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 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 your risk isn't 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 (Binosto, Fosamax)
- Risedronate (Actonel, Atelvia)
- Ibandronate (Boniva)
- Zoledronic acid (Reclast, Zometa)
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. It might 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.
Monoclonal antibody medications
Compared with bisphosphonates, denosumab (Prolia, Xgeva) 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.
If you take denosumab, you might have to continue to do so indefinitely. Recent research indicates there could be a high risk of spinal column fractures after stopping the drug.
A very rare complication of bisphosphonates and denosumab is a break or crack in the middle of the thighbone.
A second rare complication is delayed healing of the jawbone (osteonecrosis of the jaw). This can occur after an invasive dental procedure such as removing a tooth.
You should have a dental examination before starting these medications, and you should continue to take good care of your teeth and see your dentist regularly while on them. Make sure your dentist knows that you're taking these medications.
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 can 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 might 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.
If you can't tolerate the more common treatments for osteoporosis — or if they don't work well enough — your doctor might suggest trying:
- 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.
- Abaloparatide (Tymlos) is another drug similar to parathyroid hormone. You can take it for only two years, which will be followed by another osteoporosis medication.
- Romosozumab (Evenity). This is the newest bone-building medication to treat osteoporosis. It is given as an injection every month at your doctor's office. It is limited to one year of treatment, followed by other osteoporosis medications.
Lifestyle and home remedies
These suggestions might help reduce your risk of developing osteoporosis or breaking bones:
- Don't smoke. Smoking increases rates of bone loss and the chance of fracture.
- Avoid excessive alcohol. Consuming more than two alcoholic drinks a day might 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 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.
There is limited evidence that certain supplements, such as vitamin K-2 and soy, can help lower fracture risk in osteoporosis, but more studies are needed to prove benefits and determine risks.
Preparing for your appointment
Your family doctor might 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 you have a broken bone after a minor force injury, such as a simple fall, a bone density may be important to assess your risk of more fractures.
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.
What you can do
- Write down symptoms you've noticed, though it's possible you may not have any.
- Write down key personal information, including major stresses or recent life changes.
- Make a list of all medications, vitamins and supplements that you take or have taken, including doses. 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 or take a picture of the label with your smartphone and share it with your doctor.
- Write down questions to ask your doctor.
For osteoporosis, basic questions to ask your doctor include:
- Do I need to be screened for osteoporosis?
- What treatments are available, and which do you recommend?
- What side effects might I expect from treatment?
- Are there alternatives to the treatment you're suggesting?
- I have other health conditions. How can I best manage them together?
- Do I need to restrict my activities?
- Do I need to change 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?
Don't hesitate to ask other questions.
What to expect from your doctor
Your doctor is likely to ask you questions, such as:
- Have you broken bones?
- Have you gotten shorter?
- How is your diet, especially dairy intake? Do you think you get enough calcium? Vitamin D?
- How often do you exercise? What type of exercise do you do?
- How is your balance? Have you fallen?
- Do you have a family history of osteoporosis?
- Has a parent broken a hip?
- Have you ever had stomach or intestinal surgery?
- Have you taken corticosteroid medications (prednisone, cortisone) as pills, injections or creams?