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Treatments and drugs
By Mayo Clinic staffFor both men and women, the most widely prescribed osteoporosis medications are bisphosphonates. Examples include:
- Alendronate (Fosamax, Binosto)
- Risedronate (Actonel, Atelvia)
- Ibandronate (Boniva)
- Zoledronic acid (Reclast, Zometa)
Side effects include nausea, abdominal pain, difficulty swallowing, and the risk of an inflamed esophagus or esophageal ulcers. These are less likely to occur if the medicine is taken properly. Injected forms of bisphosphonates don't cause stomach upset. And it may be easier to schedule a quarterly or yearly injection than to remember to take a weekly or monthly pill, but it can be more costly to do so.
Long-term bisphosphonate therapy has been linked to a rare problem in which the middle of the thighbone cracks and might even break completely. Bisphosphonates also have the potential to affect the jawbone. Osteonecrosis of the jaw is a rare condition mostly occurring after a tooth extraction in which a section of jawbone dies and deteriorates. You should have a recent dental examination before starting bisphosphonates.
Hormone-related therapy
Estrogen, especially when started soon after menopause, can help maintain bone density. However, estrogen therapy can increase a woman's risk of blood clots, endometrial cancer, breast cancer and possibly heart disease.
Raloxifene (Evista) mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen. Taking this drug may also reduce the risk of some types of breast cancer. Hot flashes are a common side effect. Raloxifene also may increase your risk of blood clots.
In men, osteoporosis may be linked with a gradual age-related decline in testosterone levels. Testosterone replacement therapy can help increase bone density, but osteoporosis medications are better studied in men with osteoporosis and are recommended instead of or in addition to testosterone.
Less common osteoporosis medications
If you can't tolerate the more common treatments for osteoporosis — or if they don't work well enough — your doctor might suggest trying:
- Teriparatide (Forteo). This powerful drug is similar to parathyroid hormone and stimulates new bone growth. It's given by injection under the skin. After two years of treatment with teriparatide, another osteoporosis drug is taken to maintain the new bone growth.
- Denosumab (Prolia). Compared with bisphosphonates, denosumab produces similar or better bone density results while targeting a different step in the bone remodeling process. Denosumab is delivered via a shot under the skin every six months. The most common side effects are back and muscle pain.
- Osteoporosis: Handout on health. NIH Osteoporosis and Related Bone Diseases National Resource Center. http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/osteoporosis_hoh.asp. Accessed March 25, 2013.
- Goldman L, et al. Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.mdconsult.com/das/book/body/191371208-2/0/1492/0.html#. Accessed March 25, 2013.
- Bope ET, et al. Conn's Current Therapy. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.mdconsult.com/books/about.do?about=true&eid=$eid&isbn=978-1-4557-0295-4&uniqId=398813857-1936. Accessed March 25, 2013.
- Ferri FF. Ferri's Clinical Advisor 2013: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-0-323-08373-7..00002-9&isbn=978-0-323-08373-7&about=true&uniqId=343863096-23. Accessed March 25, 2013.
- Kennel KA (expert opinion). Mayo Clinic, Rochester, Minn. March 26, 2013.
- Rosen HN. Bisphosphonates in the management of osteoporosis in postmenopausal women. http://www.uptodate.com/home. Accessed March 26, 2013.
- Finkelstein JS. Treatment of osteoporosis in men. http://www.uptodate.com/home. Accessed March 26, 2013.
- Rosen CJ. Parathyroid hormone therapy for osteoporosis. http://www.uptodate.com/home. Accessed March 26, 2013.
- Rosen HN. Denosumab for osteoporosis. http://www.uptodate.com/home. Accessed March 26, 2013.
- Calcium. Office of Dietary Supplements. National Institutes of Health. http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional. Accessed March 26, 2013.
- Ask Mayo Expert. Vitamin D deficiency. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012.
- Vitamin D. Office of Dietary Supplements. National Institutes of Health. http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional. Accessed March 26, 2013.
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