Kimberly Templeton, MD
Past-President, American Medical Women's Association (AMWA)
Dr. Kim Templeton is Professor of orthopaedic surgery at the University of Kansas Medical Center in Kansas City, specializing in orthopaedic oncology. She was the first McCann Professor of Women in Medicine and Science in the United States. In 2017, Dr. Templeton was elected to a second term on the National Board of Medical Examiners, after spending several years on various committees and task forces, and is now leading part of the research arm of the RENEW task force, to address stress among medical students related to the USMLE exams. She was named "Top Doc" by Ingram's magazine and received the Marjorie J. Siddridge leadership award for women in medicine from the University of Kansas in 2012. She received the Elizabeth Blackwell Award for outstanding contributions to the cause of women in the field of medicine by the American Medical Women's Association in 2013 and the inaugural Women Leaders in Medicine Award from the American Medical Student Association in 2008. She was named to the University of Kansas Women's Hall of Fame and an honorary alumnus of the University of Kansas in 2014.
Dr. Templeton is a past- president of the US Bone and Joint Initiative (USBJI). During her tenure as president, Dr. Templeton initiated the development of the Chronic Osteoarthritis Management Initiative, the goal of which to is to evaluate and disseminate treatment guidelines and outcomes tools to better care for patients with osteoarthritis. She also initiated and developed "World Pediatric Bone and Joint Day (PB&J)". Dr. Templeton serves on the steering committee for the Burden of Musculoskeletal Conditions in the US (BMUS), the publication for the USBJI used by researchers and policymakers. Dr. Templeton wrote the first chapter for BMUS on sex and gender differences in musculoskeletal health. Prior to her presidency of the USBJI, Dr. Templeton developed national public education programs for the group, including "Fit to a T" and "PB&J" (Protect Your Bones and Joints. In 2013, Dr. Templeton was named the international ambassador of the Global Bone and Joint Decade.
Dr. Templeton is a past-president of the American Medical Women's Association. She has also served on the executive committee and chaired the Sex and Gender Women's Health Collaborative, whose mission is to improve the translation of research into sex- and gender-based differences into clinical practice through education and evaluation. Dr. Templeton is an invited founding board member of the Academy of Women's Health. In 2013, Dr. Templeton was named by the National Academy of Sciences to the musculoskeletal work group, reviewing and recommending new venues for sex and gender research for the National Aeronautic and Space Administration (NASA). Dr. Templeton has spoken around the country in the area of sex and gender medicine. She has and continues to serve on expert committees that are working to incorporate this information into health professionals' education.
Dr. Templeton is a current member and past-president of the Kansas State Board of Healing Arts. She represents the Board on the Kansas Prescription Drug Monitoring Program Advisory Committee. She recently led the group that drafted the state's policy on chronic pain management that has been approved by all relevant state agencies. She represented the Board on the Kansas Governor's Substance Abuse Task Force, while also serving on the state hospital and medical associations combined opioid use task force and the Kansas Prescription Drug and Opioid Advisory Committee. She is a Commissioner for Kansas to the Interstate Medical Licensure Compact Commission. Dr. Templeton served 2 terms as co-chair of the National Quality Forum Musculoskeletal Standing Committee and has now been appointed to the new NQF Primary Care and Chronic Illness Standing Committee. Dr. Templeton is a past member of the American Academy of Orthopaedic Surgeons Council on Advocacy and Council on Research. She developed and chaired the AAOS Washington Health Policy Fellowship for senior orthoapedic surgery residents. She is past-chair of the AMA Orthopaedic Section and past vice-chair of the Women Physician Section. Dr. Templeton served on the task force that drafted the first interdisciplinary guidelines for treatment of fragility fractures of the hip sponsored by the AAOS.
Dr. Templeton's research interests include women's health, medical education, and long-term impact of treatment of pediatric sarcomas on bone health. She is co-chair of the International Guideline Harmonization Group project. She serves on several editorial boards, including Gender and the Genome, is the author of articles and book chapters, is the editor and co-author of Women's Sports Injuries, and is co-editor of a symposium in 2013 on the musculoskeletal impact of childhood obesity for Clinical Orthopaedics and Related Research.Full Bio
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What medications may be used to treat osteoporosis and what are the risks and benefits of each?
Your bone is constantly undergoing change, with small areas of bone being removed and new bone being made. Most of the calcium in your body is stored in bone; bone is removed primarily to release calcium into your bloodstream to assist in crucial body functions, as such muscle activity. Osteoporosis occurs when more bone is lost than made. Most medications used to treat osteoporosis are intended to slow the loss of bone. The U.S. Food and Drug Administration (FDA) has approved several medications for postmenopausal women to help slow or stop bone loss, build bone and reduce the risk of fractures. These medications work well, but only when they are taken regularly. You need to have adequate calcium and vitamin D intake while taking these medications to prevent low blood calcium levels and to maximize your ability to build bone. As with any medication therapy, there are certain risks and side effects.
- Menopausal estrogen therapy and combination estrogen-progestin therapy. Although not approved by the FDA for the treatment of osteoporosis, oral and transdermal forms of estrogen, called estrogen therapy (ET), and combined estrogen-progestin, called hormone therapy (HT), are approved for preventing bone loss in recently menopausal women. Studies find that ET increases bone mass and reduces the incidence of vertebral (spine), wrist and hip fractures. However, because of the long-term risks associated with hormone replacement therapy, the FDA recommends that women first consider other osteoporosis medications and warns that hormone therapies should be used for the treatment of substantial menopausal symptoms, rather than to slow bone loss. When used, they should be at the lowest possible dose for the shortest possible time.
- Raloxifene (Evista). Available in pill form, this medication is approved for the prevention and treatment of osteoporosis in postmenopausal women. Raloxifene has positive estrogen-like effects on bone but not on the breast or lining of the uterus and may reduce the risk of estrogen-dependent breast cancer by 65 percent over four years. It is part of a class of drugs called selective estrogen receptor modulators (SERMs) that appear to prevent bone loss at the spine, hip and other points in the body. Studies find that raloxifene reduces the risk of spinal fracture in women with osteoporosis, but there are no data confirming that it reduces the risk of any other fractures. Possible side effects include hot flashes, blood clots in the veins (similar to estrogen) and leg cramps. The pill is taken once a day, with or without meals.
- Bisphosphonates. There are several medications within the bisphosphonate class of drugs. These medications work by slowing the cells that remove bone, allowing restoration of the balance between bone loss and formation. These drugs have been found to decrease your risk of fractures, although some are better at preventing fractures in the spine than other fractures. Since these medications slow bone loss, your body is not as able to release needed calcium from your bones. While taking these medications, you need to make sure your diet includes adequate amounts of calcium and vitamin D, which is needed to absorb calcium; if not, take calcium and vitamin D supplements. In addition to low blood calcium, another significant side effect of bisphosphonates is the development of fractures of the upper part of the thigh bone (femur) in people who take these medications for a long time. Here are some types of bisphosphonates:
- Alendronate (Fosamax and other brands, including generics). This is a bone-specific oral medication approved by the FDA to treat and prevent osteoporosis. Studies find alendronate increases bone mass and reduces the risk of spine, hip, wrist and other fractures by up to 50 percent in women with osteoporosis. Alendronate has also been approved for the treatment of glucocorticoid-induced osteoporosis and the treatment of osteoporosis in men. Alendronate tablets should be taken on an empty stomach in the morning and with eight ounces of water at least 30 minutes before the first food, beverage or medication of the day. To minimize side effects—which can include heartburn or irritation of the esophagus—remain upright for at least 30 minutes after taking this medication. Alendronate can be taken daily or as a weekly medicine regimen. An additional reported side effect of alendronate is the development of osteonecrosis (dead bone) of the jaw.
- Risedronate (Actonel). This oral medication is approved to treat and prevent osteoporosis in postmenopausal women and to prevent and treat glucocorticoid-induced osteoporosis in women and men. It can be taken once per day, once per week or once per month. Studies find it increases bone mass and reduce the risk of spinal, wrist, hip and other non-spinal fractures in women with osteoporosis. Take on an empty stomach in the morning with eight ounces of water, 30 minutes before eating or drinking. To minimize side effects—which can include heartburn or irritation of the esophagus—remain upright for at least 30 minutes after taking. Take any vitamins, calcium and antacids at least 30 minutes after you take risedronate.
- Ibandronate (Boniva). This oral medication has been approved by the FDA for prevention and treatment of osteoporosis in postmenopausal women. It reduces the incidence of vertebral fractures by about 50 percent and increases bone mineral density throughout the skeleton. Ibandronate also prevents bone loss in recent menopausal women but who do not yet have osteoporosis. Ibandronate must be taken once a month on an empty stomach, first thing in the morning, with eight ounces of water (no other liquid) at least 60 minutes before eating or drinking. Patients must remain upright for at least one hour after taking this medication. Ibandronate also may be given intravenously once every three months.
- Zoledronic acid (Reclast). Reclast is an intravenous medication (injected into a vein) and has been approved by the FDA to prevent postmenopausal osteoporosis for two years with a single dose or to treat postmenopausal osteoporosis with a once-yearly infusion. Zoledronic acid decreases the risk of fractures, including those of the spine and hip. It is given only once a year or once every two years (depending on the diagnosis) as a 15-minute intravenous infusion. Side effects include transient fever, muscle pain, pain in the bones or joints, flu-like symptoms and headache. These symptoms usually set in within the first three days of receiving zoledronic acid and generally go away within three to four days.
- Calcitonin (Miacalcin). This is approved for the treatment of osteoporosis in women who are five years postmenopausal and cannot tolerate estrogen therapy. Studies find that this medication helps slow bone loss, increases spinal bone density and may relieve fracture pain. Because calcitonin is a protein, it cannot be taken orally, so it is taken as a nasal spray or, in some instances, an injection. Possible side effects include nasal irritation and inflammation, bloody nose, headache and backache. Injectable calcitonin may cause an allergic reaction and flushing of the face and hands, frequent urination, nausea and skin rash. Calcitonin isn't as potent at treating osteoporosis as other medications, so it is usually reserved for people who can't take other drugs or for control of the pain associated with fractures.
- Teriparatide (Forteo). A form of parathyroid hormone, this is the first medication that stimulates bone formation instead of slowing the breakdown of bone. It is approved for postmenopausal women and for men at high risk for fractures. It increases bone mineral density and reduces fractures in postmenopausal women. The drug is administered by injection once a day (for up to 24 months). Side effects may include nausea, dizziness and leg cramps.
- Denosumab (Prolia). This injectable treatment, approved by the FDA in 2010, is a fully human monoclonal antibody. It offers another option for postmenopausal women with osteoporosis who are at high risk for fracture. It works to decrease the loss of bone and increase bone mass and strength. An injection is recommended every six months. Side effects may include back pain, pain in the extremities, musculoskeletal pain, high cholesterol levels and urinary bladder infections. Serious adverse reactions include low calcium levels in the blood, serious infections, and skin reactions such as dermatitis, rashes and eczema. Similar to bisphosphonates, Denosumab causes significant suppression of bone turnover (bone loss and formation), which may contribute to the occurrence of atypical fractures, especially of the upper thigh bone (femur); slower fracture healing; and osteonecrosis of the jaw, a severe bone disease affecting the jaw.
Talk to your health care provider about the benefits and risks of taking osteoporosis medication and discuss what treatment and prevention options are best for you, with your health history in mind.
Keep in mind that osteoporosis medication is one of several strategies for prevention or treatment of this common condition. Weight-bearing exercise and a diet containing adequate calcium and vitamin D, with supplements as needed, also are important to help keep your bones strong.
To learn more about osteoporosis and preventing broken bones, visit these sites: