Many osteoporosis medications are available to help reduce the fracture risk resulting from bone loss. They come in the form of tablets, injections, or IV infusions, which people may take daily, weekly, monthly, or yearly. These medications have some side effects, which people can discuss how best to manage with their doctor.
Osteoporosis is a bone disease that occurs when bones lose their strength. A loss in bone mineral density or mass can increase the risk of the bones breaking, as can changes to the quality or structure of bone.
People usually do not have any symptoms of osteoporosis and sometimes only become aware of it when they break a bone.
Various medications are available that work to reduce the risk of fractures from osteoporosis.
In this article, we look at the different types of osteoporosis medications, the benefits of each drug, and the potential side effects or risks.
The National Osteoporosis Foundation (NOF) lists the following drugs as treatments for osteoporosis. According to the NOF, all of the following drugs reduce the risk of fractures from bone weakness. The best medication will vary among individuals and can depend on their medical history and preferences.
Within the group of osteoporosis medications that doctors call antiresorptive agents, there are two types: bisphosphonates and RANK ligand inhibitors.
Bisphosphonates
Bisphosphonates are drugs that help slow down bone loss. Different bisphosphonates are available for osteoporosis:
- Alendronate: Alendronate is available as an oral tablet or an effervescent tablet to add to water, either of which someone can take either daily or weekly.
- Ibandronate: A person can take this drug orally on a monthly basis or through an intravenous (IV) injection every 3 months.
- Risedronate: This is an oral tablet that a person can take daily, weekly, or monthly.
- Zoledronic acid: This medication is available as an IV infusion, which a person receives once every 1–2 years.
Side effects
All of the above may cause pain in the joints, muscles, or bones. Another possible, though rare, side effect is uveitis, which is inflammation of the eye.
If people are taking bisphosphonates orally, side effects may include:
- nausea
- difficulty swallowing
- heartburn
- esophagus irritation
- gastric ulcer
People taking proton pump inhibitors for heartburn can talk with their doctor about taking other osteoporosis medication that may be more suitable for them.
Some people who receive IV bisphosphonates may experience flu-like symptoms shortly after the first infusion. These symptoms usually do not last longer than 2–3 days, and they do not occur for any following treatments.
Bisphosphonates are not suitable for people with low calcium levels in the blood or a kidney condition.
RANK ligand inhibitors
RANK ligand inhibitors can help improve bone mass and strength.
RANK ligand inhibitors work to block a type of protein called RANK ligand. RANK ligand naturally occurs in the body. Blocking RANK ligand helps prevent cells called osteoclasts from breaking down old bone material.
People may take denosumab as an injection every 6 months. The side effects of denosumab can include:
- occasional skin infections in the area of the injection
- back, arm, and leg pain
- urinary tract infections
- constipation
- rash
Side effects
In rare cases, bisphosphonates and denosumab can cause a thigh bone fracture, called atypical femur fracture. Another rare side effect of these drugs is osteonecrosis of the jaw (ONJ), which causes part of the jawbone to die.
In most cases, people with osteoporosis are not taking high enough doses of these drugs to get ONJ. As an extra precaution, people can make sure to maintain good oral hygiene while taking antiresorptive drugs.
For females with osteoporosis, hormone therapy may be an option. The types of hormone therapy available include:
- Estrogen: This is available as either an oral tablet that someone can take daily or as skin patches for one or two uses a week.
- Raloxifene: This medication comes in the form of an oral tablet that a person takes daily.
- Bazedoxifene: This also comes in tablet form for someone to take orally each day.
- Calcitonin: Calcitonin is available as a nasal spray that a person should use daily, or in the form of an injection.
Side effects
Estrogen and raloxifene increase the vertebrae density to reduce the risk of spinal fractures. Some hormone treatments may increase the risk of deep vein thrombosis (DVT).
Calcitonin helps minimize bone loss, but it may cause some of the following side effects:
Anabolic agents work to rebuild bones, repair tiny defects, and increase bone mass to help lower the risk of fractures. Anabolic medications include:
- Romosozumab-aqqg: Using this medication, a person will receive an injection twice a month over 12 months.
- Teriparatide: A person will need to inject this medication daily.
- Abaloparatide: A person will also need to administer this medication through daily injections.
Anabolic agents are suitable for postmenopausal females with osteoporosis, and teriparatide is also suitable for males with osteoporosis.
Side effects
The side effects of some anabolic agents may include:
- leg cramps
- nausea
- dizziness
Teriparatide may not be suitable for children or those with:
- Paget’s disease
- metabolic bone disease
- cancer that has spread to the bones
- previous radiation treatment to the bones
- increased blood calcium levels
The side effects of abaloparatide may include:
- excess calcium in the urine
- dizziness
- nausea
- headaches
- palpitations
- fatigue
- pain in the upper abdomen
- vertigo
Abaloparatide is not suitable for people with an increased risk of osteosarcoma, a type of bone tumor.
All osteoporosis medications help reduce the risk of fractures from bone weakness. The type of medication that people take, the duration, and any additional treatment will vary among individuals.
A doctor will carry out tests, such as checking for blood calcium levels and kidney function, to ensure that people are safe to take certain osteoporosis medications.
It is important that people report any side effects they experience from taking osteoporosis medication to their doctor.
A doctor will check treatment progress by testing bone density. Treatment is effective if bone density stays at the same level or improves and the person has no further fractures.
Alongside medication, certain lifestyle practices can help reduce the risk of fractures and further bone loss. According to the National Institutes of Health (NIH), these include:
- ensuring good nutrition by eating a diet rich in calcium, vitamin D, and protein
- exercising regularly but avoiding high impact exercise
- quitting smoking, if applicable, and avoiding secondhand smoke
- drinking alcohol in moderation
- setting up the surroundings to help prevent falls — for example, putting nonslip floors and good lighting in place
A range of different osteoporosis medications is available, all of which help reduce the risk of fractures from bone loss. When deciding the best course of treatment, doctors will take into account the individual’s medical history and personal preferences.
Osteoporosis medications do have side effects, and people can discuss how best to manage these with their doctor. These treatments may come in the form of tablets, injections, or IV infusions, and people may take them daily, weekly, monthly, or yearly.
Some medications can cause serious side effects if people stop taking them, so it is important to take any medication exactly as a doctor prescribes it. If a person wishes to discontinue or change their medication, they can discuss the best ways of doing this with their doctor.