- Osteoporosis is a condition in which your bones break down faster than they rebuild.
- Treatment usually includes a combination of medications and lifestyle changes.
- The most aggressive way to prevent additional bone loss is to take prescription medications.
Bones in your body are living tissues that constantly break down and replace themselves with new material. With osteoporosis, your bones break down faster than they regrow. This causes them to become less dense, more porous, and more brittle.
This weakens your bones and can lead to more fractures and breaks.
There’s no cure for osteoporosis, but there are treatments to help prevent and treat it once it’s diagnosed. The goal of treatment is to protect and strengthen your bones.
Treatment usually includes a combination of medications and lifestyle changes to help slow the rate of bone breakdown by your body, and in some cases, to rebuild bone.
Most people have their highest bone mass and density when they’re in their early 20s. As you age, you lose old bone at a faster rate than your body can replace it. Because of this, older people are at a higher risk of osteoporosis.
Women also have a higher risk of developing osteoporosis because they typically have thinner bones than men. Estrogen, a hormone that occurs in higher levels in women than in men, helps protect bones.
Women who are going through menopause experience a decrease in estrogen levels, which leads to more rapid bone breakdown and can result in brittle bones.
Other risks factors include:
The most aggressive way to prevent additional bone loss is to take prescription medications, such as the drugs listed below.
Bisphosphonates are the most common osteoporosis drug treatments. They're typically the first treatments recommended for women who are postmenopausal.
Examples of bisphosphonates include:
- alendronate (Fosamax), an oral medication people take daily or once per week
- ibandronate (Boniva), available as a monthly oral tablet or as an intravenous injection that you get four times per year
- risedronate (Actonel), available in daily, weekly, or monthly doses in an oral tablet
- zoledronic acid (Reclast), available as an intravenous infusion that you get once every one or two years
There are two antibody drugs on the market.
Denosumab (Prolia) links to a protein in your body that’s involved in bone breakdown. It slows the process of bone breakdown. It also helps maintain bone density.
Denosumab comes as an injection you get every six months.
The new antibody romosozumab (Evenity) helps to increase bone formation. It was approved by the Food and Drug Administration (FDA) in April of 2019. It's intended for postmenopausal women with a high risk of fracture. This includes women who:
- have risk factors for fracture
- have a history of fracture
- haven't responded to or can't take other osteoporosis drugs
Romosozumab comes as two injections. You get them once a month for up to 12 months.
Romosozumab does come with boxed warnings, which are the FDA's most serious warnings. It may increase your risk of heart attack, stroke, and cardiovascular disease. You shouldn't take romosozumab if you've had a heart attack or stroke within the past year.
Several medications that have hormone-like effects can be prescribed to treat osteoporosis.
Selective estrogen receptor modulators (SERMs)
Selective estrogen receptor modulators (SERMs) recreate the bone-preserving effects of estrogen.
Raloxifene (Evista) is one type of SERM. It’s available as a daily oral tablet.
Calcitonin is a hormone the thyroid gland makes. It helps regulate calcium levels in the body.
Doctors use synthetic calcitonin (Fortical, Miacalcin) to treat spinal osteoporosis in certain women who can’t take bisphosphonates.
Used off-label, calcitonin can also ease pain in some people who have spinal compression fractures. Calcitonin is available by nasal spray or injection.
Parathyroid hormones (PTHs)
Parathyroid hormones (PTHs) control calcium and phosphate levels in your body. Treatments with a synthetic PTH can promote new bone growth.
Two options include:
- teriparatide (Forteo)
- abaloparatide (Tymlos)
Teriparatide is available as a daily self-administered injection. However, this drug is expensive and is generally reserved for people with severe osteoporosis who have poor tolerance to other treatments.
Abaloparatide is another synthetic PTH treatment that was approved in 2017. Like teriparatide, this drug is available as a daily self-administered injection. However, it’s also costly and is typically used for people with severe osteoporosis when other treatments aren’t good options.
For women in menopause, hormone therapy — also called hormone replacement therapy — is a treatment option. But typically, doctors don’t use it as a first line of defense because it can increase the risk of:
Hormone therapy is approved for use in osteoporosis prevention, but may also be used off-label for its treatment.
Hormone therapy can include estrogen alone, or estrogen combined with progesterone. It comes as an oral tablet, skin patch, injection, and cream. The tablets and patches are used most often.
Taken daily, the tablets include:
Used once or twice per week, the patches include:
Even when you’re taking any of the medications listed above, doctors recommend getting plenty of calcium and vitamin D in your diet. That’s because this mineral and vitamin together can help slow bone loss.
Calcium-rich foods include:
- dairy products
- dark green vegetables
- enriched grains and breads
- soy products
Most cereals and orange juices are now available with added calcium as well.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) recommends that women ages 19–50 and men ages 19–70 should get 1,000 milligrams (mg) of calcium per day.
They recommend that women ages 51–70 and everyone over 70 should get 1,200 mg of calcium per day.
The NIAMS also recommends that adults under 70 should get 600 international units (IU) of vitamin D per day. Adults over age 70 should get 800 IU of vitamin D per day.
If you don’t get enough calcium or vitamin D from your diet, you can take supplements to make sure you get the recommended amount.
Exercise helps strengthen your bones. Whatever the form, physical activity helps slow age-related bone loss and can slightly improve bone density in some cases.
Exercise can also help improve your posture and balance, lowering your risk of falls. Fewer falls can mean fewer fractures.
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 such as elliptical training or biking, can also be beneficial. Both can help strengthen the bones in your legs, hips, and lower spine.
Osteoporosis affects many people all over the world, and although there isn’t currently a cure, treatments are available. Medications, hormone therapy, and exercise can strengthen your bones and slow bone loss.
If you have osteoporosis, talk to your doctor. Discuss each possible treatment and lifestyle change. Together, you can decide on a treatment plan that’s best for you.