Osteoporosis Treatment: Medications Can Help
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 medication you're taking the best one for you? How long will you have to take it? Why does your doctor recommend a weekly pill when your friend takes a pill only once a month?
Which Osteoporosis Medications Are Usually Tried First?
Bisphosphonates are usually the first choice for osteoporosis treatment. These include:
- Alendronate (Fosamax), a weekly pill
- Risedronate (Actonel), a weekly or monthly pill
- Ibandronate (Boniva), a monthly pill or quarterly intravenous (IV) infusion
- Zoledronic acid (Reclast), an annual IV infusion
Another common osteoporosis medication is denosumab (Prolia, Xgeva). Unrelated to bisphosphonates, denosumab might be used in people who can't take a bisphosphonate, such as some people with reduced kidney function.
Denosumab is delivered by shallow injections, just under the skin, every six months. If you take denosumab, you might have to do so indefinitely unless your doctor transitions you to another medication. Recent research indicates that there could be a high risk of spinal fractures after stopping the drug, 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. To avoid these side effects, don't lie down or bend over for 30 to 60 minutes after taking the medication. Taking the medication with a tall glass of water on an empty stomach may also help improve absorption. Avoid consuming anything else for 30 to 60 minutes after taking the pill.
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 may be easier for some people to schedule. Mild flu-like symptoms may occur after the first infusion, but acetaminophen can help lessen the effect.
Can Osteoporosis Medications Hurt Your Bones?
A very rare complication of bisphosphonates and denosumab is atypical femoral fracture. Additionally, they can cause osteonecrosis of the jaw, a rare condition that affects healing in the jawbone, usually after dental work. These risks tend to increase with long-term use.
Should I Take a Drug Holiday from Bisphosphonates?
Some doctors might suggest temporarily stopping bisphosphonates to reduce the risk of certain complications. This practice is known as a drug holiday. However, the positive effects of the medication can persist even after stopping it. Most experts believe that it's reasonable for people who are doing well during treatment to consider taking a holiday from bisphosphonates after five years of use.
Are Hormones Used to Treat Osteoporosis?
Estrogen, sometimes paired with progestin, was once commonly used to treat osteoporosis but is now usually reserved for women at high risk of fracture who can't take other osteoporosis drugs. Raloxifene (Evista) is another option that mimics estrogen's beneficial effects on bone density without some of the risks associated with estrogen. However, it may increase the risk of blood clots.
How Do Osteoporosis Medications Work?
Osteoporosis medications work by either reducing the rate at which bones break down or speeding up the bone-building process. These mechanisms strengthen bone and reduce the risk of fractures.
Which Drugs Help Speed Up the Bone-Building Process?
Bone-building drugs include Teriparatide (Forteo), Abaloparatide (Tymlos), and Romosozumab (Evenity). These are typically reserved for people with very low bone density, a history of fractures, or osteoporosis caused by steroid medication. However, they can only be taken for one or two years, and long-term bone-stabilizing medication like bisphosphonates may be needed afterward to maintain the bone built up.
Can Medication Alone Successfully Treat Osteoporosis?
While medication is important, other practices are essential for treating osteoporosis:
- Exercise: Weight-bearing physical activity and exercises that improve balance and posture can strengthen bones and reduce the chance of fractures.
- Good Nutrition: A healthy diet with sufficient calcium and vitamin D is essential for bone health.
- Quit Smoking: Smoking cigarettes speeds up bone loss.
- Limit Alcohol: If you choose to drink alcohol, do so in moderation.