Osteoporosis Medications

A number of medications are used to treat osteoporosis and reduce the risk of fracture. These medications generally work by reducing the rate of bone loss (called antiresorptive medications) or increasing bone growth.

These medications are only available with a doctor’s prescription. Disclose all other medications and health concerns to the doctor before starting osteoporosis medication to ensure they are safe and likely to be effective. Medications may be prescribed when osteoporosis is diagnosed, or when a patient has osteopenia (somewhat low bone density) and a relatively high risk of fracture.

Bisphosphonates for Osteoporosis

Bisphosphonates are the most common medications used for osteoporosis.¹Adler RA, El-Hajj Fuleihan G, Bauer DC, et al. Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research [published correction appears in J Bone Miner Res. 2016 Oct;31(10 ):1910]. J Bone Miner Res. 2016;31(1):16–35. doi:10.1002/jbmr.2708 Bisphosphonates slow down the process of bone loss (anti-resorptive medications) by reducing function in osteoclasts, the cells that break down bone cells and absorb calcium. Slowing down bone loss can prevent osteoporosis from developing and reduce the risk of fracture in current patients.

FDA-approved bisphosphonates for osteoporosis include:

• Alendronate (brand name Fosamax, Binosto), used to prevent and treat postmenopausal osteoporosis. This medication can also increase bone mass in men with osteoporosis, and treat secondary osteoporosis in men and women taking glucocorticoids.²Cosman F, de Beur SJ, LeBoff MS. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014;25(10):2359–2381. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176573/. doi:10.1007/s00198-014-2794-2. Alendronate is taken orally on a daily or weekly basis.
• Ibandronate (Boniva), used to treat postmenopausal osteoporosis only. Oral tablets are generally taken on a monthly basis. Ibandronate may also be administered intravenously once every 3 months.
• Risedronate (Actonel, Atelvia), for the prevention and treatment of osteoporosis caused by menopause, hypogonadism, and prolonged steroid use. This medication may be taken orally in varying doses based on the patient’s sex and underlying cause of osteoporosis. Generally, risedronate is taken orally on a regular basis, either daily, weekly, or sometimes monthly.
• Zoledronic acid (Reclast, Aclastia), used to prevent and treat osteoporosis caused by menopause, hypogonadism, and steroid use. This medication is administered intravenously once per year.

Benefits from bisphosphonates are mostly only seen in the first 5 years of taking them. It is generally recommended that use of these medicines is reviewed by a doctor every 3 to 5 years to prevent complications, such as bone death in the jaw and abnormal fractures in the femur.¹Adler RA, El-Hajj Fuleihan G, Bauer DC, et al. Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research [published correction appears in J Bone Miner Res. 2016 Oct;31(10 ):1910]. J Bone Miner Res. 2016;31(1):16–35. doi:10.1002/jbmr.2708

Thyroid and Parathyroid Hormone Therapy

Calcitonin, abaloparatide, and teriparatide are synthetic analogs of hormones produced naturally in the thyroid and parathyroid glands, and can be used to alter bone growth

• Teriparatide (Forteo) increases the rate of bone formation, rather than slowing the rate of bone loss, leading to higher bone mineral density. Teriparatide is used to treat postmenopausal osteoporosis, secondary osteoporosis caused by low testosterone in males, and prolonged steroid use in both sexes.

  Teriparatide is self-administered daily by injection in the thigh or abdomen, and is approved for daily use for up to 2 years.

• Abaloparatide (Tymlos) increases the rate of bone formation by increasing the function of osteoblasts. This medication is used to increase bone density and strength to reduce the risk of fracture in patients with postmenopausal osteoporosis.

  Abaloparatide is taken by injection, typically on a daily basis for up to 2 years.

• Calcitonin (Forical, Miacalcin) reduces the rate of bone loss (anti-resorptive) by inhibiting the function of osteoclasts, the large cells that break down bones. This medication primarily works in the spine, and is used for women who are 5 years past menopause.

  Calcitonin can be taken daily by injection or through a nasal spray. Dosage may be lowered as calcitonin becomes effective. It is generally not advised to take calcitonin for longer than 6 months.

Because calcitonin and teriparatide are less potent than bisphosphonates, they can benefit patients who cannot take or wish to avoid stronger medications.

Estrogen/Hormone Replacement Therapy for Osteoporosis

Estrogen replacement therapy for osteoporosis is primarily used to prevent excess bone loss (anti-resorptive) in women with early menopause or women who cannot tolerate other osteoporosis medications.

See Who Is at Risk for Osteoporosis?

Estrogen naturally plays a large role in the bone remodeling process by keeping bone loss at a healthy level.³Tu KN, Lie JD, Wan CKV, et al. Osteoporosis: A Review of Treatment Options. Pharmacy and Therapeutics. 2018;43(2):92–104. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768298/ By increasing estrogen levels, bone loss may be reduced through early menopause, delaying or decreasing the risk of osteoporosis. Hormone therapy may consist of estrogen only, or estrogen in combination with progestin.

Some patients may wish to avoid estrogen-based hormone therapy due to its potential complications, which can include cardiovascular complications such as stroke or heart attack, as well as issues caused by elevated estrogen levels.

Because of potential complications from hormone therapy, patients are generally advised to try other osteoporosis medications first. Estrogen/hormone replacement therapy may only be advised in small doses for short periods of time.

Raloxifene (brand name Evista), a Selective Estrogen Receptor Modulator (SERM)

Raloxifene is designed to provide the benefits of estrogen therapy with fewer risks. Raloxifene is approved to treat postmenopausal osteoporosis, and is usually prescribed to be taken orally once a day.

Denosumab

Denosumab (Prolia) targets osteoclasts, the cells that break down bone, to reduce the rate of bone loss and increase bone density. This medication is primarily used to:

• Treat postmenopausal osteoporosis
• Treat osteoporosis for patients who are intolerant or unresponsive to other osteoporosis medications
• Increase bone mass in both sexes with secondary osteoporosis caused by treatments for breast and prostate cancer

Denosumab is taken by injection in the abdomen, thigh, or upper arm, usually once every 6 months. It may be advised to take calcium and vitamin D supplements with Denosumab to ensure healthy bone growth.