There are several classes of medications used in the treatment of osteoporosis. These osteoporosis drugs are strongly indicated in women with known osteoporosis to reduce the risk for hip and vertebral fractures.

These osteoporosis drugs work to treat your condition in the following ways:

  • Slow bone loss
  • Increase bone density
  • Reduce the risk of fracture of the bones of the wrist, spine, and hip.

There are two types of medications indicated for osteoporosis:

  • Antiresorptive medications are bone tissue preserving medications that slow down the bone tissue loss associated with osteoporosis. They reduce bone loss by preventing bone deterioration activity, increasing bone density, and lowering the risk of fractures.
  • Anabolic medications build new bone tissue, thereby increasing bone mineral density, and lowering the risk of fractures.

It’s not really possible to say which one is best for you. Your doctor will determine which suits you the best.

Medication for osteoporosis is indicated in the following conditions:

  • In women whose bone density test shows T-scores of -2.5 or lower, such as -3.3 or -3.8 to reduce their risk of fracture
  • Women who have osteopenia, which is a bone weakness that is not as severe as osteoporosis
  • If you qualify for treatment based on risk factors and bone density results using the World Health Organization fracture risk assessment tool, or FRAX  
  • People who suffer from a typical osteoporosis fracture, such as that of the wrist, spine, or hip, even if their bone density results are normal.

The following prescription medications are FDA-approved for the treatment of osteoporosis:

Hormone and hormone-related therapy

This class of hormone medication for osteoporosis includes estrogen, testosterone, and the selective estrogen receptor modulator raloxifene (Evista).

In postmenopausal women, estrogen or estrogen plus progestogen or raloxifene should not be used for treating osteoporosis because of the increased risk of breast cancer and blood clots, which can cause strokes.

Estrogen therapy

Estrogen therapy is more likely to be used in women who have menopause symptoms and in younger women. The hormone estrogen controls bone metabolism. It is important for bone health because it stimulates the action of osteoblasts, which are the cells that make new bone.

Selective estrogen receptor modulator Raloxifene

Selective estrogen receptor modulator Raloxifene is available in tablet form and you should take it every day. It is usually advised to be taken for five years. Its action is similar to that of estrogen in helping bone growth.

Testosterone

Testosterone may be prescribed in men to increase their bone density and if their testosterone levels are low.

Calcitonin-salmon

Calcitonin-salmon (Fortical and Miacalcin) is a synthetic hormone. It is given in the form of injection or nasal spray. In patients with osteoporosis, calcitonin produces a moderate increase in bone mass by slowing down the rate at which osteoclasts absorb bone.

It is used to treat osteoporosis in women who are at least 5 years past menopause. It is more effective to reduce the risk of spine fractures, and may not be of much help to prevent the fractures of other bones such as the hip or the wrist.

Side effects from the inhaled form of calcitonin may include a runny nose, bleeding from the nose, or headaches. Side effects from the injected form can include rashes and flushing.

Bisphosphonates

Bisphosphonates are usually the first choice for osteoporosis treatment because they stop the body from re-absorbing bone tissue. Bisphosphonates reduce the risk of fracture in postmenopausal women with osteoporosis and are generally considered safe. They are, therefore, widely used.

There are several generic formulations and brands available that can be administered orally or intravenously with different dosing options (daily, weekly, monthly, and even yearly):

  • Alendronate: Fosamax®, Fosamax Plus D®, Binosto® – for both men and women
  • Ibandronate: Boniva – recommended only for women
  • Risedronate: Actonel®, Atelvia® – recommended only for women
  • Zoledronic acid: Reclast® – for men and women

Bisphosphonates that are given intravenously, such as ibandronate and zoledronic acid, do not cause stomach upset.

Again, it may be more convenient for some people to take a quarterly or yearly intravenous injection than to remember to take a weekly or monthly pill.

You may experience flu-like symptoms but they may come on only after the first injection.

You may be able to stop taking bisphosphonates after three to five years and still have a reduced risk of fracture because they accumulate in bone-forming a reservoir and leading to sustained release from bone for months or years even after treatment is stopped.

Possible side effects of bisphosphonates include flu-like symptoms, heartburn, and impaired kidney function. Rarely, serious side effects include osteonecrosis of the jaw or atypical mild trauma femur fractures. The risk of side effects is more after prolonged use (more than 5 years).

Biologics

Denosumab (Prolia®), a new therapy for postmenopausal osteoporosis, is available as an injection and is given every six months to both men and women. It becomes the choice when other treatments have failed and can be given even in some cases with impaired kidney function.

It prevents bone loss by blocking a certain receptor in the body leading to a decrease in bone breakdown. It stopped cortical bone loss, and increased bone mineral density, thereby lowering the risk of fracture in women with osteoporosis.

The most common side effects of biologic drugs in men with osteoporosis are back pain, arthralgia (joint pain), and nasopharyngitis. The most common side effects in patients with steroid-induced osteoporosis are backache hypertension, bronchitis, and headache.

Anabolic agents

Anabolic drugs build bone in people who suffer from osteoporosis. They are used in individuals with severe osteoporosis, where alternative osteoporosis agents are contraindicated or cannot be tolerated or have failed to give results, and glucocorticoid-induced osteoporosis.

Three of these osteoporosis drugs are currently approved:

Romososumab-aqqg (Evenity®) is approved and indicated in postmenopausal women who are at a high fracture risk. It promotes the formation of new bone and at the same time slows down bone resorption. Dosage consists of two injections given in two consecutive months during the time limit of one year.
Teriparatide (Forteo®) and Abaloparatide (Tymlos®) are newly approved injectable anabolic drugs. Forteo is a lab-made version of human parathyroid hormone (PTH) and Tymlos is a version of human parathyroid hormone-protein. They stimulate bone formation. and are administered daily for 2 years. Common side effects include headache and nausea

Supplements

It is important that you get adequate amounts of calcium and vitamin D if you have osteoporosis or if you are trying to prevent it. Ideally, you should fill those needs with your diet. But, if that is not possible, there are some plant-based calcium supplements, which your health provider may prescribe.

The recommended amount of daily calcium intake is 1,000 mg to 1,200 mg daily. You can obtain this through diet and/or supplements. Taking more than this amount of calcium is of no additional benefit. On the contrary, taking more calcium than the recommended intake has been linked to an increased risk of kidney stones and constipation.

Many people do not have adequate levels when tested for vitamin D blood levels and might need to take supplements. Your healthcare provider will recommend the right vitamin D supplement and the dose after seeing your blood levels.


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