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Treatments and drugs
By Mayo Clinic staff
Bisphosphonates
For both men and women, the most widely prescribed osteoporosis medications are bisphosphonates. Examples include:
- Alendronate (Fosamax)
- 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. 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.
Long-term bisphosphonate therapy has been linked to a rare problem in which the upper thighbone cracks, but doesn't usually break completely. Bisphosphonates also have the potential to affect the jawbone. Osteonecrosis of the jaw is a rare condition occurring after a tooth extraction in which a section of jawbone dies and deteriorates.
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.
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 uses parathyroid hormone to stimulate new bone growth. It's given by injection under the skin. Long-term effects are still being studied, so therapy is recommended for two years or less.
- Denosumab (Prolia, Xgeva). Compared to bisphosphonates, denosumab produces similar or better 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.
- Calcitonin, salmon (Fortical, Miacalcin). A substance produced by the thyroid gland, calcitonin reduces bone resorption and may slow bone loss. It's usually administered as a nasal spray and may cause nasal irritation in some people. It is the least effective of the available therapies.
- 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 Oct. 25, 2011.
- Rosen C. Osteoporosis. In: Goldman L, et al. Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/das/book/body/191371208-2/0/1492/0.html#. Accessed Oct. 25, 2011.
- De Paula FJ, et al. Osteoporosis. In: Bope ET, et al. Conn's Current Therapy. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4377-0986-5..C2009-0-38984-9--TOP&isbn=978-1-4377-0986-5&about=true&uniqId=236797353-5. Accessed Oct. 25, 2011.
- Weppner DM, et al. Osteoporosis. In: Ferri FF. Ferri's Clinical Advisor 2011: Instant Diagnosis and Treatment. Philadelphia, Pa.: Mosby Elsevier; 2011. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-0-323-05610-6..C2009-0-38600-6--TOP&isbn=978-0-323-05610-6&about=true&uniqId=230100505-53. Accessed Oct. 25, 2011.
- Koch TR, et al. Postoperative metabolic and nutritional complications of bariatric surgery. Gastroenterology Clinics of North America. 2010;39:109.
- Rosen HN. Bisphosphonates in the management of osteoporosis in postmenopausal women. http://www.uptodate.com/home/index.html. Accessed Oct. 26, 2011.
- Finkelstein JS. Treatment of osteoporosis in men. http://www.uptodate.com/home/index.html. Accessed Oct. 26, 2011.
- Rosen CJ. Parathyroid hormone therapy for osteoporosis. http://www.uptodate.com/home/index.html. Accessed Oct. 26, 2011.
- Rosen HN. Denosumab for osteoporosis. http://www.uptodate.com/home/index.html. Accessed Oct. 26, 2011.
- Kennel KA (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 27, 2011.
- National Osteoporosis Foundation: Community groups. http://www.nof.org/community/communitygroups. Accessed Oct. 26, 2011.
- Dietary reference intakes for calcium and vitamin D. Institute of Medicine. http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/Report-Brief.aspx. Accessed Oct. 27, 2011.
- AskMayoExpert. How much vitamin D is adequate to prevent vitamin D deficiency? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2011.
- Rohren CH (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 2, 2011.
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