If daily or weekly pills to treat osteoporosis aren’t a good fit for you, you may be able to receive quarterly or yearly infusions. Side effects are usually mild and typically only occur after the first infusion.

Your body is constantly breaking down and building bone tissue. Osteoporosis is the medical term for low bone density. It develops when your body breaks down bone faster than it can build new tissue.

Experts estimate that osteoporosis affects more than 10 million people in the United States over the age of 50. If your doctor thinks you’re at a high risk of fracture, they may recommend medications to slow the breakdown of your bones or speed up the rate at which you build new bone.

The first-line treatment for osteoporosis is bisphosphonates. This group of drugs prevents bone loss by inhibiting your body’s resorption of bone tissue. Doctors have used them to treat osteoporosis since the 1990s.

You may take osteoporosis medications through:

  • oral tablets
  • injections
  • nasal sprays
  • infusions

An infusion is when a healthcare professional administers the drugs slowly through a needle or an IV. Your doctor may recommend infusions if you can’t tolerate oral bisphosphonates or if you have a health condition, such as esophageal stricture, that makes you ineligible for them.

Read on to learn everything you need to know about infusions to treat and prevent osteoporosis.

Language matters

We use “women” and “men” in this article to reflect the terms that have been historically used to gender people. But your gender identity may not align with how your body responds to this disease. Your doctor can better help you understand how your specific circumstances relate to these treatments.

Zoledronic acid, aka zoledronate, is also available under the brand name Reclast. It’s approved by the Food and Drug Administration (FDA) to:

A healthcare professional administers zoledronic acid to you by infusion once per year to treat osteoporosis. The infusion contains 5 milligrams (mg) of the drug and lasts for at least 15 minutes.

You can also receive zoledronic acid infusions once every 2 years to prevent osteoporosis.

Ibandronate sodium is FDA approved to treat osteoporosis in postmenopausal women. You may also see it under the brand name Boniva.

A healthcare professional will generally administer a 3 mg dose of ibandronate every 3 months. Each infusion takes about 15 to 30 seconds.

A 2021 study found that ibandronate and zoledronic acid were similarly effective in treating older adults with osteoporosis. But ibandronate was typically more affordable.

Ibandronate is also available as a pill you take once a month.

Research also indicates that pamidronate infusions can help treat osteoporosis. But this treatment is not FDA approved.

But doctors do prescribe it to treat hypercalcemia from cancer, Paget’s disease, or cancer that has spread to your bones. A healthcare professional will generally administer pamidronate in a dose of 30 to 60 mg by slow intravenous infusion every 3 to 4 weeks, monthly, or every 3 months.

Doctors have previously used pamidronate infusions to treat childhood osteoporosis. More research is needed to understand its long-term effectiveness and safety.

Infusion vs. injection

An injection uses a needle to deliver medication under the skin, into a muscle, or into a vein. It’s usually one short “shot.” There are several injections available to treat osteoporosis.

An infusion is a longer, continuous administration of medication into a vein. Depending on which medication you take, infusions for osteoporosis can take 15 seconds to several hours.

About 30% of people experience flu-like symptoms after their first infusion. But these symptoms occur in less than 7% of people after additional doses.

You may also experience:

They usually only last a couple of days and resolve themselves. But you can take acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) to help with these side effects.

Complications

While all bisphosphonates carry a small risk of renal injury, the risk seems to be higher with infusions.

Other rare complications may include:

Side effects

Oral bisphosphonates can cause gastrointestinal side effects, such as heartburn and upset stomach. A 2016 study found that these side effects were the most common reasons participants stopped taking their medications. These side effects don’t occur with infusions.

Adherence

According to a 2019 review, people with osteoporosis prefer less frequent treatments. They’re more likely to stick to a treatment plan that involves one or a few infusions per year than one that involves taking a daily or weekly pill. Infusions may help people avoid missing doses and persist with their treatment plan.

Are infusions as effective as other treatments for osteoporosis?

A 2017 review of studies found that zoledronic acid was less effective at reducing the risk of fractures than oral bisphosphonates. But the study also notes that people tend to have better results with infusions like zoledronic acid because they can more easily stick to their treatment plan.

Oral medications

Some of the most common osteoporosis medications are pills you take by mouth. They include:

  • alendronate (Fosamax), a daily or weekly pill
  • risedronate (Actonel), available as a daily, weekly, or monthly pill
  • ibandronate (Boniva), which is also available as a monthly pill

Injections

Injectable options include monoclonal antibodies and hormone therapies. They include:

  • denosumab (Prolia), a monoclonal antibody injection you take once every 6 months
  • romosozumab (Evenity), a monthly monoclonal antibody injection for postmenopausal women at high risk of fracture
  • calcitonin (Fortical, Miacalcin), if you can’t take other medications or if they don’t work
  • teriparatide (Forteo), a daily injection you give yourself
  • abaloparatide (Tymlos), a daily injection you give yourself

Hormone treatments like Forteo and Tymlos are often very expensive. Doctors reserve them for people with severe osteoporosis.

Calcitonin is also available as a nasal spray.

Nonmedical treatments

Your doctor may recommend treating your osteoporosis without medication if it’s mild and they don’t think you’re at an increased risk of fracturing a bone in the near future.

They may recommend some combination of:

Your doctor may recommend medications to slow bone breakdown or increase your rate of new bone growth if they think you’re at a future risk of fracturing a bone. Medications can be taken orally, through injections, or as infusions.

Infusions may help you stick to your treatment plan better. They may also help you avoid gastrointestinal side effects.

Zoledronic acid and ibandronate are the only two FDA-approved infusions to treat osteoporosis.

Zoledronic acidIbandronate
Dosage• 5 mg once per year for treatment
• 5 mg once every 2 years for prevention		• 3 mg every 3 months
FDA approval• men
• postmenopausal women
• people taking glucocorticoids		• postmenopausal women