Osteoporosis Treatments

Osteoporosis Treatments

Osteoporosis Drugs and Treatments

There is no cure for osteoporosis. The goal of treatment is to protect and strengthen the bones. Treatment usually includes a combination of drugs and lifestyle changes to help slow the rate of bone resorption by the body.

Osteoporosis Drugs

Prescriptions drugs are the most aggressive way to forestall bone loss. Below are some of the drugs currently in use.

Bisphosphonates are the most common osteoporosis drug treatments. Types include:

  • alendronate (Fosamax), an oral medication typically taken once a week
  • ibandronate (Boniva), offered as a monthly oral tablet or as an intravenous injection four times a year
  • risedronate (Actonel), available in daily, weekly, bimonthly, or monthly doses
  • zoledronic acid (Reclast), given intravenously once every one or two years

The side effects of these drugs can include acid reflux, nausea, and stomach pain. In rare cases, they can cause bone damage in the jaw (jaw osteonecrosis). This rare side effect is usually associated with high doses of bisphosphonates.

Denosumab (Xgeva and Prolia) is an antibody that links to a protein involved in the body’s process of bone resorption. This antibody has proved effective in slowing bone resorption and maintaining bone density. Injections are given every six months. Side effects can include skin irritations, muscle stiffness, pain or spasms, fatigue, and excessive sweating. In very rare cases the drug may cause bone fractures.

Hormone Therapy

Postmenopausal women are at a high risk for osteoporosis. With menopause comes a drop in protective estrogen production. For these women, hormone therapy (hormone replacement therapy) is a treatment option. However, it’s not typically used as a first line of defense. The hormone treatment poses increased risks of stroke, heart attack, breast cancer, and blood clots.

Selective Estrogen Receptor Modulators (SERMs) re-create the bone-preserving effect of estrogen. Raloxifene (Evista) is a SERM treatment available in a daily oral tablet.

Thyrocalcitonin is a hormone made by the thyroid gland. It helps regulate calcium levels in the body. Synthetic thyrocalcitonin, or calcitonin (Fortical, Miacalcin), is used to treat spinal osteoporosis in patients who can’t take bisphosphonates. It can also ease pain in some patients with spinal compression fractures. The drug is available by nasal spray or injection. Side effects from nose sprays may include runny nose or nosebleeds. Calcitonin is considered a second or third line of treatment for patients unable to tolerate bisphosphonates.

Parathyroid Hormone (PTH) controls calcium and phosphates levels in the bone. Treatments with a synthetic PTH like teriparatide (Forteo) can actually promote new bone growth. The drug is given by daily injection in combination with calcium and vitamin D supplements. This drug is very expensive. It’s generally reserved for patients with severe osteoporosis who have poor tolerance for other treatments.

Lifestyle Changes

Calcium and Vitamin D

Getting enough calcium and vitamin D in your diet can help slow bone loss. Calcium-rich foods include dairy products, dark green vegetables, enriched grains and breads, and soy products. Most cereal and orange juice are now available with added calcium. Monitor your vitamin D intake. Your body needs it to absorb the calcium it needs.

The chart below shows the amount of daily calcium and vitamin D intake recommended by the National Institutes of Health in milligrams (mg) and international units (IU).



Vitamin D

0 to 6 months

210 mg

200 IU

7 to 12 months

270 mg

200 IU

1 to 3 years

500 mg

200 IU

4 to 8 years

800 mg

200 IU

9 to 18 years

1,300 mg

200 IU

19 to 50 years

1,000 mg

200 IU

51 to 70 years

1,200 mg

400 IU

Over 70 years

1,200 mg

600 IU

Physical Activity

Exercise provides the resistance your bones need to stay strong. Strength training benefits the bones in your arms and upper spine. This can mean free weights, weight machines, or resistance bands. Weight-bearing exercise like walking or jogging and low-impact aerobics like elliptical training or biking can be beneficial. Both may help strengthen the bones in your legs, hips, and lower spine. Whatever the form, physical activity helps slow age-related bone loss. Physical activity can slightly improve bone density in some cases. Exercise can also help improve your posture and balance, lowering the risk for falls. Fewer falls for patients with osteoporosis can mean fewer fractures.

Discuss each possible treatment and lifestyle change in detail with your doctor. Together, the two of you can weigh the risks and benefits of any plan to treat your osteoporosis.

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