Which Osteoporosis Medication, If Any, Is Right For You?

We’ve written about osteoporosis before, so here’s a quick recap first in case you missed these:

• The Bare-bones Truth About Osteoporosis
• Exercises To Do (And Exercises To Avoid) If You Have Osteoporosis
• We Are Such Stuff As Fish Are Made Of
• Vit D + Calcium: Too Much Of A Good Thing?

All of those look and diet and/or exercise, with “diet” including supplementation. But what of medications?

So many choices (not all of them right for everyone)

The UK’s Royal Osteoporosis Society says of the very many osteoporosis meds available:

❝In terms of effectiveness, they all reduce your risk of broken bones by roughly the same amount.

Which treatment is right for you will depend on a number of things.❞

…before then going on to list a pageful of things it will depend on, and giving no specific information about what prescriptions or proscriptions may be made based on those factors.

Source: Royal Osteoporosis Society | Which medication should I take?

We’ll try to do better than that here, though we have less space. So let’s get down to it…

First line drug offerings

After diet/supplementation and (if applicable) hormones, the first line of actual drug offerings are generally biphosphates.

Biphosphates work by slowing down your osteoclasts—the cells that break down your bones. They may sound like terrible things to have in the body at all, but remember, your body is always rebuilding itself and destruction is a necessary act to facilitate creation. However, sometimes things can get out of balance, and biphosphates help tip things back into balance.

Common biphosphates include Alendronate/Fosamax, Risedronate/Actonel, Ibandronate/Boniva, and Zolendronic acid/Reclast.

A common downside is that they aren’t absorbed well by the stomach (despite being mostly oral administration, though IV versions exist too) and can cause heartburn / general stomach upset.

An uncommon downside is that messing with the body’s ability to break down bones can cause bones to be rebuilt-in-place slightly incorrectly, which can—paradoxically—cause fractures. But that’s rare and is more common if the drugs are taken in much higher doses (as for bone cancer rather than osteoporosis).

Bone-builders

If you already have low bone density (so you’re fighting to rebuild your bones, not just slow deterioration), then you may need more of a boost.

Bone-building medications include Teriparatide/Forteo, Abaloparatide/Tymlos, and Romosozumab/Evenity.

These are usually given by injection, usually for a course of one or two years.

Once the bone has been built up, it’ll probably be recommended that you switch to a biphosphate or other bone-stabilizing medication.

Estrogen-like effects, without estrogen

If your osteoporosis (or osteoporosis risk) comes from being post-menopausal, estrogen is a very common (and effective!) prescription. However, some people may wish to avoid it, if for example you have a heightened breast cancer risk, which estrogen can exacerbate.

So, medications that have estrogen-like effects post-menopause, but without actually increasing estrogen levels, include: Raloxifene/Evista, and also all the meds we mentioned in the bone-building category above.

Raloxifene/Evista specifically mimics the action of estrogen on bones, while at the same time blocking the effect of estrogen on other tissues.

Learn more…

Want a more thorough grounding than we have room for here? You might find the following resource useful:

List of 82 Osteoporosis Medications Compared (this has a big table which is sortable by various variables)

Take care!