Osteoporosis is a condition that causes bones to become porous and weaker, increasing the risk of fractures. Several medications can help manage the condition by slowing bone loss or increasing density.

Osteoporosis occurs when bone breaks down faster than it can rebuild. This weakens the bone to the point that it can break easily. Typically, medications for osteoporosis aim to either slow down bone loss or help rebuild bone. Nonpharmacological options aim to help avoid activities that may lead to a fracture.

This article reviews the different options available to help manage osteoporosis.

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Bisphosphonate therapy refers to a group of medications prescribed to help treat thinning bone associated with osteoporosis, Paget’s disease, or bone cancer that leads to bone loss. These medications can help slow bone loss and may help with building bone mass.

Examples include:

Alendronate, risedronate, and ibandronate are oral medications. Healthcare professionals may administer ibandronate and zoledronic acid through an intravenous (IV) infusion into the person’s veins.

Depending on the dosage, a person will typically take oral forms of the medication once a day, week, or month. They usually take the medication in the morning with water on an empty stomach. After taking them, a person needs to sit up for 30–60 minutes.

Oral versions may cause gastrointestinal side effects, such as:

Following instructions and remaining upright after taking the dose can help prevent these side effects.

A person may receive infusions, such as Zometa, at a doctor’s office or medical center once a year. They may experience injection site reactions as a side effect.

All bisphosphonate therapies have a risk of a rare condition called osteonecrosis of the jaw as well as low trauma femur fractures.

Antibodies are a type of biological treatment. The first approved antibody treatment for osteoporosis was denosumab.

A doctor may recommend a biological treatment for people with a high fracture risk or who cannot take oral medication.

Denosumab inhibits RANKL, which is a protein that plays a role in the formation and action of osteoclasts. These are the cells that degrade bone. By inhibiting osteoclasts, these antibodies help to decrease bone breakdown and strengthen bones. Doctors inject the medication once every 6 months.

Another type of biologic, romosozumab-aqqg (Evenity), has a similar method of action, but it targets sclerostin. This protein helps regulate bone breakdown and repair in the body. As such, romosozumab-aqqg also helps reduce bone reabsorption and promote bone growth. Doctors administer romosozumab-aqqg in two injections once a month.

Though generally safe and effective for most people, possible side effects can include:

  • hypersensitivity
  • serious infections
  • hypercholesterolemia (high cholesterol levels)
  • dermatological reactions
  • musculoskeletal pain

Doctors may recommend hormone replacement therapy (HRT) until the age of 60 for people who have a higher risk of fractures and symptoms of menopause. HRT may help with preventing or controlling symptoms of both conditions.

Menopause adds an additional risk of osteoporosis due to decreasing estrogen levels. Studies indicate that HRT can help with preventing osteoporosis and bone fractures. However, earlier studies note that the risks, such as increased risk of breast cancer, may outweigh the benefits.

More recently, evidence suggests that risks associated with HRT are minimal, and the therapy can provide effective, safe prevention of osteoporosis. However, experts still recommend using the smallest effective dose for as short a duration as possible.

Possible side effects include:

  • small increased risk of breast and ovarian cancer
  • deep vein thrombosis
  • heart attack
  • stroke
  • memory impairment

The risk of side effects increases after the age of 60.

Read more about HRT, its uses, and the different forms.

Different types of HRT and medications are available. People should work with a doctor to determine which may work best for them. Some examples and types include:

  • Selective estrogen receptor modulators (SERMs): These drugs can help treat osteoporosis due to mimicking estrogen’s beneficial effects on bone density. Examples include tamoxifen and raloxifene.
  • Calcitonin: This drug also inhibits osteoclasts. As such, it can inhibit bone resorption and result in increased bone mass.
  • Parathyroid hormone analogs: These are synthetic forms of parathyroid hormone. They help increase bone formation and improve bone density and strength. Examples include teriparatide and abaloparatide.

Dosing and side effects can vary between the medications. A person should discuss their options with a doctor to determine the best medication for their needs.

Medications and therapies can generally help to strengthen bones and prevent further bone loss. However, a person can take additional steps to help treat osteoporosis at home. Recommended steps include:

  • exercising — strength training can help keep the bones strong, while cardio workouts can help with weight management
  • avoiding smoking (if applicable) and secondhand smoke
  • drinking alcohol in moderation, if applicable
  • adding protein and calcium to the diet and consuming enough calories to maintain a moderate weight
  • getting enough sun exposure and vitamin D

A person may also benefit from taking steps to help reduce the risk of falls at home. This may include:

  • installing grab bars in the shower or tub
  • placing anti-slip mats around the kitchen, bathroom, or other areas prone to moisture
  • installing handrails on stairs

Osteoporosis occurs due to loss of bone strength and density. It increases a person’s risk of fractures.

Several treatment options can help reduce the loss of bone density and possibly help regrow bone. Treatments may vary in effectiveness, who they are meant for, and possible side effects.

Individuals should discuss their options with a doctor to determine what may work best for them.