9 commonly asked questions about osteoporosis medicines (2024)

Osteoporosis treatment: Medications can help

Osteoporosis treatment may involve medicines along with lifestyle change. Get answers to some of the most common questions about osteoporosis treatment.

By Mayo Clinic Staff

If you're undergoing osteoporosis treatment, you're taking a step in the right direction for your bone health. But perhaps you have questions about your therapy. Is the medicine you're taking the best one for you? How long will you have to take it? Why does your healthcare professional recommend a weekly pill when your friend takes a pill only once a month?

Which osteoporosis medicines are usually tried first?

Bisphosphonates are often the first choice for osteoporosis treatment. These include:

  • Alendronate (Fosamax), a weekly pill.
  • Risedronate (Actonel, Atelvia), a weekly or monthly pill.
  • Ibandronate, a monthly pill or quarterly intravenous (IV) infusion.
  • Zoledronic acid (Reclast), an annual IV infusion.

Another common osteoporosis medicine is denosumab (Prolia). Unrelated to bisphosphonates, denosumab might be used in people who can't take a bisphosphonate or did not tolerate one, such as some people with reduced kidney function.

Denosumab is delivered by injections, just under the skin, every six months. If you take denosumab, you might have to do so until your healthcare professional transitions you to another medicine. Unlike bisphosphonates, denosumab is not taken for a certain time and then simply stopped. It is followed by other medicine. Research shows that there could be a high risk of spinal fractures after stopping denosumab, so it's important that you take it consistently.

What are common side effects of bisphosphonate pills?

The main side effects of bisphosphonate pills are stomach upset and heartburn. Don't lie down or bend over for 30 to 60 minutes to avoid the medicine washing back up into the esophagus. Most people who follow these tips don't have these side effects.

Bisphosphonate pills aren't absorbed well by the stomach. It is important to take the medicine with a tall glass of plain water on an empty stomach, before first food or other medications or pills in the morning. Don't put anything else into your stomach for 30 to 60 minutes. After waiting, you can eat, drink other liquids and take other medicines.

Do intravenous bisphosphonates have advantages over the pill form?

Intravenous forms of bisphosphonates, such as ibandronate and zoledronic acid, don't cause stomach upset. And it may be easier for some people to schedule a quarterly or yearly infusion than to remember to take a weekly or monthly pill.

Intravenous bisphosphonates may cause mild flu-like symptoms in some people, but usually only after the first infusion. You can lessen the effect by taking acetaminophen (Tylenol, others) before and after the infusion.

Can osteoporosis medicines hurt your bones?

A very rare complication of bisphosphonates and denosumab is a break or crack in the middle of the thighbone. This injury, known as atypical femoral fracture, can cause pain in the thigh or groin that begins subtly and may gradually worsen.

Bisphosphonates and denosumab also can cause osteonecrosis of the jaw. This is a rare condition in which a section of jawbone is slow to heal or fails to heal, often after a tooth is pulled or other invasive dental work. This happens more commonly in people with cancer that involves the bone as they may take much larger doses of a bisphosphonate than those typically used for osteoporosis.

Should I take a drug holiday from bisphosphonates?

The risk of developing atypical femoral fracture or osteonecrosis of the jaw tends to increase the longer you take bisphosphonates. So your healthcare professional might suggest that you temporarily stop taking this type of drug. This practice is known as a drug holiday.

Even if you stop taking the medicine, its positive effects can persist. That's because after taking a bisphosphonate for several years, the medicine remains in your bone.

Because of this lingering effect, most experts believe that it's reasonable for people who are doing well during treatment — those who have not broken any bones and are maintaining bone density — to consider taking a holiday from their bisphosphonate after taking it for five years.

Are hormones used to treat osteoporosis?

Estrogen, sometimes paired with progestin, was once commonly used to treat osteoporosis. This treatment can increase the risk of blood clots, endometrial cancer, breast cancer and possibly heart disease. It's now usually reserved for women at high risk of fracture who can't take other osteoporosis drugs.

Women who are considering hormone replacement therapy to reduce menopausal symptoms, such as hot flashes, may factor in increased bone health when weighing the benefits and risks of estrogen treatment. Current recommendations say to use the lowest dose of hormones for the shortest period of time.

Raloxifene (Evista) mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen. Taking this drug can 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.

How do osteoporosis medicines work?

Throughout your life, healthy bones continuously break down and rebuild. As you age — especially after menopause — bones break down more quickly. Because bone rebuilding cannot keep pace, bones deteriorate and become weaker.

Most osteoporosis medicines work by reducing the rate at which your bones break down. Some work by speeding up the bone-building process. Either mechanism strengthens bone and reduces your risk of fractures.

Which medicines help speed up the bone-building process?

Bone-building medicines include:

  • Teriparatide (Forteo).
  • Abaloparatide (Tymlos).
  • Romosozumab (Evenity).

These types of medicine are typically reserved for people who have very low bone density, who have had fractures or whose osteoporosis is caused by steroids. They also may be used when other medicines are not tolerated, or bone density worsens despite other medications. They are not usually used in combination or along with the other medicines.

Teriparatide and abaloparatide require daily injections. Studies in laboratory rats found an increase in the risk of bone cancer, so these medicines are not used in people at high risk of bone cancer. But these medicines have been in use for more than 10 years and so far an increase in bone cancer has not been found in people who have taken these medicines.

Romosozumab is given as a monthly injection at your healthcare professional's office. It is a new drug and less is known about long-term side effects. It is not given to people who have recently had a stroke or heart attack. Treatment stops after 12 monthly doses.

These bone-building medicines can be taken for only one or two years and the benefits begin disappearing quickly after you stop. To protect the bone that's been built up, you'll need to start taking a bone-stabilizing medicine such as a bisphosphonate.

Can medicine alone successfully treat osteoporosis?

Don't rely entirely on medicines as the only treatment for your osteoporosis. These practices also are important:

  • Exercise. Weight-bearing physical activity and exercises that improve balance and posture can strengthen bones and reduce the chance of a fracture. The more active and fit you are as you age, the less likely you are to fall and break a bone.
  • Good nutrition. Eat a healthy diet and make sure you're getting enough calcium and vitamin D.
  • Quit smoking. Smoking cigarettes speeds up bone loss.
  • Limit alcohol. If you choose to drink alcohol, do so in moderation. For healthy women, that means up to one drink a day. For healthy men, it would be up to two drinks a day.

From Mayo Clinic to your inbox

Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview.

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

Aug. 28, 2024

  1. Osteoporosis: In-depth. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/osteoporosis. Accessed March 19, 2024.
  2. Goldman L, et al., eds. Osteoporosis. In: Goldman-Cecil Medicine. 27th ed. Elsevier; 2024. https://www.clinicalkey.com. Accessed March 19, 2024.
  3. Kellerman RD, et al. Osteoporosis. In: Conn's Current Therapy 2024. Elsevier; 2024. https://www.clinicalkey.com. Accessed March 19, 2024.
  4. Ferri FF. Osteoporosis. In: Ferri's Clinical Advisor 2024. Elsevier; 2024. https://www.clinicalkey.com. Accessed March 19, 2024.
  5. Rosen HN, et al. Overview of the management of low bone mass and osteoporosis in postmenopausal women. https://www.uptodate.com/contents/search. Accessed March 19, 2024.
  6. Osteoporosis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/osteoporosis/osteoporosis. Accessed March 21, 2024.
  7. Rosen HN. Risks of bisphosphonate therapy in patients with osteoporosis. https://www.uptodate.com/contents/search. Accessed March 19, 2024.
  8. Kearns AE (expert opinion). Mayo Clinic. March 27, 2024.

See more In-depth

See also

  1. Health foods
  2. Ankylosing spondylitis: Am I at risk of osteoporosis?
  3. Anorexia nervosa
  4. Back Pain
  5. Bone density test
  6. Bone health tips
  7. Calcium
  8. Timing calcium supplements
  9. Celiac disease
  10. CT scan
  11. Exercising with osteoporosis
  12. Fall prevention
  13. High-protein diets
  14. Male hypogonadism
  15. Osteoporosis
  16. Osteoporosis rehabilitation
  17. Spinal compression fracture
  18. Symptom Checker
  19. Ultrasound
  20. Vertebroplasty

.

9 commonly asked questions about osteoporosis medicines (2024)
Top Articles
Latest Posts
Recommended Articles
Article information

Author: Lilliana Bartoletti

Last Updated:

Views: 6353

Rating: 4.2 / 5 (73 voted)

Reviews: 80% of readers found this page helpful

Author information

Name: Lilliana Bartoletti

Birthday: 1999-11-18

Address: 58866 Tricia Spurs, North Melvinberg, HI 91346-3774

Phone: +50616620367928

Job: Real-Estate Liaison

Hobby: Graffiti, Astronomy, Handball, Magic, Origami, Fashion, Foreign language learning

Introduction: My name is Lilliana Bartoletti, I am a adventurous, pleasant, shiny, beautiful, handsome, zealous, tasty person who loves writing and wants to share my knowledge and understanding with you.