Treatment for osteoporosis involves slowing the rate of bone lose or increasing the rate of bone formation. There are two types of medications for this.
- Drugs that slow the rate of bone loss are called antiresorptive medications.
- Ones that increase the rate of bone formation are called anabolic medications.
These drugs reduce bone loss by binding to bone and preventing normal bone cells from reabsorbing bone. They include:
- Bisphosphonates. These are the most common treatment for osteoporosis. They can stop bone loss and help reduce the risk of fractures by up to 50 percent. They're not hormones, so women who cannot take estrogen can use them. Bisphosphonates approved for the treatment and prevention of postmenopausal osteoporosis include alendronate (Binosto, Fosamax), ibandronate (Boniva), risedronate (Actonel) and zoledronic acid (Reclast).
- Denosumab. This drug is approved for postmenopausal osteoporosis. It is injected under the skin every six months at a doctor’s office.
- Calcitonin. This is a naturally occurring hormone that decreases bone breakdown. It is FDA-approved for osteoporosis treatment but not prevention. It appears weaker than bisphosphonate medications in preventing fractures. Calcitonin controls bone breakdown and may ease pain in people with spine fractures. It’s available as a nasal spray (Miacalcin, Fortical).
- Selective estrogen receptor modulators (SERMs). These drugs work like estrogen, but with fewer side effects. Raloxifene (Evista) is an FDA-approved SERM for the treatment and prevention of postmenopausal osteoporosis. It can prevent bone loss, especially in the spine and hip. Studies have shown it decreases the rate of spine fractures. It also produces small increases in bone mass and can lower the risk of breast cancer. In 2013, the FDA approved Duavee, a combination product containing the SERM bazedoxifene and conjugated estrogens for menopausal symptoms and osteoporosis.
Until recently, estrogen hormone replacement therapy (HRT) was the traditional way to treat menopausal symptoms and also prevent osteoporosis. However, recent evidence suggests estrogen can increase the risk of breast cancer, strokes and heart attacks. Because of this, estrogen supplementation after menopause is usually not used to prevent osteoporosis.
Teriparatide (Forteo) and abaloparatide (Tymlos) are anabolic medicines approved to treat men and postmenopausal women who have severe osteoporosis with a high risk of fractures. These man-made versions of parathyroid hormone have been shown to stimulate new bone formation, decrease the risk of spinal fractures and improve bone density. Each is given as a daily injection for up to two years.
Romosozumab (Evenity), the most-recently approved medication, works by blocking sclerostin – a protein that stops bone from forming. It’s given by injection once a month for a year (after 12 months, it loses its effectiveness). It’s approved for postmenopausal women who have had fractures, are at very high risk for them or haven’t responded to other treatments. The drug comes with an FDA warning for an increased risk of heart attack, stroke and cardiovascular death.