Osteoporosis Medications

Osteoporosis medications improve your bone mineral density and prevent fractures. Some osteoporosis meds help you build more bone, while others slow the loss of bone.   

As you get older, your bones may start to wear down faster than your body can repair them. If you lose a lot of bone density, the doctor could diagnose you with osteoporosis.

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

But they aren’t always enough. That’s why the 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?

The doctor will suggest a prescription medication partly based on how severe your osteoporosis is. But that isn’t the only thing they’ll consider. What you take will also depend 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’ve already been through menopause, others are better for older postmenopausal women.
  • Ease. From pills to shots, medications come in different forms. Some you take every day, and others just once a year. The right medication is partly about which 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.

Types of Osteoporosis Medications

Osteoporosis drugs are grouped into two categories: 

  • Antiresorptive drugs slow the rate that your body breaks down bone. They include bisphosphonates, denosumab, estrogens, calcitonin, and others. 
  • Anabolic drugs increase bone formation. Examples are romosozumab (Evenity) and teriparatide (Forteo). 

Continued

Some osteoporosis drugs fall into both categories. 

The medication your doctor suggests depends on many things including whether they are preventing or treating your osteoporosis as well as other medical conditions you have. Not all osteoporosis drugs are FDA-approved for all people with osteoporosis. For example, a drug approved to treat osteoporosis in postmenopausal women may not be approved for treating osteoporosis in men. Talk to the doctor about your specific medication and whether or not it’s approved or being used off-label. 

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:

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 rare, but both the pills and the IV may cause two other issues:

  • Taking these medicines for more than 3-5 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.

Continued

Denosumab

If you’re highly likely to have a fracture, your doctor may suggest denosumab (Prolia, Xgeva). You might also get it when bisphosphonates either didn’t work well enough or couldn’t be used for some reason. Depending on which medicine you’re on, you’ll get this as a shot every 1-6 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 like 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 the amount of calcium in your body, 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:

Romosozumab (Evenity)

This monoclonal antibody is among the newest drugs to be FDA-approved for treating postmenopausal osteoporosis. It blocks a protein called sclerostin, which controls bone turnover. The dual-acting type of osteoporosis medication helps build bone while reducing bone density loss. 

You get it as a shot. 

Joint pain and headaches are common side effects. Romosozumab may also increase the risk of heart attack, stroke, and death. Don’t take this drug if you’ve had a heart attack or stroke within the previous year.

Hormone Therapy

Hormones can be used to treat osteoporosis, but some have serious side effects.

Parathyroid hormone . Given as abaloparatide (Tymlos) or teriparatide (Forteo), it grows 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.

Continued

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. Research shows that calcitonin doesn’t prevent non-spinal bone fractures as well as bisphosphonates or denosumab. 

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. The SERM 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 pros and cons of these medications.

WebMD Medical Reference Reviewed by Brunilda Nazario, MD on July 30, 2020

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."

Pharmacy and Therapeutics: “Osteoporosis: A Review of Treatment Options.”

New York State Department of Health: “FDA-Approved Medications for Osteoporosis Treatment.”

Cleveland Clinic: “Romosozumab: A New Era in Osteoporosis Treatment.”

News release, FDA: “FDA approves new treatment for osteoporosis in postmenopausal women at high risk of fracture.”

© 2020 WebMD, LLC. All rights reserved.

Pagination