogen and progesterone. A doctor may prescribe HRT to a female experiencing menopause, due to the lack of estrogen production.

HRT includes estrogen and progestogen, a synthetic version of progesterone. HRT may help prevent bone loss and reduce the risk of fractures.

Salmon calcitonin

Salmon calcitonin is a derivative of human calcitonin. It inhibits osteoclasts similar to bisphosphonates and can prevent bone resorption. Doctors use salmon calcitonin to treat osteoporosis in postmenopausal females.

Synthetic parathyroid hormone (PTH)

PTH is a synthetic version of the parathyroid hormone that the body produces. It regulates the levels of phosphate and calcium in the body.

While constant exposure to PTH causes bone resorption, intermittent administration of synthetic PTH promotes bone formation, including increased bone mass and improved bone architecture.

Calcium and vitamin D

A doctor may also recommend that someone with osteoporosis take calcium and vitamin D supplements. A person needs sufficient vitamin D to form the hormone calcitriol. Calcitriol aids in the absorption of calcium, which in turn helps strengthen the bones and improve bone mass.

Infusion therapy involves injecting medication directly into the bloodstream to bypass barriers to absorption. Intravenous infusion therapy is a common form of administering medication in osteoporosis.

The first-line infusion therapy option for osteoporosis is typically a class of drugs known as bisphosphonates. Examples include ibandronate and zoledronic acid.

Side effects of bisphosphonates include bone joint or muscle pain, hypocalcemia, and rarely, flu-like symptoms and fever. Other treatment options for osteoporosis include denosumab, HRT, salmon calcitonin, and synthetic PTH.