- 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 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. 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:
- certain medications, such as steroids, proton pump inhibitors, and some seizure medications
- certain diseases, such as rheumatoid arthritis (RA) and multiple myeloma
The most aggressive way to prevent bone loss is to take prescription medications, such as the drugs listed below.
These are the most common osteoporosis drug treatments. They include:
- Alendronate (Fosamax) is an oral medication people take daily or once per week.
- Ibandronate (Boniva) is available as a monthly oral tablet or as an intravenous injection that you get four times per year.
- Risedronate (Actonel) is available in daily, weekly, bimonthly, or monthly doses in an oral tablet.
- Zoledronic acid (Reclast) is available as an intravenous infusion that you get once every one or two years.
Denosumab (Xgeva, Prolia) is an antibody. It links to a protein in your body that’s involved in bone breakdown. This antibody slows the process of bone breakdown. It also helps maintain bone density.
Denosumab comes as an injection you get every six months.
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.
Another type of SERM is called bazedoxifene, which is used in combination with a type of estrogen called conjugated (or mixed) estrogens in the brand-name product Duavee. Duavee comes in a tablet you take once per day.
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 people who can’t take bisphosphonates. 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.
Teriparatide (Forteo) is one of these treatments. It’s 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 for other treatments.
Abaloparatide (Tymlos) is another synthetic PTH treatment. It was approved in 2017. Like teriparatide, abaloparatide is available as a daily self-administered injection.
Also like teriparatide, this drug is costly and is typically used for people with severe osteoporosis when other treatments are not good options.
For women in menopause, hormone therapy, which is also called hormone replacement therapy, is a treatment option. But typically, doctors don’t use it as a first line of defense because it increases the risk of:
- heart attack
- breast cancer
- blood clots
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. The tablets (Premarin, Menest, Estrace) are taken daily. The patches (Climara, Vivelle-Dot, Minivelle) are used once or twice per week.
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 is the primary mineral in your bones, and vitamin D helps your body absorb the calcium it needs. 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 aged 19–50 and men aged 19–70 should take 1,000 milligrams (mg) of calcium per day. They recommend that women aged 51–70 and everyone over 70 should take 1,200 mg of calcium per day.
The NIAMS also recommends that adults under age 70 should take 600 international units (IU) of vitamin D per day. They recommend that adults over age 70 should take 800 IU of vitamin D per day.
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, the two of you can decide on a treatment plan that’s best for you.