Medications

Medicines are used to both prevent and treat osteoporosis. Some medicines slow the rate of bone loss or increase bone thickness. Even small amounts of new bone growth can reduce your risk of broken bones.

If you take medicine for osteoporosis, you will also need to take calcium and vitamin D supplements, eat a healthy diet, and exercise regularly. A large part of treating or reducing the effects of osteoporosis is getting enough calcium and vitamin D.

Medication Choices

Medicines for treatment and prevention

Medicines used to prevent or treat osteoporosis include:

• Bisphosphonates, such as alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel), and zoledronic acid (Reclast), which slow the rate of bone thinning and can lead to increased bone density.⁴ These medicines may be used in men and women.

  Should I take bisphosphonate medicines for osteoporosis?

• Raloxifene (Evista), a selective estrogen receptor modulator (SERM), which is used only in women. Raloxifene slows bone thinning and causes some increase in bone thickness.²²
• Calcitonin (Calcimar or Miacalcin), a naturally occurring hormone that helps regulate calcium levels in your body and is part of the bone-building process. When taken by shot or nasal spray, it slows the rate of bone thinning. Calcitonin also relieves pain caused by spinal compression fractures. Calcitonin is used in men and women.
• Parathyroid hormone (teriparatide [Forteo]), used for the treatment of men and postmenopausal women with severe osteoporosis who are at high risk for bone fracture. It is given by injection.

Hormone therapy

Hormone therapy for osteoporosis in women includes:

• Estrogen. Estrogen without progestin (estrogen replacement therapy, or ERT) may be used to treat osteoporosis in women who have gone through menopause and do not have a uterus. Because taking estrogen alone increases the risk of developing cancer of the lining of the uterus (endometrial cancer), ERT is only used if a woman has had her uterus removed (hysterectomy).
• Estrogen and progestin. In rare cases, the combination of estrogen and progestin (hormone replacement therapy, or HRT) is recommended for women who have osteoporosis.

For men, testosterone (shots, gel, or patches) sometimes is given to prevent osteoporosis caused by low testosterone levels, although use of testosterone to treat osteoporosis has not been approved by the U.S. Food and Drug Administration (FDA).

A woman's level of the hormone estrogen, which affects the growth and loss of bone, decreases naturally during and after menopause. Estrogen replacement therapy (ERT) or combination estrogen/progesterone replacement therapy (HRT) can help to reduce bone loss. Many experts recommend that long-term hormone replacement therapy only be considered for women with a significant risk of osteoporosis that outweighs the risks of taking HRT or ERT.

Researchers are studying the effects of low-dose estrogen on women age 65 and older. An early, small study indicates that a low estrogen dose (one-quarter that of conventional ERT) may provide the same benefit (increased bone density and decreased fractures) as the higher dose. In the same study, about one-third of the women were given the low estrogen dose and progesterone (because these women had not had hysterectomies). This group of women also experienced increased bone density. But the long-term risks of taking low-dose estrogen (and progesterone in one-third of the cases) were not studied and are unclear.²⁰ Experts recommend that HRT or ERT be used at the lowest dose for the shortest length of time to reach your treatment goals.

While hormone therapy is typically not recommended for most women with osteoporosis, if you are at high risk and cannot take other medicines, your doctor may recommend it under certain circumstances. If you continue to have bone loss while taking bisphosphonate medicine, such as risedronate (Actonel) or alendronate (Fosamax), you may need to take both bisphosphonate medicine and hormone therapy. Studies show that taking a bisphosphonate with hormone therapy results in increased bone mass when compared to taking either medicine alone.^{17, 18}

What To Think About

Calcium, vitamin D, bisphosphonates, calcitonin, and teriparatide may be used by men or women. HRT, ERT, and raloxifene are prescribed only for women. Testosterone is prescribed only for men.

Compression fractures and other broken bones resulting from osteoporosis can cause significant pain that lasts for several months. Medicines available to relieve your pain include:

• Nonprescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen.
• Nonprescription acetaminophen, such as Tylenol or Panadol.
• A narcotic pain reliever, such as codeine or morphine.
• Calcitonin, such as Calcimar or Miacalcin.

If you are taking medicine but still have pain or have side effects from the medicine, such as an upset stomach, talk with your doctor.

Statins are medicines used to treat high cholesterol, which increases the risk of developing life-threatening diseases, such as coronary artery disease, heart attack, and stroke. Recent studies have reported conflicting results on statins' potential for lowering a woman's risk of bone fractures. Evidence does not yet support the use of statins to prevent or treat osteoporosis.^{23, 24}