Types of osteoporosis medication

There are different types of medications for osteoporosis. Their use depends on an individual’s clinical history.

For instance, hormonal changes in postmenopausal people are primarily responsible for reducing bone density. Hence, hormone replacement therapy is part of osteoporosis treatment for this age group.

Different osteoporosis medications have unique mechanisms of action and side effects.

Types of osteoporosis medications

Here are the classes of osteoporosis medications.

Bisphosphonates

Bisphosphonates are medications that reduce bone breakdown and inhibit the activity of bone cells responsible for bone breakdown. The drugs in this group bind strongly to calcium and attach to the bone surface. Bisphosphonates come in oral and intravenous (IV) forms.

Usually, the body absorbs oral bisphosphonates poorly. Drug absorption decreases further when a person takes them with food, calcium, or beverages other than water.

Gastrointestinal discomforts and symptoms such as difficulty swallowing and inflammation of the esophagus are possible side effects of oral bisphosphonates. IV bisphosphonates have fewer gastrointestinal side effects, but some individuals may have a flu-like reaction to the infusion.

Examples of bisphosphonates are:

• alendronate (Fosamax)
• risedronate (Actonel, Atelvia)
• ibandronate (Boniva)
• zoledronic acid (Reclast)

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Parathyroid hormone

Parathyroid hormone (PTH) medications stimulate bone formation by activating specific bone stem cells and inhibiting bone breakdown. PTH also stimulates the production of several growth factors in bone cells, which promotes bone formation.

PTH is most effective at stimulating bone growth in low doses. PTH medications are available in subcutaneous injections (under your skin).

Common examples of PTH drugs are:

• teriparatide (Forteo)
• abaloparatide (Tymlos)

Administration of teriparatide could cause these side effects:

• skin discoloration at the injection site
• headache
• nausea
• elevated blood calcium level

Calcium and vitamin D supplements

Vitamin D regulates the blood level of calcium, the mineral responsible for strengthening the bone and its density.

People with low calcium and vitamin D levels may require supplements to boost the concentration of these minerals.

Hormone replacement therapy

This therapy aims to boost estrogen levels in postmenopausal people.

Hormone replacement therapy (HRT) usually helps to increase bone mass density and reduce bone breakdown. Typically, medications that activate or inhibit estrogen activity are the HRT drugs doctors use for osteoporosis treatment.

Examples are:

• tibolone (Livial)
• raloxifene (Evista)

The side effects of raloxifene may include the following:

• deep vein thrombosis
• hot flashes
• leg cramps

Monoclonal antibody therapy

Monoclonal antibody therapy uses medications that inhibit bone breakdown by binding to a specific protein in the bone tissues. This type of therapy may also increase bone formation and density. Monoclonal antibody medications are available in subcutaneous forms.

Common examples are

• denosumab
• romosozumab

Side effects of denosumab are:

• hypocalcemia
• nausea
• musculoskeletal pain
• skin reactions
• infections, including urinary tract infections (UTIs)

Potential side effects of Romosozumab include:

• joint pains
• headache
• hypersensitivity reactions such as angioedema and urticaria

Other osteoporosis medications

Other available medications can help with the treatment of osteoporosis.

Fluorides

Fluorides can increase bone density and strength, as well as help promote bone growth factors. A 2021 meta-analysis of inflammatory bowel disease patients found that a daily dose of 20 milligrams (mg) of fluoride equivalents significantly decreased the risk of bone fractures and increased bone density.

An example of fluoride is sodium fluoride.

Can you treat osteoporosis without medication?

Some lifestyle choices trigger chronic inflammation or affect the blood calcium level, resulting in bone weakness and a reduction of bone density. Therefore, changes to these habits can improve blood calcium levels and reduce the risk of osteoporosis.

Making certain lifestyle and dietary changes can aid in the treatment and prevention of osteoporosis by helping people:

• avoid exposure to environmental toxins
• reduce intake of alcohol and cigarette smoking
• increase the intake of calcium-fortified foods
• reduce the intake of coffee and refined salt
• engage in physical activity
• avoid prolonged intake of drugs such as corticosteroids

Summary

Osteoporosis medications work via different mechanisms to either reduce the rate of bone breakdown or stimulate bone formation.

Bisphosphonates are common osteoporosis medications that help to reduce bone tissue loss, while parathyroid medications trigger bone formation. In postmenopausal people, estrogen replacement therapy may decrease the progression of bone loss and the risk of bone fractures.

In some individuals, calcium and vitamin D supplements can strengthen bones and increase bone density. Lifestyle modifications and dietary changes are natural remedies for preventing or managing osteoporosis without medications.