Osteoporosis, a medical term that comes from the Latin word for "porous bones," is one of the most significant health crises facing Americans today. In fact, the U.S. National Institutes of Health warn that more than 50 million Americans are at risk, and the International Osteoporosis Foundation reports that one in three women and one in five men around the world are at risk of fracturing a bone due to this disease.
But there's good news. Besides a wide range of preventative measures, such as engaging in regular exercise, eating more foods that are rich in calcium, and eating less meat and dairy, there is also a wide range of medications to help treat osteoporosis.
Consult with your physician about which of the following medical treatments are right for you, as each medication treats a very specific root factor or type of bone loss:
- Hormone therapy or hormone-related medications
Let's break down how each of these medications for osteoporosis work, how they affect your bone health, and some of the potential side effects you'll want to be aware of.
Bisphosphonates are one of the most widely used medications for osteoporosis, especially among women with millions of postmenopausal women on this type of drug. There are many specific drugs in this class of medications, with notable options including:
- Alendronate (brand name Fosamax): This is an oral medication that you can either take once every seven days or once a day.
- Ibandronate (brand name Boniva): It's available either as a once-a-month oral medication or as an injection that your doctor gives you four times a year.
- Risedronate (brand name Actonel): This is an oral medication that you can either take once a day, once a week or once a month.
- Zoledronic acid (brand name Reclast): Your doctor gives this to you via an IV infusion once a year.
The benefit of bisphosphonates is twofold:
- These drugs slow down the rate at which you lose bone density.
- These drugs may also help to lower the pain you may feel with osteoporosis.
With the wide range of options in this drug class, you can also choose how actively you want to manage your osteoporosis. For example, some people don't mind taking a daily or weekly pill while others love the convenience of getting an IV infusion just once a year.
Of course, as with any bone health treatment, bisphosphonates have powerful benefits and also potentially powerful side effects that you need to be aware of.
The downside to bisphosphonates is that they must be taken correctly — if they are not taken correctly, they are known to cause esophageal ulcers. If you're taking an oral dose, you may experience irritation or pain in your throat or digestive system, including heartburn, pain when you swallow, and even ulcers in your stomach.
If you're taking your bisphosphonate dose via an injection or an IV, you may experience symptoms like muscle aches, fever and headaches for a few days after the treatment.
Additionally, bisphosphonates are known to affect your levels of calcium. Your doctor will screen you for your calcium levels and, if your calcium levels are already low, will work with you on raising your calcium levels before prescribing a bisphosphonate.
Osteoclasts are a type of bone cell that speeds up the rate at which your bones lose their mineral density.
Without going to deep into scientific terms, a specific type of protein known as a receptor activator of nuclear factor kappa-Β ligand (RANKL) affects osteoclasts and can, therefore, influence the production of osteoclasts, and thus the speed of the development of your osteoporosis and bone loss.
A relatively new treatment, denosumab (brand name Prolia) uses an antibody that links up with the RANKL protein and helps slow down how your bones breakdown and lose density.
It's specifically aimed at adults where osteoclasts are a root cause of their weaker bones. This includes women with postmenopausal osteoporosis who are at risk of fractures of their spine and hip, as well as men with a high risk of osteoporosis-related bone fractures.
You receive the antibody treatment through twice-yearly injections from your doctor.
Side effects for this antibody medication include reduced levels of calcium in your blood, which can cause secondary symptoms like muscle cramps and tingling in your fingers or toes. Those who have a weaker immune system, such as men or women with cancer or HIV, are also at a higher risk of developing serious infections when on this antibody drug.
Next page: More information on osteoporosis medications, and more.
If your bone loss is linked to your hormone levels, treatments addressing your health on a hormonal level can positively impact your bone strength and your osteoporosis risks.
For women, the biggest factor is estrogen. This sex hormone has a protective effect on your bone density, which is why osteoporosis rates skyrocket after menopause when a woman's estrogen levels plummet.
Raloxifene hydrochloride (brand name Evista) is an estrogen agonist/antagonist, which essentially means your body responds to it as if it were natural estrogen. Studies have found that in postmenopausal women, this medication can help to build bone mass when taken once a day as an oral tablet.
It's critical that you avoid this drug if you have risk factors for a stroke, as it may be linked to increased rates of having a stroke. Other side effects include a risk of blood clots, as well as symptoms similar to having a hot flash.
Injectable teriparatide (brand name Forteo) is a bone-building agent made up of a synthetic form of parathyroid hormone (PTH). PTH plays a critical role in regulating how your body absorbs and uses calcium. Unlike many medications that work to slow or stop bone loss, teriparatide has been found to help to increase bone density and even cause new bones to grow. Interestingly enough, it's one of the few treatments effective for loss of bone in your jaw.
Teriparatide is given to postmenopausal women or men with osteoporosis via injection once a day. The requirement for regular shots of this medication may deter some people.
Side effects can include depression, heartburn, cramping in your legs, and itching and/or redness at the spot where you get the daily shot.
Finally, there's hormone replacement therapy. The use of HRT to treat osteoporosis has been studied widely, and it's been shown to be effective at reducing your risk of fractures (in some cases, by up to 25% in adults where low estrogen is linked with poor bone health:
- Women who are going through early menopause
- Women who have a poor score on their bone density test AND are presenting symptoms of menopause
- Women who have numerous risk factors of osteoporosis, such as a family history of bone loss and a small, petite frame
How you get your HRT varies across the board. It's available either as estrogen alone, or a combination of progesterone and estrogen, and can be taken as an oral pill, an injection, a topical cream, or a skin patch that you wear that slowly "drips" estrogen into your system. However, statistically, most women opt for a pill or a patch.
Daily estrogen pills used for osteoporosis treatment include the brand names Premarin, Menest and Estrace, while skin patches used once or twice a week include the brand names Climara, Vivelle-Dot and Minivelle.
The side effects of estrogen prevent many women from using this option depending on their lifestyle and other health factors. Common side effects include a greater risk of cancer in your uterus, an increased risk of cardiovascular health problems (including stroke), a higher risk of cancer in your ovaries, and more.
Thus, for many, HRT is the option they go to when all other options don't work effectively. If you're considering using HRT to treat osteoporosis, be sure to review all of your personal risk factors for things like breast cancer and heart attack, as there may be other treatments you want to try first.
Questions to Ask Your Doctor
Trying to decode the above and make a decision is no easy feat, which is why it's critical to work closely with your doctor and have open, honest communication to ensure you understand how your different options work, and how they may impact other areas of your health and wellbeing.
However, some people find it intimidating to talk to their doctor. Bring the following list of questions with you to your next visit to help you get all the information you need to feel comfortable with your treatment decisions:
- What are some of the underlying causes of my osteoporosis?
- What can I do to prevent this from getting worse?
- What are the results of my bone density test?
- How often should I get this bone density test done?
- What are the medications available to me to treat my form of osteoporosis?
- What are the side effects of these medications?
- Which medication do you think would work best for me and my current risk factors, as well as my family medical history and other health factors?
- What else can I do in terms of diet and lifestyle to improve my bone health and slow, stop or reverse my bone loss?
Things to Do No Matter What Medication You and Your Doctor Choose
Regardless of what specific medication you choose, increase how effective your treatment is by looking at all factors that play a role in your bone health.
This includes eliminating or reducing things that directly lead to bone loss. After all, why take a drug to slow bone loss while also doing other things that speed up the bone loss? This includes risk factors like smoking and drinking too much alcohol.
Next, look at ways to support the medications and improve your bone strength.
Start with calcium. Eat more calcium-rich foods (you'll want 1,000 milligrams of calcium a day if you're a woman aged 50 and under, or a man aged 70 and under). If you're older than this, you'll want to strive for 1,200mg of this bone-building mineral a day. Great options to consider include soy and dark, leafy greens.
Finally, find ways to increase the amount of physical activity you enjoy. Regular exercise has been shown in dozens of studies to actually improve bone density and slow bone loss. For the best results, try weight-bearing and strength-training workouts, such as biking, jogging and lifting weights.
By reducing your risk factors and increasing the lifestyle factors that build your bones, you help ensure that whatever medications you're on can achieve maximum results.