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Medications for Osteoporosis

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The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Prescription Medications

Bisphosphonates

  • Alendronate (Fosamax)
  • Risedronate (Actonel)
  • Ibandronate (Boniva)
  • Zoledronic acid (Zometa, Reclast)

Hormone replacement therapy (HRT)

  • Estrogen alone (also called estrogen replacement therapy or ERT)
  • Estrogen and progestin HRT (also called combined HRT)

Other medications

  • Raloxifene (Evista)
  • Calcitonin (Miacalcin)
  • Denosumab (Prolia)
  • Teriparatide (Forteo)

Bisphosphonates

The main bisphosphonates approved for the treatment of osteoporosis are:

  • Alendronate sodium (Fosamax)
  • Risedronate sodium (Actonel)
  • Ibandronate (Boniva)
  • Zoledronic acid (Zometa, Reclast) which is administered through the vein

Other bisphosphonates include pamidronate (Aredia) and etidronate (Didronel).

Among postmenopausal women with osteoporosis, bisphosphonates can provide the following health benefits:

  • Reduced bone loss
  • Increased bone density in the spine and hip
  • Reduced risk of spine and hip fractures

Bisphosphonates that are taken by mouth should be taken on an empty stomach. Therefore, it is recommended that you take it first thing in the morning with a full glass of water, at least 30 minutes before eating, drinking, or taking other medications. To minimize side effects, remain in an upright position for at least 30 minutes after taking this medication.

Possible side effects for bisphosphonates include:

Hormone Replacement Therapy (HRT)

Estrogen Replacement Therapy (ERT)

Common brand names include:

  • Premarin
  • Ogen
  • Estrace
  • Estraderm
  • Estratab

ERT has been used for both the prevention and treatment of osteoporosis. ERT has been shown to reduce bone loss, increase bone density in the spine and hip, and reduce the risk of spine and hip fractures in postmenopausal women. ERT is available as a pill or skin patch.

Although ERT may cut the risk of osteoporosis, it’s important to note that recent research shows a strong association between longer-term ERT or HRT use and a significantly increased risk of invasive breast cancer, strokes, heart attacks, and blood clots. Be sure to discuss all of the health risks and benefits of hormone therapy with your doctor to determine if it is right for you.

Estrogen and Progestin HRT (Combined HRT)

Common brand names include:

  • Activella
  • Femhrt
  • Ortho-Prefest
  • Premphase
  • Prempro

Combined HRT has been used for both the prevention and treatment of osteoporosis. Combined HRT has been shown to reduce bone loss, increase bone density in the spine and hip, and reduce the risk of spine and hip fractures in postmenopausal women. Combined HRT is available as a pill.

Although combined HRT may cut the risk of osteoporosis, it’s important to note that recent research shows a strong association between longer-term ERT or HRT use and a significantly increased risk of invasive breast cancer, strokes, heart attacks, and blood clots. Be sure to discuss all of the health risks and benefits of hormone therapy with your doctor to determine if it is right for you.

Other Medications

Raloxifene (Evista)

Raloxifene is one of a class of drugs called selective estrogen receptor modulators (SERMs). It helps prevent bone loss at the spine, hip, and total body and may increase bone mass. This medication may also reduce the risk of spine fractures, and there is some evidence that it can also reduce the risk of breast cancer. Raloxifene is available as a pill and should be taken once a day, with or without meals.

Possible side effects include:

  • Hot flashes
  • Headache
  • Nausea and vomiting
  • Diarrhea
  • Joint pain
  • Leg pain
  • Sleep problems
  • Increased risk of blood clots and stroke (rare side effects)
Calcitonin (Miacalcin)

Calcitonin is a naturally occurring hormone that slows bone loss, increases bone density, and reduces the risk of spinal fractures. It may also help reduce or relieve the pain of bone fractures. Calcitonin is approved by FDA for women who are at least five years past menopause. It is available as an injection or a nasal spray.

Possible side effects associated with the injected form of calcitonin include:

  • Allergic reaction
  • Flushing of the face and hands
  • Urinary frequency
  • Nausea
  • Skin rash

Nasal calcitonin may cause a runny nose.

Denosumab (Prolia)

Denosumab, given as an injection, is a type of monoclonal antibody. The medication works by targeting cells called osteoclasts, which break down bone. Denosumab is intended for postmenopausal women who have osteoporosis and are at a high risk for fractures.

Common side effects include:

  • Back pain
  • Pain in the extremities
  • Pain in muscles, tendons, ligaments, and bones
  • High cholesterol levels
  • Bladder infections
Teriparatide (Forteo)

Teriparatide is given as an injection from a pen. It is a man-made form of parathyroid hormone, which stimulates bone growth. Teriparatide is indicated for people with osteoporosis who are at high risk for fractures.

Common side effects include:

  • Neck pain
  • Headache
  • Weakness
  • Nausea and vomiting
  • High blood pressure
  • Lightheadedness and fainting
  • Rash
  • Sweating

Special Considerations

Whenever you are taking a prescription medication, take the following precautions:

  • Take your medication as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Know what the results and side effects may be. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medication and herb or dietary supplements.
  • Plan ahead for refills so you don’t run out.

Revision Information

  • Bisphosphonates for treatment and prevention of osteoporosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated April 6, 2013. Accessed July 16, 2013.

  • Calcium and vitamin D for treatment and prevention of osteoporosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated June 25, 2013. Accessed July 16, 2013.

  • Hormonal replacement therapy (HRT) and osteoporosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated January 11, 2012. Accessed July 16, 2013.

  • Managing and treating osteoporosis. National Osteoporosis Foundation website. Available at: http://www.nof.org/articles/235. Accessed July 16, 2013.

  • Osteoporosis overview. NIH Osteoporosis and Related Bone Diseases National Resource Center website. Available at: http://www.niams.nih.gov/Health%5FInfo/Bone/Osteoporosis/overview.asp. Accessed July 16, 2013.

  • Teriparatide. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated February 13, 2013. Accessed July 16, 2013.

  • 7/28/06 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Barrett-Connor E, Mosca L, et al. Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women. N Engl J Med. 2006;355(2):190-192.

  • 6/4/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: FDA approves new injectable osteoporosis treatment for postmenopausal women. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm214150.htm. Published June 1, 2010. Accessed July 16, 2013.

  • 10/25/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: US Food and Drug Administration. Possible increased risk of thigh bone fracture with bisphosphonates. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm229171.htm. Published October 13, 2010. Accessed July 16, 2013.

  • 3/11/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Reid IR, Black DM, et al. Reduction in the risk of clinical fractures after a single dose of zoledronic Acid 5 milligrams. J Clin Endocrinol Metab. 2013 Feb;98(2):557-563.