Osteoporosis treatment: Medications can help

Osteoporosis treatment may involve medication along with lifestyle change. Get answers to some of the most common questions about osteoporosis treatment.

By Mayo Clinic Staff

If you're undergoing osteoporosis treatment, you're taking a step in the right direction for your bone health. But perhaps you have questions about your therapy. Is the medication you're taking the best one for you? How long will you have to take it? Why does your doctor recommend a weekly pill when your friend takes a pill only once a month?

Which medications are commonly used for osteoporosis treatment?

Bisphosphonates are the most common medications prescribed for osteoporosis treatment. These include:

  • Alendronate (Fosamax)
  • Risedronate (Actonel)
  • Ibandronate (Boniva)
  • Zoledronic acid (Reclast)

Hormones, such as estrogen, can play a role in osteoporosis prevention and treatment. However, there has been some concern about potential side effects tied to the use of hormone therapy. Current recommendations say to use the lowest dose of hormones for the shortest period of time.

Still, women who have reasons — such as menopausal symptoms — to consider using hormones can weigh the benefit of improved bone health into their decision.

Some hormonelike medications also are approved for preventing and treating osteoporosis, such as raloxifene (Evista).

Denosumab (Prolia, Xgeva) is a newer medication shown to reduce the risk of osteoporotic fracture in women and men. Unrelated to bisphosphonates, denosumab might be used in people who can't take a bisphosphonate, such as some people with reduced kidney function.

Teriparatide (Forteo) is typically reserved for men and postmenopausal women who have very low bone density, who have had fractures or whose osteoporosis is caused by steroid medication. Teriparatide has the potential to rebuild bone.

Abaloparatide (Tymlos) is the newest osteoporosis medication. Like teriparatide, it has the potential to rebuild bone. In a research trial comparing these two treatments, abaloparatide appeared to be as effective as teriparatide but was less likely to cause an excess of calcium.

How do most osteoporosis medications work?

With the exception of teriparatide, osteoporosis medications slow bone breakdown. Healthy bones continuously break down and rebuild.

As you age — especially after menopause — bones break down faster. Because bone rebuilding cannot keep pace, bones deteriorate and become weaker.

Osteoporosis medications basically put a brake on the process. These drugs effectively maintain bone density and decrease the risk of breaking a bone as a result of osteoporosis.

How do you know if you're taking the right bisphosphonate?

Drugs in the bisphosphonate class are more alike than they are different. They all help maintain bone density. And, all bisphosphonates have been shown to reduce the chance of a fracture.

The decision to take one drug over another often is based on:

  • Preference
  • Convenience
  • Adherence to the dosing schedule
  • Cost, including whether or not the drug is a "preferred" option on your insurance company's list of acceptable medications (formulary)

Your doctor might recommend a monthly dose of medication if it's going to be better tolerated or better accepted. But if you're likely to forget to take your medicine on a monthly schedule, you might do better taking medication once a week.

When might other osteoporosis medications be used?

Drugs such as denosumab, teriparatide and abaloparatide can be used by anyone with osteoporosis, but are more likely to be recommended for people with unique circumstances, including severe osteoporosis with very low bone density, multiple fractures, steroid use and young age.

These drugs, which are injected, might also be given to people who can't tolerate an oral bisphosphonate. Intravenous (IV) forms of zoledronic acid and ibandronate also can be an option for people who can't tolerate an oral bisphosphonate.

What are common side effects of bisphosphonate pills?

Bisphosphonate pills aren't absorbed well in the stomach. The main side effects of bisphosphonate pills are stomach upset and heartburn. Generic forms of these drugs may be more likely to cause these side effects.

To ease these potential side effects, take the medication with a tall glass of water on an empty stomach. Don't lie down or bend over or eat for 30 to 60 minutes to avoid the medicine washing back up into the esophagus. When the recommended wait time is over, eat to neutralize the remaining medication.

Most people who follow these tips don't have these side effects. But it's possible to take the medicine correctly and still have stomach upset or heartburn.

July 29, 2017 See more In-depth