Medication for Osteoporosis & Low Bone Mass

At NYU Langone, our endocrinologists prescribe several different kinds of medication to treat osteoporosis. They may also prescribe medication for people diagnosed with low bone mass on a bone density test—specifically those who have other risk factors, such as a family history of the condition, prolonged use of corticosteroids, or a previous fracture.

Before deciding on a medication, you and your doctor may discuss the severity of bone loss; which bones are most affected; and any possible medication side effects. Most medications for osteoporosis and low bone mass are well tolerated and very effective in increasing bone density and preventing fractures. 

The medications prescribed for treating people with osteoporosis target the bone remodeling cycle, the process by which bone cells are broken down and remade. During a stage called resorption, bone is broken down and removed by bone cells called osteoclasts. During bone formation, bone is built back up by cells called osteoblasts. 

Osteoporosis medications attempt to either slow the bone loss that occurs in the resorption phase of the cycle or speed up the rate at which bone forms in the formation cycle. The goal is to increase bone density and improve overall strength, thereby reducing the risk of fractures. 

There is not yet a consensus within the medical community on how long to use osteoporosis medications or when to change to a different drug. This is partly due to the fact that, rarely, complications can occur after long-term use of bisphosphonates and denosumab. Most experts agree that the decision should be based on a person’s medical and fracture history, including the degree of osteoporosis, and his or her response to medication.

Antiresorptive Medications

Antiresorptive medications work by inhibiting the activity of osteoclasts, cells that break down bone, so the rate at which people with osteoporosis lose bone slows—but they can still make new bone. 

The most common antiresorptive medications, and among the most widely recommended osteoporosis medications, are called bisphosphonates. They are taken by mouth on a weekly or monthly basis or are administered through a vein as an intravenous (IV) infusion once a year in a doctor’s office or at an infusion center. Bisphosphonates significantly reduce the risk of hip and spine fractures. 

Bisphosphonates are usually well tolerated, although some people have minor gastrointestinal side effects. Sometimes these medications can cause flu-like symptoms for a few days when they are given as an IV infusion. This is temporary, though.

A newer antiresorptive medication called denosumab was approved by the U.S. Food and Drug Administration (FDA) in 2013. It works by targeting an earlier step in the bone remodeling process—preventing osteoclasts from maturing, which keeps them from resorbing, or breaking down, bone. 

Denosumab is administered by your doctor as an injection under the skin every six months. As with bisphosphonates, the medication significantly reduces the risk of hip and spine fractures. 

This medication can lower calcium levels, so it’s important to have your calcium and vitamin D levels checked and regularly report any new symptoms to your doctor.

Estrogen Therapy

Estrogen therapy after menopause can help women maintain bone density. Although the hormone reduces fractures, it has many possible side effects and is not generally prescribed for osteoporosis. 

However, if you are already taking estrogen for other reasons, such as alleviating the symptoms of menopause, your doctor may consider it to be part of your treatment plan for osteoporosis.

Raloxifene

Raloxifene is part of a class of medications called selective estrogen receptor modulators, which were developed to provide the beneficial effects of estrogen without the risks, such as certain cancers. 

Raloxifene increases bone density and reduces spinal fractures. It is taken by mouth once a day. The medication is also prescribed for people with low bone mass to prevent osteoporosis. 

Although side effects are uncommon, raloxifene should not be given to anyone with an elevated risk of blood clots. It is usually prescribed several years after menopause to avoid an increase in hot flashes.

Testosterone

In men whose testosterone level is low, the hormone can be used as additional therapy to help manage osteoporosis. Testosterone builds muscle and increases bone density. 

It is most commonly administered in the form of a gel that you apply on your skin in tiny amounts. Your doctor determines the appropriate dosage.

Teriparatide

If you have osteoporosis and are at high risk for breaking a bone, teriparatide, a type of parathyroid hormone, is a very effective, potent drug. It works by increasing the rate of bone formation in the body. Studies have shown it is associated with a sharp increase in bone density throughout the body. This medicine also decreases the risk of fractures in the spine and at other sites.

Teriparatide is self-administered as a daily injection and is usually prescribed for a maximum of two years. It is typically well tolerated, with occasional redness at the injection site.

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