What You Should Know About Osteoporosis Meds

Bone may be solid, but they are always changing. As you get older, your bones may start to wear down faster than your body can repair them, a condition called osteoporosis.

Osteoporosis can’t be cured, but with medicine and lifestyle changes, you can slow or even stop its progress. Regular exercise, a diet rich in calcium and vitamin D, and prevention of falls can all make a difference.

But they’re not always enough. That’s why your doctor may suggest medicine. When it comes to osteoporosis meds, you have a lot of options, so it helps to know the landscape.

Which Medicine Is Right for Me?

Your doctor will suggest a prescription medication partly based on how severe your osteoporosis is, but that’s not the only thing she’ll consider. It also depends on:

  • Your sex. Some medicines are approved only for women, while others work for men as well.
  • Your age. While certain medications are best for younger women who have already been through menopause, others are better for older postmenopausal women.
  • Ease. From pills to shots, meds come in different forms. Some you take every day, others just once a year. The right medication is partly about what form and timing works best for you.
  • Cost. Shots or meds you get through an IV mean a trip to the doctor’s office. That may cost you more money than pills you can take at home. It helps to check your insurance to know what they’ll pay for.
  • Your medical history. If you have kidney problems, a history of breast cancer or trouble with your esophagus, some medicines may be better for you than others.

Bisphosphonates

This is the most commonly used class of medicines to treat osteoporosis in men and women. They work by slowing the rate of bone loss.

The main bisphosphonates are:

  • Alendronate (Binosto, Fosamax). You can take this pill once a day or once a week.
  • Ibandronate (Boniva). This med is only for postmenopausal women. You can take a once-a-month pill or get it through an IV every 3 months.
  • Risedronate (Actonel, Atelvia). You take this pill once a day, once a week, or once a month.
  • Zoledronic acid (Reclast, Zometa). You get this med through an IV once a year.

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Will I ever stop taking them? Check with your doctor regularly to see how your meds are working. If you do well on them for up to 5 years -- no fractures and your bone density is steady -- your doctor may suggest you take a break.

These medications stay in your body for a while after you stop taking them. That means you’ll still get some benefit even after you’re off them.

Side effects: For the pills, the most common ones are:

If you take the pills exactly as directed, you’re less likely to have problems. With the IV meds, you may get fever, headache, and muscle aches for up to 3 days.

It’s very rare, but both the pills and the IV may cause two other issues:

  • Taking these medicines for more than 3 to 5 years may increase your risk of a break in your thigh bone.
  • You may get osteonecrosis of the jaw (this is when your jawbone doesn’t heal after you have a tooth pulled or something similar) if you have been on these medicines for more than 4 years, or if you have also been on steroids.

Denosumab

If you’re highly likely to have a fracture, your doctor may suggest denosumab (Prolia, Xgeva). It’s also given when bisphosphonates either didn’t work well enough or couldn’t be used for some reason. Depending on which medicine you are on, you will get this as a shot every 1 to 6 months.

Will I ever stop taking it? There’s no hard and fast rule for how long you can take this medication. It doesn’t stick around in your body as bisphosphonates do. It’s best to see your doctor regularly to check how well it’s working and if you have any side effects.

Side effects: Denosumab may lower your calcium, so it’s important that your calcium and vitamin D levels are high enough before you start taking it.

It may also make you more likely to get infections, especially on your skin. Call your doctor if you get:

  • Fever or chills
  • Red, swollen skin
  • Stomach pain
  • Pain or burning when you pee

Other common side effects include:

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Hormone Therapy

Various hormones can also be used to treat osteoporosis, but some have serious side effects.

Parathyroid hormone: Given as teriparatide (Forteo) or abaloparatide (Tymlos), it helps grow bone. It’s used mostly if you have very low bone density and you’ve already had fractures.

It comes as a shot that you need to get every day. You’ll take it for 2 years at most. Then, you’ll switch to a different medication to help maintain the added bone.

Common side effects include dizziness, headaches, and feeling like you might throw up.

Calcitonin (Miacalcin): This hormone comes as a spray or a shot. It’s only for women who are at least 5 years past menopause. It helps reduce spine fractures, but it doesn’t help with other bones.

Because calcitonin may be linked to cancer, the FDA recommends it only when other treatments can’t be used.

Estrogen: While estrogen, another hormone, can help with osteoporosis in women who have been through menopause, it also has serious side effects, such as:

Because of this, the FDA suggests taking only the smallest dose for the shortest possible time and only if you’re highly likely to get fractures.

SERMs: Short for selective estrogen receptor modules, these offer similar benefits to estrogen without some of the serious side effects. In fact, raloxifene (Evista) may even lower the chances you’ll get breast cancer. But it still may lead to blood clots and stroke. Your doctor can help you weigh the risks and benefits of these medications.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on October 09, 2018

Sources

SOURCES:

Mayo Clinic: “Osteoporosis,” “Osteoporosis: Medications Can Help,” “Denosumab (Subcutaneous Route).”

National Osteoporosis Foundation: “Treatment,” “Denosumab (Prolia),” “Teriparatide Parathyroid Hormone (PTH) (1-34) (Forteo®),” “Calcitonin-Salmon (Fortical® and Miacalcin®).”

NIH SeniorHealth: “Osteoporosis.”

American College of Rheumatology: “Osteoporosis.”

National Osteoporosis Society (UK): “Drug Treatments for Osteoporosis: denosumab (Prolia).”

FDA: “Questions and Answers: Changes to the Indicated Population for Miacalcin (calcitonin-salmon).”

UpToDate: "Postmenopausal hormone therapy in the prevention and treatment of osteoporosis;" "Overview of the management of osteoporosis in postmenopausal women;" "Denosumab drug information;" "Alendronate drug information; and "Calcitonin drug information." 

Medline Plus: "Calcitonin Salmon Injection."

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