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Osteoporosis Medications: How They Work

From the latest medications to daily supplements -- what's your osteoporosis medication doing for you?

Bone Remodeling Can Go Awry

As it turns out, this delicate balance of bone remodeling can become disrupted as we get older.

"Around menopause in women, and also for some older men, this balance becomes disordered," says Felicia Cosman, MD, clinical director of the National Osteoporosis Foundation. "The amount of bone removed starts to exceed the amount replaced."

The culprit? Estrogen, a hormone that helps maintain healthy bone. As estrogen levels decline before and during menopause, "women can lose a significant amount of bone," says Cosman.

As bone resorption exceeds growth, bones lose density and strength, becoming more likely to break.

Osteoporosis Medication Can Restore Balance

Fortunately, osteoporosis treatments can restore the balance of bone remodeling. Numerous osteoporosis medications are proven to rebuild bone and prevent fractures.

"The large majority of these medicines are anti-resorptive medications," Cosman tells WebMD. These drugs slow down bone resorption, so bone growth has time to catch up.

Here are a few facts about several osteoporosis medications:


Bisphosphonates are the most commonly used prescription medications for osteoporosis. There are three major drugs in this family:

Bisphosphonates enter the bones, binding to areas of bone undergoing resorption. When osteoclasts try to dissolve bone coated with the drug, it disrupts the osteoclasts' function. The result? Less bone gets resorbed, and the bone has a better chance to rebuild.

"Bisphosphonates are the most effective medicines we have to treat osteoporosis," says Mary Rhee, MD, MS, an endocrinologist and assistant professor of medicine at Emory University in Atlanta. The key health benefits: increased bone density and reduced risk of fracture.


Calcitonin is a hormone made in the thyroid gland. In animals, calcitonin binds to osteoclasts, preventing bone resorption. The drug preparation of calcitonin is usually made from salmon calcitonin, which is more potent than human calcitonin.

Taken as a medicine, calcitonin slows bone loss, increases bone density, and may relieve bone pain. It is most often used as additional therapy, or when someone cannot tolerate a bisphosphonate. The key health benefit: Reducing the risk of spinal fractures.


Raloxifene is a selective estrogen receptor modulator, or SERM, originally used to treat breast cancer. Now, it’s also approved to prevent and treat osteoporosis. Raloxifene binds to estrogen receptors throughout the body to produce some estrogen-like effects. One effect is prevention of bone resorption.

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