Treatment recommendations are often based on an estimate of your risk of breaking a bone in the next 10 years using information such as the bone density test. If the risk is not high, treatment might not include medication and might focus instead on modifying risk factors for bone loss and falls.
For both men and women at increased risk of fracture, the most widely prescribed osteoporosis medications are bisphosphonates. Examples include:
- Alendronate (Fosamax)
- Risedronate (Actonel, Atelvia)
- Ibandronate (Boniva)
- Zoledronic acid (Reclast)
Side effects include nausea, abdominal pain and heartburn-like symptoms. These are less likely to occur if the medicine is taken properly. Intravenous forms of bisphosphonates don't cause stomach upset but can cause fever, headache and muscle aches for up to three days. And it may be easier to schedule a quarterly or yearly injection than to remember to take a weekly or monthly pill, but it can be more costly to do so.
Using bisphosphonate therapy for more than five years has been linked to a very rare problem in which the middle of the thighbone cracks and might even break completely.
Bisphosphonates also have the potential to affect the jawbone. Osteonecrosis of the jaw is a rare condition that can occur typically after a tooth extraction in which a section of jawbone fails to heal where the tooth was pulled. You should have a recent dental examination before starting bisphosphonates.
Estrogen, especially when started soon after menopause, can help maintain bone density. However, estrogen therapy can increase the risk of blood clots, endometrial cancer, breast cancer and possibly heart disease. Therefore, estrogen is typically used for bone health in younger women or in women whose menopausal symptoms also require treatment.
Raloxifene (Evista) mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen. Taking this drug may reduce the risk of some types of breast cancer. Hot flashes are a common side effect. Raloxifene also may increase your risk of blood clots.
In men, osteoporosis may be linked with a gradual age-related decline in testosterone levels. Testosterone replacement therapy can help improve symptoms of low testosterone, but osteoporosis medications have been better studied in men to treat osteoporosis and thus are recommended alone or in addition to testosterone.
Other osteoporosis medications
If you can't tolerate the more common treatments for osteoporosis — or if they don't work well enough — your doctor might suggest trying:
- Denosumab (Prolia). Compared with bisphosphonates, denosumab produces similar or better bone density results and reduces the chance of all types of fractures. Denosumab is delivered via a shot under the skin every six months.
- Teriparatide (Forteo). This powerful drug is similar to parathyroid hormone and stimulates new bone growth. It's given by daily injection under the skin. After two years of treatment with teriparatide, another osteoporosis drug is taken to maintain the new bone growth.
Soy protein appears to have activity similar to estrogen on bone tissue. Some studies indicate that bone fracture risk is lessened in postmenopausal Asian women who consume higher amounts of soy protein. But soy should be used with caution by women who have a family or personal history of breast cancer. Most available soy products have not been shown to reduce the chance of fractures.
Ipriflavone is a product made in a laboratory from one of the isoflavones found in soy. When combined with calcium, ipriflavone appears to prevent bone loss and reduce pain associated with compression fractures in the spine.