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Medicines for osteoporosis

Alendronate (Fosamax); Ibandronate (Boniva); Risedronate (Actonel); Zoledronic acid (Reclast); Raloxifene (Evista); Teriparatide (Forteo); Denosumab (Prolia); Romosozumab (Evenity); Low bone density - medicines; Osteoporosis - medicines

Osteoporosis is a disease that causes bones to become brittle and more likely to fracture (break). With osteoporosis, the bones lose density. Bone density is the amount of calcified bone tissue that is in your bones.

When are Medicines Used?

Your health care provider may prescribe certain medicines to help lower your risk of fractures. These medicines can make the bones in your hips, spine, and other areas less likely to break.

Your provider may prescribe medicines when:

  • A bone density test shows you have osteoporosis, even if you have not had a fracture before, but your fracture risk is high.
  • You have a bone fracture, and a bone density test shows you have a bone density lower than normal, but not osteoporosis.
  • You have a bone fracture that occurs without any significant injury.

Bisphosphonates

Bisphosphonates are the main medicines that are used to both prevent and treat bone loss. They are most often taken by mouth. You may take a pill once daily, weekly, or monthly. You also may get bisphosphonates through a vein (IV). Most often this is done once or twice a year.

Common side effects with bisphosphonates taken by mouth are heartburn, nausea, and pain in the belly. When you take bisphosphonates:

  • Take them on an empty stomach in the morning with 6 to 8 ounces (oz), or 180 to 240 milliliters (mL), of plain water (not carbonated water or juice).
  • After taking the pill, remain sitting or standing for at least 30 minutes.
  • Do not eat or drink for at least 30 to 60 minutes.

Rare side effects are:

  • Low blood calcium level
  • A certain type of leg-bone (femur) fracture
  • Damage to the jaw bone
  • Fast, abnormal heartbeat (atrial fibrillation)

Your provider may have you stop taking this medicine after about 5 years. Doing so decreases the risk of certain side effects. This is called a medicine holiday.

Other Drugs for Osteoporosis

Raloxifene (Evista) may also be used to prevent and treat osteoporosis.

  • It can reduce the risk of spinal fractures, but not other types of fractures.
  • The most serious side effect is a very small risk of blood clots in the leg veins or in the lungs.
  • This medicine may also help decrease the risk of heart disease and breast cancer.
  • Other selective estrogen receptor modulators (SERMs) are also used to treat osteoporosis.

Denosumab (Prolia) is a medicine that prevents bones from becoming more fragile. This medicine:

  • Is given as an injection every 6 months.
  • May increase bone density more than bisphosphonates.
  • Is generally not a first-line treatment.
  • May not be a good choice for people who have weak immune systems or who take medicines that affect the immune system.

Teriparatide (Forteo) is a bio-engineered form of parathyroid hormone. This medicine:

  • May increase bone density and decrease the risk for fractures.
  • Is given as an injection underneath the skin at home, often every day.
  • Does not seem to have severe long-term side effects, but may cause nausea, dizziness, or leg cramps.

Estrogen, or hormone replacement therapy (HRT). This medicine:

  • Is very effective in preventing and treating osteoporosis.
  • Was the most commonly used osteoporosis medicine for many years. Its use decreased because of concern that this medicine caused heart disease, breast cancer, and blood clots.
  • Is still a good option for many younger women (50 to 60 years old). If a woman is taking estrogen already, she and her provider must discuss the risks and benefits of doing so.

Romosozumab (Evenity) targets a hormone pathway in bone called sclerostin. This medicine:

  • Is given monthly as an injection under the skin for one year.
  • Is effective at increasing bone density.
  • May make calcium levels too low.
  • May possibly increase the risk of heart attack and stroke.

Parathyroid hormone

  • This medicine is given as daily shots under the skin. Your provider or nurse will teach you how to give yourself these shots at home.
  • Parathyroid hormone works better if you have never taken bisphosphonates.

Calcitonin is a medicine that slows the rate of bone loss. This medicine:

  • Is sometimes used after a bone fracture because it decreases bone pain.
  • Is much less effective than bisphosphonates.
  • Comes as a nasal spray or an injection.

When to Call the Doctor

Contact your provider for these symptoms or side effects:

  • Chest pain, heartburn, or problems swallowing
  • Nausea and vomiting
  • Blood in your stool
  • Swelling, pain, redness in one of your legs
  • Fast heart beat
  • Skin rash
  • Pain in your thigh or hip
  • Pain in your jaw
Open References

References

De Paula FJA, Black DM, Rosen CJ. Osteoporosis: basic and clinical aspects. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 30.

Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2019;104(5):1595-1622. PMID: 30907953 pubmed.ncbi.nlm.nih.gov/30907953/.

Weber TJ. Osteoporosis. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 225.

  • Osteoporosis

    Animation

    •  

    Osteoporosis - Animation

    If you've ever watched an apartment or office building under construction, you've seen the metal scaffolding that keeps the building standing upright. Inside your body, bones are the scaffolding that keep you standing upright. As you get older, these supports can weaken. And if they get too weak, you could wind up with a fracture. Let's talk about the bone-thinning condition called osteoporosis. Your internal scaffolding was built when you were young. Calcium and other minerals helped strengthen your bones, provided that you got enough of them from your diet. As you get older, those minerals can start to leech out of your bones, leaving them brittle, fragile, and easily breakable, a condition known as osteoporosis. Women over 50 are especially at risk for osteoporosis because during menopause they lose estrogen, which helps to keep bones strong. The tricky part about osteoporosis is that it's hard to tell you have it. You may not have any symptoms until you've already fractured a bone. Getting a bone density scan, which measures bone thickness, is one way to find out whether you have osteoporosis so you can start treatment right away if you need it. To keep your bones strong, try to get at least 1,200 milligrams of calcium daily, paired with 1,000 international units of vitamin D, which helps your body absorb calcium. You can eat foods that are high in these nutrients, like frozen yogurt, salmon, and low-fat milk, or, if you're not a big fan of fish or dairy, you can take supplements. Weight bearing exercise is also your ally when it comes to strengthening bones. A combination of weight bearing exercises like walking or playing tennis, plus strength training and balance exercises will reduce your risk of getting a fracture if you fall. You will want to get at least thirty minutes of exercise three times a week to see the benefits. And, stop smoking. Cigarette smoke both accelerates bone loss and blocks treatments from being as affective. If you've been diagnosed with osteoporosis, your doctor may recommend drugs called bisphosphonates to prevent further bone damage. Other medicines, including calcitonin, parathyroid hormone, and raloxifene are also treatment options. Don't let bone loss get so far along that you could have a disabling fracture from a minor fall. Start strengthening your bones with diet and exercise while you're still young. As you get older, talk to your doctor about bone density scans, and ask whether you need to take medicine if you're at risk for, or are starting to show signs of osteoporosis. And if your bones aren't as strong as they used to be, avoid falls by wearing shoes that fit well, and clearing clutter on the floor before it can trip you up, and bring you down.

  • Osteoporosis

    Osteoporosis - illustration

    The bone disease osteoporosis is caused by more bone matrix being resorbed than being deposited. This imbalance results in a progressive loss of bone density and a thinning of bone tissue. Osteoporotic bones are more porous and therefore more vulnerable to fracture.

    Osteoporosis

    illustration

  • Osteoporosis

    Animation

    •  

    Osteoporosis - Animation

    If you've ever watched an apartment or office building under construction, you've seen the metal scaffolding that keeps the building standing upright. Inside your body, bones are the scaffolding that keep you standing upright. As you get older, these supports can weaken. And if they get too weak, you could wind up with a fracture. Let's talk about the bone-thinning condition called osteoporosis. Your internal scaffolding was built when you were young. Calcium and other minerals helped strengthen your bones, provided that you got enough of them from your diet. As you get older, those minerals can start to leech out of your bones, leaving them brittle, fragile, and easily breakable, a condition known as osteoporosis. Women over 50 are especially at risk for osteoporosis because during menopause they lose estrogen, which helps to keep bones strong. The tricky part about osteoporosis is that it's hard to tell you have it. You may not have any symptoms until you've already fractured a bone. Getting a bone density scan, which measures bone thickness, is one way to find out whether you have osteoporosis so you can start treatment right away if you need it. To keep your bones strong, try to get at least 1,200 milligrams of calcium daily, paired with 1,000 international units of vitamin D, which helps your body absorb calcium. You can eat foods that are high in these nutrients, like frozen yogurt, salmon, and low-fat milk, or, if you're not a big fan of fish or dairy, you can take supplements. Weight bearing exercise is also your ally when it comes to strengthening bones. A combination of weight bearing exercises like walking or playing tennis, plus strength training and balance exercises will reduce your risk of getting a fracture if you fall. You will want to get at least thirty minutes of exercise three times a week to see the benefits. And, stop smoking. Cigarette smoke both accelerates bone loss and blocks treatments from being as affective. If you've been diagnosed with osteoporosis, your doctor may recommend drugs called bisphosphonates to prevent further bone damage. Other medicines, including calcitonin, parathyroid hormone, and raloxifene are also treatment options. Don't let bone loss get so far along that you could have a disabling fracture from a minor fall. Start strengthening your bones with diet and exercise while you're still young. As you get older, talk to your doctor about bone density scans, and ask whether you need to take medicine if you're at risk for, or are starting to show signs of osteoporosis. And if your bones aren't as strong as they used to be, avoid falls by wearing shoes that fit well, and clearing clutter on the floor before it can trip you up, and bring you down.

  • Osteoporosis

    Osteoporosis - illustration

    The bone disease osteoporosis is caused by more bone matrix being resorbed than being deposited. This imbalance results in a progressive loss of bone density and a thinning of bone tissue. Osteoporotic bones are more porous and therefore more vulnerable to fracture.

    Osteoporosis

    illustration

Self Care

 

Tests for Medicines for osteoporosis

 
 

Review Date: 5/20/2024

Reviewed By: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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