To slow the progression of osteoporosis, your doctor may prescribe different medications, which, combined with calcium and vitamin D supplements, will help keep your bones stronger and slow their wear and tear.
Osteoporosis happens when your bones lose density and strength. You may have heard your doctor refer to it as “resorption,” the natural process by which cells called osteoclasts break down and reabsorb old bone.
Osteoporosis and resorption are closely related. Resorption happens faster than the formation of new bone by osteoblasts, which are cells that build new bone. This leads to bone loss and weak bones with gaps or pores.
“With age, your bones become porous — hence the term “porosis” — making them more fragile and prone to fracture,” says Elaine Yu, MD, director of the Bone Density Center at Massachusetts General Hospital.
Why Treating Osteoporosis Matters
Medical treatment for osteoporosis helps you keep your bones strong, prevent fractures, and maintain mobility, regardless of your age. It can also reduce the risk of ongoing or long-term pain.
“Medications can improve bone health by 10% to 15%, and the magnitude of the improvement far outweighs the side effects,” Yu says.
Medicines That Help Make Your Bones Stronger
There are two main types of medications that slow the progression of osteoporosis: bisphosphonates and anabolic medications.
Bisphosphonates
Bisphosphonates are also called antiresorptives (anti-bone resorption drugs). If you already have low bone density or have had fractures from minor injuries, your doctor may recommend bisphosphonates.
Some of the most commonly prescribed bisphosphonates for treating osteoporosis include:
- Alendronate (Binosto, Fosamax): One pill daily or weekly
- Risedronate (Actonel, Atelvia): One pill daily, weekly, or monthly
- Ibandronate: A monthly pill or an intravenous (IV) infusion every three months
- Zoledronic acid (Reclast): One annual IV infusion
Anabolic medications
Unlike bisphosphonates, which slow bone loss (resorption), anabolic medications help form new bone and are used in cases of advanced osteoporosis. Some of them include:
Abaloparatide (Tymlos). A synthetic form of a natural hormone in the body (parathyroid hormone). You give yourself a daily injection in your abdomen. It helps create new bone and increases its density and strength. It isn’t typically used for more than two years.
Romosozumab (Evenity). A monoclonal antibody — a lab-made protein that mimics the antibodies in your immune system. You receive two injections per month for one year. It stimulates new bone formation and reduces the loss of old bone.
Teriparatide (Forteo, Bonsity). Stimulates bone formation. You inject it daily under the skin of your thigh or abdomen. It is typically used for one to two years.
More Treatment Options
Biologics
Denosumab (Prolia, Jubbonti, Stoboclo) is a biologic (made from living organisms) drug.
These drugs can also be prescribed as biosimilars, which have the same safety and efficacy characteristics as their original biologics. You will receive an injection under your skin every six months at your hospital or clinic.
Denosumab can give you similar results to bisphosphonates. Some studies have shown that it increases bone density in the lower back and wrist more than bisphosphonates. It also helps slow bone loss.
Selective estrogen receptor modulators (SERMs)
Raloxifene (Evista) is another osteoporosis medication used only in women after menopause, when they no longer have menstrual periods. It acts like estrogen to slow bone loss. Studies show that Evista does not increase the risk of breast or uterine cancer, but it can cause blood clots and increase hot flashes.
Hormonal therapy
Hormone replacement therapy (HRT), which can be estrogen-only or estrogen and progestin, helps keep your bones strong and reduces the risk of fractures.
A medication called Duavee (estrogen and bazedoxifene) is approved to treat moderate to severe menopausal hot flashes. It can also prevent osteoporosis in women who have gone through menopause and still have their uterus.
But Duavee may increase the risk of some health problems, such as gallbladder disease, certain types of cancer, and dementia. It may also increase the risk of blood clots, stroke, or heart attack, even after you stop taking it.
That’s why your doctor will see if the benefits of taking Duavee are greater than the risks.
Exercises, Hormones, Calcium, and Vitamin D
In addition to treatment with bisphosphonates and anabolic steroids, Yu recommends:
- Taking estrogen, in some cases, especially if you’re past menopause
- Taking a calcium supplement (1,500 milligrams) with vitamin D
- Doing low-impact exercises, such as using resistance bands, squats, walking, or dancing
How Long Do You Need Treatment?
“It’s difficult to apply a universal rule for all patients with osteoporosis, as each patient has different levels of frailty,” Yu says.
“I like to reevaluate treatments every two years to determine if the patient has side effects that could worsen or if a dose needs to be increased,” she says.
Side Effects
“The side effects of bisphosphonates and anabolic steroids are minimal compared to their benefits. You should check with your doctor regularly to see how you respond to treatment,” Yu says.
Side effects of bisphosphonates:
- You may have pain in your bones, joints, or muscles.
- You may have nausea, heartburn, or difficulty swallowing.
- You may feel irritation in your esophagus.
- You may have a fever or headache.
- You may have swollen eyes.
- In some cases, these medicines can affect your kidneys.
- Rare side effect: You may develop osteonecrosis of the jaw (the jawbone weakens, dies, and may become exposed in the mouth), especially if you take the medication for more than two years.
If you’re on bisphosphonate treatment for more than two years, your doctor may consider temporarily discontinuing the medication, which is known as a “bisphosphonate holiday,” says Yu.
Side effects of anabolic medications:
- You may feel nauseous or dizzy.
- You may have a headache.
- You may have high levels of calcium in your blood (hypercalcemia).
- You may have redness, itching, or swelling from the injections.
Costs and Coverages
Private health insurance often covers the testing and treatment of osteoporosis. But if you can’t afford insurance, what can you do?
There are federal programs that can help you with costs:
Medicare
The federal program for people over the age of 65 and some people with disabilities. It covers diagnostic tests such as bone densitometry (BDXA), which uses X-rays to evaluate the health and thickness of your bones. It is recommended to do this every two years.
It also covers injectable medicines if they are provided to you by a doctor.
Calcium and vitamin D supplements are not covered as medications but may be included if your doctor prescribes them as part of your treatment. The cost depends on whether you qualify for help programs such as Extra Help or Medicare savings programs.
Medicaid
Medicaid is the other federal and state program that provides coverage if you have low income, a disability, or are elderly.
It covers osteoporosis treatment, including doctor visits, blood tests, bone density tests, hospitalizations, and, depending on the state in which you live, medications such as bisphosphonates, as well as calcium and vitamin D supplements.
Federally Qualified Health Centers (FQHCs)
These centers offer medical care at rates adjusted to your income. They can prescribe and help you obtain the medications and supplements you need to treat osteoporosis.
Key Questions to Ask Your Doctor
If you have osteoporosis, it’s important to have a detailed conversation with your doctor to fully understand your diagnosis, treatment options, and preventative measures.
Here is a list of key questions you could ask your doctor:
Diagnosis and Assessment
- How severe is my osteoporosis?
- How high is my risk of fractures? How is that risk measured?
- Are there other conditions that are affecting my bones?
Treatment
- What treatment do you recommend and why?
- What are the possible side effects?
- For how long should I take this medication?
Nutrition and Supplements
- How much calcium and vitamin D do I need per day?
- Which foods should I avoid or eat more of?
Lifestyle and Fracture Prevention
- Which exercises are safe for me?
- What should I do to prevent falls?
Follow-Up
- What symptoms or warning signs should I look out for?
- When should I follow up with you?
Causes and Risk Factors
- Why do I have osteoporosis?
- Is it hereditary? Should I tell my family?
- Are my hormone levels (such as estrogen or testosterone) affecting my bones?
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
Elaine Yu, MD, director, Bone Density Center, Massachusetts General Hospital.
WashUMedicine: “Are you at risk for Osteoporosis?”
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ClevelandClinic.org: “Bisphosphonates.”
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