Osteoporosis treatment can help reduce bone loss and, in some cases, help rebuild bones. Options include formal treatments, such as medications and hormone therapy, as well as certain dietary and exercise habits.
Your bones are living tissues that constantly break down and replace themselves with new material. When you have osteoporosis, your bones break down more quickly than they regrow. As a result, they become less dense, more porous, and more brittle.
This condition 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 involves a combination of medications and lifestyle changes to help slow the rate of bone breakdown and, in some cases, 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.
Females have a higher risk of developing osteoporosis because they typically have thinner bones than males. Estrogen, a hormone that occurs in higher levels in females than in males, helps protect bones.
People 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:
- smoking
- the use of certain medications, such as steroids, proton pump inhibitors, and some seizure medications
- malnutrition
- certain diseases, including rheumatoid arthritis and multiple myeloma
The most aggressive way to prevent additional bone loss is to take prescription medications. The medications below are commonly used to treat osteoporosis.
Bisphosphonates
Bisphosphonates are the most common medications for osteoporosis treatment. They’re typically prescribed as the first line of treatment in postmenopausal females.
Examples of bisphosphonates include:
- alendronate (Fosamax), an oral medication that you take daily or weekly
- ibandronate (Boniva), which is available as a monthly oral tablet or as an intravenous (IV) injection that you get four times per year
- risedronate (Actonel), which is available in daily, weekly, or monthly doses in an oral tablet
- zoledronic acid (Reclast), which is available as an IV infusion that you get once every 1 or 2 years
Antibody drugs
There are two antibody drugs on the market.
Denosumab
Denosumab (Prolia) links to a protein in your body that’s involved in bone breakdown. It slows the process of bone breakdown and helps maintain bone density.
Denosumab comes as an injection you get every 6 months.
Romosozumab
The new antibody romosozumab (Evenity) helps increase bone formation. It was approved by the Food and Drug Administration (FDA) in
- 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 per 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 heart 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)
SERMs re-create the bone-preserving effects of estrogen.
Raloxifene (Evista) is one type of SERM. It’s available as a daily oral tablet.
Calcitonin
Calcitonin is a hormone your thyroid gland makes. It helps regulate calcium levels in your body.
Doctors use synthetic calcitonin (Fortical, Miacalcin) to treat spinal osteoporosis in certain females who can’t take bisphosphonates. It can also be used off-label to ease pain in some people who have spinal compression fractures.
This medication is available as a nasal spray or an injection.
Parathyroid hormones (PTHs)
PTHs regulate calcium and phosphate levels in your body. Treatments with a synthetic PTH can promote new bone growth.
Two PTH options are teriparatide (Forteo) and abaloparatide (Tymlos).
Teriparatide is available as a daily injection that you give yourself. But this drug is expensive and is generally reserved for people with severe osteoporosis with a
Abaloparatide is another synthetic PTH treatment that was approved in 2017. Like teriparatide, this drug is available as a daily self-administered injection. But it’s also costly and is
In 2022, the FDA also approved abaloparatide for use in males with osteoporosis who have a high risk of fracture or do not respond well to other treatments.
For those who are in perimenopause or menopause, hormone therapy — also called hormone replacement therapy — is a treatment option. But doctors typically don’t use it as a first line of defense because it can increase the risk of the following conditions:
- stroke
- heart attack
- breast cancer
- blood clots
Hormone therapy is approved for use in osteoporosis prevention but may also be used off-label for osteoporosis treatment.
Hormone therapy can include estrogen alone or estrogen combined with progesterone. It’s available as an oral tablet, a skin patch, an injection, or a cream. The tablets and patches are used most often.
Daily tablet options include:
- Premarin
- Menest
- Estrace
Once- or twice-weekly patches include:
- Climara
- Vivelle-Dot
- Minivelle
Certain dietary changes, such as the use of some supplements, and lifestyle changes, such as regular exercise, can aid in the management of osteoporosis.
Diet and nutrition
Even if you’re taking medication to treat osteoporosis, you should make sure your diet includes plenty of calcium and vitamin D, which can help slow down 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
Women ages 51 to 70 years and everyone over 70 years old should get 1,200 mg of calcium per day.
The NIAMS also recommends that adults under 70 years old get 600 international units (IU) of vitamin D per day and that adults over 70 get 800 IU of vitamin D per day.
If you don’t get enough calcium or vitamin D through your daily diet, you can take supplements to make sure you get the recommended amount.
Before taking a supplement, you should check with your doctor. They can review your current medications and take note of other any medical conditions you have to help you pick the right doses of calcium and vitamin D.
When choosing a supplement, try to buy from reputable brands. Check product labels for certifications from third-party organizations such as NSF International, US Pharmacopeia, and UL Solutions to ensure that products have been tested for purity, quality, and safety.
Physical activity
Exercise helps strengthen your bones. Whatever the form, physical activity helps slow down 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. Examples of balance exercises include walking backward, doing lunges, and walking on uneven surfaces.
Strength or resistance training is beneficial for your bones as well. This can involve the use of free weights, weight machines, or resistance bands.
Weight bearing exercise, such as walking or running, and low impact aerobic activities, 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 help strengthen your bones and slow down bone loss.
If you have osteoporosis, you can talk with your doctor about each possible treatment and lifestyle change. Together, you can decide on a treatment plan that’s best for you.