Osteoporosis Treatment Options
Osteoporosis prevention and treatmentinclude exercise and the right amount of calcium in your diet. Most adults over age 50 need a total of around 1,200 mg daily. The best way to get calcium is through the foods you eat. You may need calcium supplements if your diet is not providing enough calcium to keep your bones strong. Taking too much calcium, however, can increase the risk of kidney stones and possibly heart disease. Vitamin D helps your body absorb calcium and build it into the bones. Most adults don’t have enough vitamin D in their bodies.
Older men and women probably should take vitamin D supplements. The National Osteoporosis Foundation recommends 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 doctor 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 of breaking bones differs for each person. Some people may need to take medications to treat osteoporosis.
The U.S. Food and Drug Administration (FDA) has approved several medications for preventing and treating osteoporosis. These drugs include
Bisphosphonates 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.
The bisphosphonates alendronate, risedronate, and zoledronic acid have also been approved for the treatment of steroid-induced osteoporosis in men and women who need long-term use of medications to treat inflammatory conditions (which can contribute to osteoporosis).
Daily and weekly forms
Risedronate (Actonel, Atelvia)
Daily, weekly, and monthly forms
Once every three months
Zoledronic Acid (Reclast)
Once a year for treatment, or every two years for prevention
Side effects of bisphosphonates are uncommon, but may include abdominal, bone, or muscle pain. These medications may also cause nausea or heartburn. Tablet forms may cause irritation of the esophagus.
High-dose, long-term bisphosphonate therapy, which might be given during cancer treatment, for example, has been linked to osteonecrosis (degeneration) of the jaw bone. This problem happens most often after dental operations. There is also a concern that long-term treatment may increase the risk of so-called atypical femoral fractures—fractures through the shaft of the thigh bone with little or no trauma.
Bisphosphonates are not recommended for premenopausal women who may become pregnant or for people with severely impaired kidney function.
Denosumab is approved for preventing and treating osteoporosis in postmenopausal women at increased risk for fractures. Denosumab is used when patients cannot tolerate other osteoporosis medicines or if other medicines are not working well.
Denosumab is also used to treat bone loss in women who are receiving treatment for breast cancer. It is also used to prevent bone problems in patients with bone metastases (cancer that has spread to the bones) from certain types of tumors.
Denosumab is injected under the skin, usually by a doctor or nurse. When denosumab is used to treat osteoporosis, it is usually injected once every 6 months. When is is used to reduce fractures from cancer that has spread to the bones, it is usually injected once every 4 weeks.
Denosumab may cause sides effects. Call your doctor right away if you have a serious side effect such as
- numbness or tingling around your mouth or in your fingers or toes
- fast or slow heart rate
- muscle cramps or contraction
- overactive reflexes
- trouble breathing
Less serious side effects of denosumab may include
- feeling weak or tired
- diarrhea, nausea
This is not a complete list of side effects and others may occur. Ask your doctor for medical advice about side effects.
Selective Estrogen Receptor Modulators (SERMs)
Raloxifene is approved for preventing and treating osteoporosis in postmenopausal women. It is from a class of drugs called selective estrogen receptor modulators (SERMs), which are estrogen-like medications. 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 premenopausal women.
Teriparatide is a part of the parathyroid hormone molecule, which is a naturally-occurring hormone that regulates calcium levels in the body. 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 premenopausal women.
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.
Studies show that the risks of estrogen therapy—including heart attack, stroke, blood clots, and breast cancer—outweigh its benefits in most older women. For this reason, estrogen therapy is not usually prescribed 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 needed.<
Alendronate, risedronate, zoledronic acid, teriparatide, and denosumab have been approved to treat osteoporosis in men. Denosumab is also approved to protect bone mass in men taking androgen deprivation therapy for prostate cancer. Although there are fewer studies in men, the effects of these medications 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. However, 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. Other approved osteoporosis treatments for men are effective in men with low testosterone levels.
Jens Bollerslev, MD
Rikshospitalet Medical Clinic
Steven T. Harris, MD
UC San Francisco
Dolores Shoback, MD
UC San Francisco/VA Medical Cente
Last Review: May 2013