Your bone density can be measured by a machine that uses low levels of X-rays to determine the proportion of mineral in your bones. During this painless test, you lie on a padded table as a scanner passes over your body. In most cases, only a few bones are checked — usually in the hip, wrist and spine.
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.
Lifestyle and home remedies
These suggestions may help reduce your risk of developing osteoporosis or experiencing broken bones:
- Don't smoke. Smoking increases rates of bone loss and the chance of experiencing a fracture.
- Avoid excessive alcohol. Consuming more than two alcoholic drinks a day may decrease bone formation. Being under the influence of alcohol also can increase your risk of falling.
- Prevent falls. Wear low-heeled shoes with nonslip soles and check your house for electrical cords, area rugs and slippery surfaces that might cause you to trip or fall. Keep rooms brightly lit, install grab bars just inside and outside your shower door, and make sure you can get into and out of your bed easily.
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.
Preparing for your appointment
Your family doctor may suggest bone density testing. Screening for osteoporosis is recommended for all women by age 65. Some guidelines also recommend screening men by age 70, especially if they have health issues likely to cause osteoporosis.
If the bone density test is very abnormal or you have other complex health issues, you might be referred to a doctor who specializes in metabolic disorders (endocrinologist) or a doctor who specializes in diseases of the joints, muscles or bones (rheumatologist).
Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
- Write down any symptoms you've noticed, though it's possible you may not have any.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins and supplements that you're currently taking or have taken in the past. It's especially helpful if you record the type and dose of calcium and vitamin D supplements, because many different preparations are available. If you're not sure what information your doctor might need, take the bottles with you.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For osteoporosis, some basic questions to ask your doctor include:
- Do I need to be screened for osteoporosis?
- What kinds of tests do I need to confirm the diagnosis?
- What treatments are available, and which do you recommend?
- What types of side effects can I expect from treatment?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there any alternatives to the primary approach that you're suggesting?
- I have other health conditions. How can I best manage them together?
- Are there any activity restrictions that I need to follow?
- Do I need to make changes in my diet?
- Do I need to take supplements?
- Is there a physical therapy program that would benefit me?
- What can I do to prevent falls?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- Have you experienced any fractures or broken bones?
- Have you noticed a loss of height?
- How is your diet, especially dairy intake? Do you think you get enough calcium? Vitamin D?
- Do you take any vitamins or supplements?
- How often do you exercise? What type of exercise do you do?
- How is your balance? Have you experienced any falls?
- Do you have a family history of osteoporosis?
- Has anyone in your family had bone fractures, especially hip fractures in your parents?
- Have you ever had stomach or intestinal surgery?
- Have you taken corticosteroid medications (prednisone, cortisone) as pills, injections or creams?