The primary goal in treating people with osteoporosis is preventing bone fractures. A comprehensive treatment program includes a focus on proper nutrition, exercise, and prevention of falls that may result in fractures.
Your doctor may also prescribe one of several medications that have been shown to slow or stop bone loss or build new bone, increase bone density, and reduce the risk of developing a bone fracture.
If you take medication to prevent or treat osteoporosis, it is still essential that you also obtain the recommended amounts of calcium and vitamin D. Exercising and maintaining other aspects of a healthy lifestyle are also important.
Bisphosphonates are group of osteoporosis medications that slow down the breakdown of bone, increase bone density, and decrease the amount of calcium released from the bones into the blood. In postmenopausal women with osteoporosis, bisphosphonates increase bone density in both the spine and hip, and reduce the risk of fracture. Side effects may include digestive system problems.
- Alendronate (Fosamax®)
- Ibandronate (Boniva®)
- Risedronate (Actonel®)
Alendronate and risedronate are approved for treating osteoporosis in men and those with osteoporosis caused by prolonged use of glucocorticoids.
Biphosphonates are poorly absorbed by the stomach and must be taken on an empty stomach with no food or drink to be consumed in the next 30 minutes.
Zoledronic acid injection (Reclast®) is a bisphosphonate that is administered by IV infusion once each year.
Selective Estrogen Receptor Modulators (SERMs)
Selective estrogen receptor modulators (SERMs) are a class of medications that act on the estrogen receptors throughout the body in a targeted fashion. These drugs are not estrogens, but they mimic the effects of estrogen on bones and slow down the osteoclast cells that break down bone tissue. SERMs have been shown to prevent bone loss, have beneficial effects on bone mass, and reduce the risk of spine fractures.
Additionally, they do not have estrogen's potentially harmful effects on breast tissue or the uterus. In fact, they have been shown to reduce the risk of developing invasive breast cancer.
Raloxifene (Evista®) is a SERM that is approved for the treatment and prevention of osteoporosis. It is taken as a tablet once a day. Side effects may include hot flashes, sweating, clot formation in some blood vessels, muscle soreness, weight gain, or a rash.
Denosumab (Prolia®) is a monoclonal antibody that binds to a particular RANKL receptive on the bone to reduce the resoprtion of bone. It is approved for the treatment of women with postmenopausal osteoporosis at high risk of developing a fracture.
Denosumab is administered every 6 months via subcutaneous injection, similar to some vaccines.
Denosumab lowers calcium levels in the blood so cannot be used by women with low blood calcium levels. Hypocalcemia (low blood calcium levels) may treated with calcium and vitamin D supplements before starting Prolia.
Bone Anabolic Agents
Teriparatide (Forteo®) is an injectable, recombinant form of human parathyroid hormone (PTH) that stimulates osteoblast cells in the bone to grown create new bone tissue.
It is used primary for people with osteoporosis who have already experienced a bone fracture, have a particularly low bone mineral density, or cannot tolerate biphosphonates.
Teriparatide is administered as a once-a-day injection.
Calcitonin (Miacalcin, Fortical) is another medication that slows down bone resorption by slowing down the osteoclast cells in the bone.
Calcitonin is approved for the treatment of osteoporosis in women who are at least 5 years beyond menopause. It is taken as a single daily nasal spray or as an injection under the skin. In women who are at least 5 years beyond menopause, calcitonin slows bone loss and increases spinal bone density. Some patients report that calcitonin also relieves pain from bone fractures. The effects of calcitonin on fracture risk are still unclear.
Estrogen replacement therapy has been shown to be effective in preventing osteoporosis, but it may not be prescribed unless there are other medical indications because of the health risks may outweigh the benefits.
Reference: The National Institute of Arthritis and Musculoskeletal and Skin Diseases