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Osteoporosis Treatments and Medications

Creator: SingleCare
Published: 07-07-2020

Medically reviewed by Gerardo Sison, Pharm.D.

Licensed Pharmacist

Updated May. 16, 2023 • Published Jul. 7, 2020

Fact Checked

You could have weak and brittle bones without knowing it. Osteoporosis is a serious condition that can result in frequent fractures and uncertainty of when your next broken bone will occur. It’s a silent condition, often without symptoms, and treating it can be confusing. Treating your osteoporosis starts with understanding the condition and what it means for you. Let’s take a look at what exactly causes osteoporosis and how it’s treated.

What is osteoporosis?

Osteoporosis is a condition that affects the density and quality of the bone. The name literally translates to mean “porous bone,” and can cause bones to become fragile or at high risk of fracture. Unfortunately, there are not typically any symptoms and most osteoporosis patients do not know they have the disease until a fracture occurs.

Roughly 54 million Americans have osteoporosis. Some studies have shown that one in four older men and one in three older women over 50 will have a bone fracture as a result of osteoporosis. Many people without osteoporosis may experience low bone mass which is a leading risk factor of the disease. Often, before the condition is diagnosed, a hip fracture or other osteoporotic fracture will occur.

Treatment for osteoporosis is typically focused on reducing bone loss and preventing further fractures. There are a variety of specialists, self-care treatments, and medications that those living with this condition can take advantage of.

How is osteoporosis diagnosed?

Since there are not any common or obvious symptoms of osteoporosis, a medical diagnosis from a professional will be the only confirmation of the disease. However, there are some conditions that can cause a high risk of osteoporosis. If you have or have dealt with rheumatoid arthritis, leukemia, diabetes, or a variety of other conditions, then you may have a heightened risk.

The main way of diagnosing osteoporosis involves a bone mineral density (BMD) test. Bone mineral density tests, sometimes called bone mass measurement tests, tell you how much bone mineral is in certain areas of your body. The scan can be performed on most bones including the spine, hips, wrist, and more.

Your doctor will refer you for a scan to be completed by a dual-energy x-ray absorptiometry (DXA or DEXA) or bone densitometry. This is typically performed in a radiology center which is likely where your doctor will have you go. These scans might sound scary but they are completely painless and pretty quick.

Once your doctor determines that bone loss or low bone mineral density is occurring, they may request blood tests or other evaluations in an attempt to find the cause of osteoporosis. Like with many other conditions, your doctor will also evaluate factors such as your age, physical activity, and family history to rule out other conditions.

Osteoporosis treatment options

Due to osteoporosis being a disease caused by a variety of factors, there are also many different treatment options. Currently, there is not a sure-fire way to reverse osteoporosis or cure it. However, many of the treatment options will work to slow down or almost completely eliminate bone loss.

Before starting more intense treatments, some doctors many have you modify your diet and exercise routines. This can include starting a diet that focuses on essential nutrients like calcium and vitamin D as well as exercise like light aerobics throughout the week. During these treatment types, your doctor might also prescribe or recommend dietary supplements containing calcium or vitamins such as vitamin D.

Additionally, your doctor may prescribe medications that directly impact bone health or hormones like estrogen in the body. These treatment options can be a little more intensive than a simple change in diet and exercise, but many patients can often lower their risk of fractures with these medications.

Since osteoporosis typically isn’t discovered until after a fracture, there is a possibility that you will have to be treated for fractures when you begin your treatment. This will be addressed by your doctor and, chances are, you will be encouraged to take it easy to avoid more fractures.

Osteoporosis medication

Medications for treating osteoporosis can vary greatly in their class and use. The general focus of treating osteoporosis with medication is to slow or stop bone loss, which these medications will help with. There are even a few over-the-counter options your doctor may recommend at the beginning of your treatment plan. One important note with osteoporosis is that sometimes different medications have to be given to men and women due to hormonal changes with some medications.

Bisphosphonates

This group of medications is used to treat and prevent bone loss. Bisphosphonates work by interfering with the process bodies go through when breaking down bone tissue. By blocking the action of osteoclasts (cells that break down bone), bisphosphonates improve and strengthen bone mass. Oral and injection forms of bisphosphonates are currently on the market and can include brands like Fosamax (alendronate), Boniva (ibandronate), and Actonel (risedronate). A few of the side effects associated with bisphosphonates are nausea, heartburn, bone or joint pain, and muscle cramps.

RANK ligand (RANKL) inhibitors

These medications are typically available via injection and work to prevent bone loss. RANKL inhibitors prevent the development of osteoclasts to stop bone loss. This is also a common treatment for women that are considered a fracture risk after menopause. However, it is also used to treat men suffering from bone loss after being treated with certain drugs for prostate cancer. The most commonly prescribed medications for this drug class are Xgeva and Prolia, which both have the same generic name denosumab. Side effects for RANK ligand inhibitors include back pain, fatigue, nausea, and muscle cramps.

Calcitonin

This drug is not widely used due to the development of other medications. However, when other options are not tolerated it is typically used in post-menopausal women. More specifically, it is used for women who have been post-menopausal for five years. Calcitonin is most commonly administered as a nasal spray but is also available as an injection. The most common brand names for this drug include Miacalcin and Calcimar. Calcitonin slows down bone loss and helps maintain strong bones. Side effects for calcitonin can include nausea, flushing of the face, and dizziness.

Estrogen

Different forms of estrogen and estrogen-related medications are sometimes prescribed to some women with osteoporosis. Estrogen hormone therapy, selective estrogen receptor modulators (SERMs), and tissue-specific estrogen complex (TSEC) agents are all types of medications that may be prescribed to you. This is because estrogen helps protect against bone loss. Later in life, after menopause, women stop producing estrogen which causes bone loss and reduces the body’s ability to retain calcium. Some of the more common estrogen and estrogen-related medications prescribed are Vivelle (estradiol), Cenestin (conjugated estrogens), Duavee (conjugated estrogens/bazedoxifene), and Evista (raloxifene). Side effects of estrogen medications include hot flashes, leg cramps, headaches, and nausea.

Anabolic agents

Using hormone analogs can also help when injected to treat osteoporosis. Compared to other drugs that prevent bone loss, these treatments work by increasing bone mineral density and can even rebuild bone. A large side effect of these medications is rapid bone loss after stopping treatment. This means that antiresorptive drugs are usually given after treatment stops. Common brands for this group of drugs include Forteo (teriparatide) and Tymlos (abaloparatide). Both of these drugs are hormone-based treatments, which mimic the actions of parathyroid hormone.

Sclerostin inhibitors

Recently, a newer medication by the brand name Evenity has entered the market. Evenity, also known as romosozumab-aqqg, treats osteoporosis for postmenopausal women. The injection works by increasing bone density as well as bone strength while increasing new bone formation. Side effects for Evenity include joint pain, headache, increased risk of stroke, and muscle spasms.

What is the best medication for osteoporosis?

Treating osteoporosis involves a variety of factors to consider. Because fractures and weak bones can be a serious concern, you will need to approach treatment with some caution. Your osteoporosis treatment may take time and what works for you might not work for someone else. You should always consult your healthcare professional on treatments and, oftentimes, you will need them to prescribe your medication.

Best medications for osteoporosis
Drug name	Drug class	OTC/Rx	Administration route	Standard dosage	How it works	Most common side effects
Fosamax (alendronate)	Bisphosphonate	Rx	Oral	10 mg once daily in the morning or 70 mg once weekly, while standing, 30 minutes before a meal	Slows down bone loss and maintains strong bones	Stomach pain, constipation, nausea
Boniva (ibandronate)	Bisphosphonate	Rx	Oral and injection	150 mg taken once monthly or 3 mg infusion every 3 months	Slows down bone loss and maintains strong bones	Stomach upset, headache, pain in arms and legs
Actonel (risedronate)	Bisphosphonate	Rx	Oral	5 mg, 35 mg, 75 mg, or 150 mg taken as directed by your doctor	Slows down bone loss and maintains strong bones	Stomach upset, back pain, joint pain
Prolia (denosumab)	RANK ligand inhibitor	Rx	Injection	60 mg injection every 6 months	Prevents osteoclasts from breaking down bone	Back pain, joint pain, headache
Miacalcin (calcitonin)	Calcitonin	Rx	Nasal spray and injection	200 international units (nasal spray) or 100 international units (injection) daily as directed by your doctor	Slows down bone loss	Headache, back pain, nausea
Evista (raloxifene)	Selective estrogen receptor modulators (SERMs)	Rx	Oral	60 mg tablet taken by mouth once daily	Activates estrogen receptors in bone to slow down bone loss	Hot flashes, leg cramps, joint pain
Duavee (conj estrogens-bazedoxifene)	Tissue specific estrogen complex (TSEC)	Rx	Oral	0.45 - 20 mg tablet taken daily by mouth	Acts like estrogen but is not a hormone	Stomach upset, nausea, muscle spasms
Evenity (romosozumab-aqqg)	Sclerostin inhibitor	Rx	Injection	210 mg injected once monthly	Increases bone formation and improves density and strength	Joint pain, headache
Tymlos (abaloparatide)	Parathyroid hormone-related protein (PTHrp) analog	Rx	Injection	80 mcg injected daily	Increases bone density and strength	Dizziness, nausea, headache

Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.

Side effects of osteoporosis medication

Medications for osteoporosis can vary greatly in their form, method of use, chemical makeup, and frequency of use. As you can imagine, this means their side effects will also vary greatly. While there are some similar side effects between medications, there may be a variety of side effects you could experience. This is not a full list and you should discuss any possible side effects with your healthcare professional.

What are the most common side effects of osteoporosis medications?

Stomach upset
Muscle spasms
Joint pain
Pain in the arms or legs
Dizziness
Nausea
Low calcium levels

What is the best home remedy for osteoporosis?

Any home remedies for osteoporosis will be focused on the same goals as prescription medications. The biggest thing you can do to combat osteoporosis at home is a healthy diet and exercise routine that stimulates healthy functions in the body. A healthy, bone-focused diet may include using supplements like vitamin D or calcium as well as eating vitamin D rich foods. For men and women with osteoporosis, it is usually recommended to take 1000 mg of calcium (from diet and/or supplements) and 600 international units of vitamin D daily. But if you’re looking for natural remedies as well, this list may be of use. Many natural solutions for osteoporosis have the potential to interact with prescription drugs, so consult your doctor before using them.

Home remedies for osteoporosis can include:

Red clover: It is thought that red clover may have compounds similar to estrogen. Studies have shown that ingesting red clover may have beneficial effects on bone strength. However, if you are taking any prescription medications there may be interference with red clover.
Melatonin: Recent studies have shown that melatonin may play a role in bone growth and bone loss. Taking certain doses of it as a supplement might help with maintaining healthy bones. However, more studies are needed to confirm its potential benefits.
Soy: Tofu, soy milk, and other soybean products contain isoflavones, which are estrogen-like compounds. Much like with estrogen itself, isoflavones can help protect bones and prevent bone loss. It’s important to talk to your doctor before treating with soy, especially if you have a history with breast cancer or if your doctor determines you are at high risk for it.
Horsetail: Horsetail (Equisetum arvense) is an herbal remedy that contains silica, a mineral known to strengthen bones. Some report that it may help with bone cell regeneration after a fracture, although further research is needed to assess these benefits.
Tai chi: This ancient practice promotes muscle strength, combats stiffness, and may even reduce joint pain. Many older adults have found that it can help with balance and mobility as well.
Black cohosh: This herb contains phytoestrogens and is sometimes used to decrease menopausal symptoms. Because phytoestrogens are estrogen-like in nature they are believed to help prevent bone loss. A 2008 study even found that using black cohosh in mice promoted bone formation. However, black cohosh may have adverse effects from interacting with other medications and there is no established guidelines for the optimal dosage.

Frequently asked questions about osteoporosis

Is osteoporosis reversible?

Unfortunately, the official word from more healthcare professionals is that no, you cannot reverse osteoporosis. However, with many more prescriptions and treatments becoming available it may be possible in the future. The good news is, there are plenty of cases of patients nearly stopping or curbing osteoporosis. It is a disease that is more manageable now than ever before, with hope for an ability to reverse it one day.

Can you rebuild bone density?

Yes. Many treatments for osteoporosis involve a focus to slow bone loss and rebuild bone density. It’s a long process and usually requires a bit of work, but it can be done.

How do you treat osteoporosis naturally?

The most common natural treatments for osteoporosis start with changing your diet and exercise routines. Maintaining a healthy diet that promotes bone health can make all the difference when trying to treat osteoporosis naturally. There are some other at-home remedies for osteoporosis including soy, horsetail, and black cohosh. But it’s important to talk with your doctor before trying these remedies.

What kind of doctor would you see for osteoporosis?

A surprisingly large number of doctors and specialists can help with your diagnosis and treatment of osteoporosis. This includes family doctors (primary care physicians), endocrinologists, gynecologists, physiatrists, geriatricians, and more. Because osteoporosis usually isn’t caught until a fracture occurs, there is a good chance that any doctor could order your initial bone mineral density (BMD) test.

What are the injections for osteoporosis?

There are many different treatment options for osteoporosis. Some of the injectable treatments include brands like Boniva, Prolia, Evenity, and Tymlos. It’s not uncommon for your doctor to prescribe an at-home injection as one of the first medications to try out for osteoporosis treatment. However, some injections need to be administered by a healthcare professional at the doctor’s office.

Related resources for osteoporosis