Most people with osteoporosis will need some form of prescription medication. If you have an osteoporosis-related fracture, you will need a medication to help your bones recover and to prevent future fractures. If you've learned you have low bone density but don't have a fracture, you may take a medication to help prevent fractures and further bone loss.
The FDA has approved many medications specifically for osteoporosis. They fall into two groups—antiresorptives and anabolics.
Antiresorptives limit bone loss by decreasing the rate of absorption by osteoclasts, which are cells that absorb bone. By reducing how quickly osteoclasts work, antiresorptives may prevent further loss of bone mass.
There are a number of classes of antiresorptives—bisphosphonates, calcitonin, estrogen therapy or hormone therapy, and estrogen agonists/antagonists.
Bisphosphonates increase your bone mineral density by slowing down the rate at which your osteoclasts absorb bone. Therefore, they help prevent wrist, spine, hip, and other bone fractures.
The bisphosphonates below are approved to prevent and/or treat osteoporosis:
Side effects of bisphosphonates depend on how they're taken. Pill side effects include:
If you receive your medication via IV, you may experience:
You may also experience abdominal, bone, joint, and muscle pain—regardless if your medication is in pill or IV form.
Calcitonin is a hormone naturally produced in the thyroid. When given to patients with osteoporosis, calcitonin produces modest increases in bone mass because it slows the rate at which osteoclasts absorb bone.
Only women who are at least five years past menopause can take calcitonin. Patients with severe osteoporosis seem to do the best with this drug. Calcitonin can be taken via injection or nasal spray, where it is quickly absorbed into the blood stream.
Side effects of calcitonin depend on its mode of delivery. Injection side effects include:
Nasal spray side effects include:
To learn more about antiresorptives, read our article about calcitonin and bisphosphonates.
Estrogen or hormone replacement therapy
When women reach menopause, levels of the sex hormone estrogen drop. This has a direct effect on women's bones because estrogen helps protect bones. A lack of estrogen means that women's bones will likely weaken and may become vulnerable to fracture. Only post-menopausal women can use estrogen therapy (ET) and estrogen with progesterone hormone therapy (HT). These FDA-approved treatments are available under a variety of brand names and may decrease your chances of getting an osteoporosis-related fracture by increasing your bone mineral density.
ET and HT help protect your bones, but the treatments may heighten the risk of breast cancer, strokes, heart attacks, and blood clots. This has led many doctors to suggest that their patients try other medications before these therapies. If you do take ET or HT, you will likely take the lowest dose for a short period of time.
To learn more, read our article about osteoporosis and estrogen replacement therapy.
Also called selective estrogen receptor modulators (SERMs), these drugs can be used only by women. They provide the same benefits as estrogen therapy but without many of the dangerous side effects. But that doesn't mean they're flawless. Possible side effects include blood clots, hot flashes, and leg cramps. Raloxifene is the only FDA-approved estrogen agonist/antagonist for osteoporosis.
In 2010, the FDA approved denosumab to treat osteoporosis in post-menopausal women who are at high risk for fractures. If osteoporosis has lead to a broken bone or if you have multiple risk factors for fracture, your doctor may recommend that you try this osteoporosis medication.
It works by affecting the way a certain protein (the RANKL protein) works in your body. RANKL is involved in the process of breaking down bones (bone resorption), so if it is blocked, bones can't be broken down as quickly.
Denosumab is taken as an injection, generally every 6 months. Your doctor or another healthcare professional will administer the injection.
If you have low blood calcium (called hypocalcemia), you should not take denosumab.
Anabolics, the second group of osteoporosis medications, promote rapid bone formation. Teriparatide is a synthetic form of parathyroid hormone and is the only FDA-approved anabolic.
Both men and women can take teriparatide, which is administered in a daily injection. The drug promotes bone growth and increases bone density, which will reduce your risk of fracture.
Teriparatide is connected to a rare form of bone cancer when given in high doses, so it is approved for use of no more than two years.
There are many approved prescription drugs available to treat and prevent osteoporosis. Talk with your doctor about what medication will best help you.