What medications are used to treat osteoporosis?

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What medications are used to treat osteoporosis?

There are several classes of medications used to treat osteoporosis. Your healthcare provider will work with you to find the best fit. It’s not really possible to say there is one best medication to treat osteoporosis. The ‘best’ treatment is the one that is best for you.

Hormone and hormone-related therapy

This class includes estrogen, testosterone and the selective estrogen receptor modulator raloxifene (Evista®). Because of the potential for blood clots, certain cancers and heart disease, estrogen therapy is likely to be used in women who need to treat menopause symptoms and in younger women.

Testosterone might be prescribed to increase your bone density if you are a man with low levels of this hormone.

Raloxifene acts like estrogen with the bones. The drug is available in tablet form and is taken every day. In addition to treating osteoporosis, raloxifene might be used to reduce the risk of breast cancer in some women. For osteoporosis, raloxifene is generally used for five years.

Calcitonin-salmon (Fortical® and Miacalcin®) is a synthetic hormone. It reduces the chance of spine fractures, but not necessarily hip fractures or other types of breaks. It can be injected or it can be inhaled through the nose. Side effects include runny nose or nosebleed and headaches for the inhaled form. Side effects include rashes and flushing for the injected form. It is not recommended as a first choice. There are possible more serious side effects, including a weak link to cancer.

Bisphosphonates

Bisphosphonate osteoporosis treatments are considered antiresorptive drugs. They stop the body from re-absorbing bone tissue. There are several formulations with various dosing schemes (monthly, daily, weekly and even yearly) and different brands:

  • Alendronate: Fosamax®, Fosamax Plus D®, Binosto®.
  • Ibandronate: Boniva®.
  • Risedronate: Actonel®, Atelvia®.
  • Zoledronic acid: Reclast®.

You may be able to stop taking bisphosphonates after three to five years and still get benefits after you stop. Also, these drugs are available as generic drugs. Of these products, Boniva and Atelvia are recommended only for women, while the others can be used by both women and men.

Possible side effects of bisphosphonates include flu-like symptoms (fever, headache), heartburn, and impaired kidney function. There are potentially serious side effects also, such as the rare occurrence of jaw bone damage (osteonecrosis of the jaw) or atypical femur fractures (low trauma fractures of the thigh). The risk of these rare events increases with prolonged use of the medication (>5 years).

Biologics

Denosumab (Prolia®) is product that is available as an injection given every six months to women and men. It is often used when other treatments have failed. Denosumab can be used even in some cases of reduced kidney function. Its long-term effects are not yet known, but there are potentially serious side effects. These include possible problems with bones in the thigh or jaw and serious infection.

Anabolic agents

These products build bone in people who have osteoporosis. There are three of these products currently approved:

  • Romososumab-aqqg (Evenity®) has been approved for postmenopausal women who are at a high risk of fracture. The product both enables new bone formation and decreases the breakdown of bone. You will get two injections, one right after the other, once per month. The time limit is one year of these injections.
  • Teriparatide (Forteo®) and Abaloparatide (Tymlos®) are injectable drugs given daily for 2 years. They are parathyroid hormones, or products similar in many ways to the hormones.

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