Osteoporosis Treatment Options

The key to good osteoporosis care is understanding the causes of osteoporosis and knowing the risks of bone fractures. Having a DEXA bone mineral density test reveals important information on your risk for osteoporotic fractures (see Osteoporosis Signs and Symptoms).

Osteoporosis prevention and treatment include exercise and the right amount of calcium in your diet. Most adults over age 50 need 1,200 mg daily, although you may need more if you have osteoporosis. Calcium supplements may be necessary if your diet is not providing enough calcium to keep your bones strong. Taking too much calcium, however, may increase the risk of kidney stones. Vitamin D helps your body absorb calcium. Most adults don’t have enough vitamin D in their bodies.

Older men and women probably should take vitamin D supplements. Current recommendations are for 800 to 1,000 IU (International Units) of vitamin D3 per day. Younger men and women may need to take vitamin D supplements, too. Very high doses of vitamin D can cause serious health problems so talk with your physician about how much is right for you.

A well-balanced diet with calcium-rich foods, plus calcium and vitamin D supplements, however, may not be enough to protect bones and prevent osteoporosis in all people. Each individual’s health and family history are different, so the risk profile for breaking bones differs for each person. Some people may need to take medications to treat osteoporosis.

For Women:

The U.S. Food and Drug Administration (FDA) has approved several medications for preventing and treating osteoporosis. These drugs include:

Bisphosphonates: Alendronate, Risedronate, Ibandronate, Zoledronic Acid

Bisphosphonates—which inhibit the breakdown of bone—are used to prevent and treat postmenopausal osteoporosis by slowing bone loss while increasing bone mass. Bisphosphonates help reduce the risk of spine, non-spine, and hip fractures.

Alendronate, risedronate, and zolderonic acid have also been approved for the treatment of steroid-induced osteoporosis in men and women who require long-term use of medications to treat inflammatory conditions (which can contribute to osteoporosis).

 
If you are taking an oral bisphosphonate, you should take the drug upon arising in the morning after an overnight fast, with one full glass of water. Stay in an upright position after taking the dose.

If you are taking alendronate or risedronate, do not drink or eat anything else for the following 30 minutes so your body can absorb the medication. If you are taking ibandronate, you must wait 60 minutes to eat or drink anything.

Side effects of bisphosphonates are uncommon, but may include abdominal, bone, or muscle pain. These medications may also cause nausea or heartburn. Irritation of the esophagus may occur with the tablet forms of this medication.

Relatively high-dose, long-term bisphosphonate therapy, which might be administered during cancer treatment, for example, has been linked to osteonecrosis (degeneration) of the jaw bone. This problem tends to arise most frequently after dental operations. There is some suggestion that, very rarely, degeneration of the jaw may also develop after relatively low-dose, long-term bisphosphonate treatment by mouth. This is an area of active research investigation. Bisphosphonates are not recommended for pre-menopausal women who may become pregnant.

Calcitonin

Calcitonin is a naturally-occurring hormone made by specialized cells in the thyroid gland. Together with parathyroid hormone, calcitonin helps to regulate calcium levels in the body. Calcitonin, which is given as a nasal spray, has been shown to modestly increase bone density, and may reduce the risk of spine fractures.  Its effects on building bone are generally smaller than other approved therapies. Side effects from nasal calcitonin are uncommon, but may include nasal irritation, backache, bloody nose, and headaches.

Selective Estrogen Receptor Modulators (SERMs): Raloxifene

Raloxifene is approved for preventing and treating osteoporosis in postmenopausal women. It is from a class of drugs called selective estrogen receptor modulators (SERMs). These estrogen-like medications were developed to benefit the bone, while avoiding the potential risks associated with estrogen therapy (such as increased risk of breast cancer or heart disease).

Raloxifene increases bone density and reduces the risk of spine fractures, but it has not been shown to decrease the risk of non-spinal fractures. Raloxifene also decreases the risk of invasive breast cancer.

Raloxifene is taken in pill form, once a day, with or without meals. While uncommon, side effects may include hot flashes, leg cramps, or blood clots in the legs or lungs. Raloxifene is not recommended for pre-menopausal women.

Teriparatide

Teriparatide is a fragment or portion of the full-length parathyroid hormone molecule, which is a naturally-occurring hormone involved in calcium regulation. Teriparatide treatment stimulates new bone formation, rather than preventing bone breakdown. Because of potential safety concerns, the use of this drug is restricted to men and women with severe osteoporosis—who have a high risk of a fracture—and can be given for no more than two years.

Teriparatide is given as a daily, self-administered injection. Side effects are uncommon but may include leg cramps, headaches, and dizziness. This medication is not recommended for pre-menopausal women.

Estrogen

Estrogen can be taken alone or in combination with a progestin, a synthetic form of the female hormone progesterone that helps protect against uterine cancer.  (If your uterus has been surgically removed, you do not need to take a progestin with the estrogen.)

Estrogen hormone therapy prevents bone loss and reduces the risk of fracture in the spine and hip. It can also relieve other symptoms of menopause, such as hot flashes and vaginal dryness. Estrogen is usually given in pill form, although it is also available in other forms such as a skin patch or gel.

Recent studies show that the risks of estrogen therapy—including heart attack, stroke, blood clots, and breast cancer—outweigh its benefits in most women.  For this reason, estrogen therapy is no longer considered appropriate solely for fracture prevention.  In fact, even when estrogen is used to treat menopausal symptoms, the U.S. Food and Drug Administration recommends that it be used in as low a dose, for as short a time, as necessary.

Each of these medications has certain benefits and side effects. You should work with your doctor to find the treatment that is right for you. To find an endocrinologist, please visit our physician referral directory.

For Men:

Alendronate, risedronate, zoledronic acid, and teriparatide have been approved to treat osteoporosis in men. Although there are fewer studies in men, the effects of these agents on bone mass are similar to their effects in women and are likely helpful in treating men with osteoporosis.

The question of whether testosterone supplementation is useful for treatment of osteoporosis in men remains controversial. In men who clearly have low levels of testosterone, treatment with testosterone appears to increase bone density.

Because testosterone levels tend to decline with age, many older men have testosterone levels that are low. Testosterone supplements may improve bone mineral density in these men as well, but the doses necessary and the best way to administer this treatment are unclear. There is no information about whether testosterone treatment in men is effective in reducing fracture risk.

Finally, the risks of long-term testosterone treatment in older men are unknown. At present, it is generally not recommended that testosterone be used as the primary osteoporosis treatment for men. It is important to remember that the approved osteoporosis treatments for men (alendronate, risedronate, zoledronic acid, and teriparatide) seem to be effective in men with low testosterone levels.