Osteoporosis medications & treatments
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Osteoporosis is a bone disease that affects around 54 million Americans. Men and women of any age and race can suffer from osteoporosis but it is most common in non-Hispanic white women and Asian women. It is estimated that over 50% of postmenopausal white women will have an osteoporotic-related fracture (broken bone). In white men, the risk of a fracture is roughly 20%, but the one-year mortality in men who have a hip fracture is twice that of women. African-American and Hispanic men and women have a lower risk of developing osteoporosis but their fracture risk is the same. The number of cases is expected to triple as the American population ages.
What is osteoporosis?
Osteoporosis is defined as “porous bone”. It occurs when your bone density or bone mass decreases. This weakens your bone strength and can increase your risk of fractures. It is a silent disease because you will usually not have any recognizable symptoms and may not get diagnosed until you suffer a broken bone. Even then, around 80% of patients are still not properly diagnosed with osteoporosis.
Risk factors for osteoporosis include:
- Age. As you get older, your risk of osteoporosis increases.
- Gender. Women are more likely to get osteoporosis than men, especially after menopause.
- Race. Osteoporosis is most commonly diagnosed in non-Hispanic and Asian women.
- Family history of osteoporosis. You are more likely to develop osteoporosis if your parents had it.
- Previous fracture. You may have undiagnosed osteoporosis if you have broken a bone following a minor fall.
- Certain medications. If you are taking medications such as hormone therapy for prostate cancer or breast cancer, or corticosteroids (prednisone) you are at an increased risk of developing osteoporosis.
- Certain medical conditions. Some conditions such as inflammatory bowel disease, rheumatoid arthritis, and eating disorders (anorexia) increase your risk.
- Smoking. Smoking almost doubles your risk.
- Alcohol. If you have more than 2 drinks per day, your risk increases.
- Low body mass index. Being underweight can increase your risk.
- Low physical activity. Exercise can help prevent bone loss.
How is osteoporosis diagnosed?
To properly diagnose osteoporosis, your doctor or healthcare professional should do a thorough medical and social history review to assess your risk and run some tests to check your bone health.
Osteoporosis does not typically have symptoms until you suffer a fracture. Some symptoms you might see, especially following a vertebral fracture include:
- Loss of height
- Stooped or hunched over posture
- Lower back pain
The key to correctly diagnosing osteoporosis is through a bone mineral density (BMD) test. The most common BMD test is dual-energy x-ray absorptiometry (DXA or DEXA). This test is quick and noninvasive. It involves using low levels of X-rays to determine the bone mineral in sites that are more likely to fracture, such as the spine or hip. It is capable of detecting small percentages of bone loss.
Your doctor will then compare your test results to the average bone density of people of your age, sex, and race. If your results confirm a diagnosis of osteoporosis, they may suggest some lifestyle changes and prescribe medications to prevent further bone loss and decrease your chance of a fracture.
What are some osteoporosis treatment options?
While medications are the hallmark of osteoporosis treatment, lifestyle changes are recommended for all patients. Treatment will depend on your bone density test as well as your risk factors for falls and fractures.
Medications are used to slow or stop bone loss and can be different for men and women.
- Bisphosphonates. This is the most common medication prescribed to men and women who are at a higher risk of fractures. They work by stopping the body from re-absorbing bone tissue, which helps prevent bone loss. There can be taken orally or by intravenous (IV) infusion, and include Fosamax (alendronate), Boniva (ibandronate), and Actonel (risedronate). They carry a rare but serious side effect of jaw bone damage (osteonecrosis of the jaw).
- RANK ligand (RANKL) inhibitors. Prolia (denosumab) is a monoclonal antibody that inhibits the activation of osteoclasts (cells that break down bone) to help stop bone loss. It is commonly prescribed to postmenopausal women and men who are at a high risk of fractures.
- Hormone-related therapies. Estrogen, especially in women who have just started menopause, can help maintain bone density. It can cause serious side effects such as blood clots and an increased risk of cancer so it should be used at the lowest effective dose for the shortest amount of time. They might also use selective estrogen receptor modulators which provide the benefits of estrogen without some of the risks. It does increase the risk of blood clots. Some examples of these include Vivelle (estradiol), Evista (raloxifene), and Duavee (conjugated estrogens/bazedoxifene).
- Anabolic therapy. These medications mimic the actions of your parathyroid hormone and stimulate new bone formation. They are used for cases of severe osteoporosis in people who have low bone density. Some examples include Forteo (teriparatide) and Tymlos (baloparatide).
- Evenity (romosozumab-aqqg). This new bone-building medication is given as two back-to-back injections under the skin once a month for up to 12 months. It should not be given to anyone with a history of heart attacks or strokes.
- Miacalcin (calcitonin salmon). This injection or nasal spray made from a hormone in the thyroid gland is used in women with postmenopausal osteoporosis who have failed other therapies.
- Vitamins and dietary supplements. In addition to prescription medication, your healthcare provider may recommend some over-the-counter calcium and vitamin D supplements to ensure you are getting enough calcium and vitamin D to build and maintain healthy bones.
Maintaining a healthy lifestyle can also help prevent or slow down your loss of bone mass. Weight-bearing exercises such as walking, stair climbing, and weight lifting can help prevent fractures that occur as a result of falling and improve bone strength.
What is the best medication for osteoporosis?
The best medication for the treatment of osteoporosis will depend on the individual’s specific medical osteoporosis, medical history, medications that the individual is already taking that may potentially interact with osteoporosis drugs, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter osteoporosis medications approved by the Food and Drug Administration (FDA).
Best medications for osteoporosis
|Drug name||Drug class||Administration route||Standard dosage||Common side effects|
|Fosamax (alendronate)||Bisphosphonate||Oral||1 tablet (10mg) once daily or 1 tablet (70mg) once weekly.||Stomach pain, musculoskeletal pain, acid reflux, gas, nausea, headache, diarrhea, constipation|
|Actonel (risedronate)||Bisphosphonate||Oral||1 tablet (5mg) once daily or 1 tablet (35mg) once weekly, or 1 tablet (150mg) once monthly.||Joint pain, diarrhea, headache, nausea, constipation, rash, stomach pain|
|Boniva (ibandronate)||Bisphosphonate||Oral/injection||1 tablet (150mg) once monthly or 3mg via IV infusion every 3 months.||Upper respiratory infection, diarrhea, dizziness, muscle pain, headache, stomach pain|
|Zometa (zoledronic acid)||Bisphosphonate||Injection||5mg via IV infusion every 2 years.||Bone pain, nausea, fatigue, vomiting, constipation, diarrhea|
|Prolia (denosumab)||Monoclonal antibody||Injection||60mg under the skin every 6 months.||Back pain, musculoskeletal pain, dizziness, upper respiratory tract infection, stomach pain|
|Evenity (romosozumab)||Monoclonal antibody||Injection||210mg under the skin once a month for 12 months.||Joint pain, headache, injection site reactions, muscle spasms, swelling|
|Miacalcin (calcitonin salmon)||Calcium metabolism modifier||Nasal spray/injection||1 spray (200 IU) once daily, alternating nostrils or 100 IU under the skin every other day.||Runny nose, joint pain, injection site reaction, nausea, headache, flushing|
|Evista (raloxifene)||Selective estrogen receptor modulator (SERM)||Oral||1 tablet (60mg) once daily.||Hot flashes, flu-like symptoms, cramps, muscle spasms, joint pain, infection|
|Duavee (bazedoxifene/conjugated estrogens)||SERM/estrogen derivative||Oral||1 tablet (20mg/0.45mg) once daily.||Muscle spasms, nausea, diarrhea, indigestion, stomach pain, dizziness|
|Estrace (estradiol)||Estrogen derivative||Oral||1 tablet (0.5mg) once daily for 23 days of a 28-day cycle.||Upset stomach, nausea, vomiting, bloating, breast tenderness, headache, weight changes|
|Tymlos (abaloparatide)||Parathyroid hormone analog||Injection||80mg under the skin once daily.||Injection site reaction, calcium in the urine, dizziness, nausea, headache, heart palpitations|
|Forteo (teriparatide)||Parathyroid hormone analog||Injection||20mcg under the skin once daily.||Joint pain, running nose, weakness, nausea, dizziness, headache|
Your healthcare provider will determine the right dosage based on your response to the treatment, medical osteoporosis, weight, and age. Other possible side effects may exist; this is not a complete list.
What are the most common side effects of osteoporosis medications?
As with all medicines, those used for osteoporosis will have some side effects, depending on the class you are taking. Some of the most common side effects across all classes of medications that treat osteoporosis include:
- Bone and joint pain
- Upset stomach
- Stomach pain
- Indigestion or acid reflux
- Muscle spasms
What are some home remedies for osteoporosis?
Maintaining a healthy lifestyle including a nutritious diet and regular exercise can help reduce your risk of developing osteoporosis.
Some ways to maintain good bone health and prevent osteoporosis include:
- Get the recommended amount of calcium and vitamin D through your diet or vitamin D and calcium supplements. The recommended amounts for people with osteoporosis are 1000mg per day of calcium and 600 IU of vitamin D. These recommended amounts can change based on your sex and age.
- Regular weight-bearing exercises such as walking, jogging, stair climbing, or weightlifting.
- Limit your alcohol intake.
- Stop smoking.
Frequently asked questions about osteoporosis
What are some complications of osteoporosis?
Bone fractures, especially in the spine or hip, are the most serious complications of osteoporosis. Up to 20-24% of patients die in the first year after a hip fracture. One-third of hip fracture patients become totally dependent or in a nursing home within the first year.
Who should get a bone mineral density test?
The National Osteoporosis Foundation (NOF) recommends the following patients have a bone density test:
- All women over the age of 65 and men over 70
- Postmenopausal women and men aged 50 to 69 years with risk factors for fracture.
- Adults who have had a fracture after age 50.
- Adults with a condition or taking a medication that is associated with low bone mass or bone loss.
What medications can increase your risk of osteoporosis?
Certain medications can cause bone loss which can lead to osteoporosis, including:
- Glucocorticoids such as Deltasone (prednisone)
- Anticonvulsant medications such as Dilantin (phenytoin) and Tegretol (carbamazepine)
- Progestins such as Provera (medroxyprogesterone)
- Proton pump inhibitors such as Prilosec (omeprazole)
- Selective serotonin receptor inhibitors (SSRIs) such as Prozac (fluoxetine)
- Aromatase inhibitors (AIs) used to treat breast cancer such as Arimidex (anastrozole)
- Thiazolidinediones (TZDs) used to treat type 2 diabetes such as Actos (pioglitazone)
What other health conditions increase your risk of osteoporosis?
There are many health conditions and problems that increase the likelihood of osteoporosis, including:
- Rheumatoid arthritis
- Multiple Sclerosis
- Celiac disease
- Inflammatory bowel disease
- Breast cancer
- Prostate cancer
- Sickle Cell Disease
- Parkinson’s disease
- Spinal cord injuries
- Chronic kidney disease
- Liver disease
Related resources for osteoporosis
- Osteoporosis. StatPearls
- About osteoporosis. Osteoporosis Foundation
- Osteoporosis overview. MayoClinic
- Osteoporosis symptoms and causes. Cleveland Clinic
- What is osteoporosis and what causes it? Bone Health and Osteoporosis Foundation
- Osteoporosis summary. MedlinePlus
- Overview of osteoporosis. NIH: Osteoporosis and Related Bone Diseases