Osteoporosis Treatment Everyday Health MenuNewslettersSearch Osteoporosis Osteoporosis TreatmentLearn how lifestyle changes and medications can help you manage your risks of bone fractures. By Cathy CassataMedically Reviewed by Michael Natter, MDReviewed: July 29, 2022Medically ReviewedA variety of medicines can be prescribed to lower fracture risk in osteoporosis.iStock.comWhile there is no cure for osteoporosis, a disease in which bones become brittle and weak, various medicines and lifestyle approaches can help slow the rate of bone loss and reduce your risk of bone fractures. It’s important to talk with your doctor about the best osteoporosis treatment options for you. All drugs have side effects, and some osteoporosis drugs have rare side effects that could actually harm your bones. Treatment Plan Depends on Fracture Risk Your doctor can develop your osteoporosis treatment plan based partly on your fracture risk. Besides looking at your bone mineral density and personal variables, one way of quantifying fracture risk is by using FRAX, a fracture risk assessment tool developed at the University of Sheffield in the United Kingdom. (1) FRAX calculates the 10-year probability of experiencing a bone fracture based on a person’s risk factors, such as age and family history, as well as the person’s bone mineral density at the femoral neck — the section of bone that connects the femur (thigh bone) to the “ball” of the hip joint (known as the femoral head). Bone mineral density is measured with a dual energy X-ray absorptiometry (DXA or DEXA) test, a low-radiation X-ray. If your fracture risk is determined to be low and you are diagnosed with osteopenia, you may be advised to make lifestyle changes — such as adopting a healthy diet, performing more weight-bearing exercise, stopping smoking if you smoke, and cutting back on alcohol if you drink — and to take precautions to reduce your risk of a fall, but not to take medication. If you are at increased risk for a break in the near future, your doctor may prescribe a medication to try to restore the balance of bone resorption and formation in your body. A variety of types of drugs are prescribed for osteoporosis, including:Anti-resorptive medication — which includes bisphosphonates, hormone therapy, and some other drug classes — which slow the breakdown of boneAnabolic drugs, of which there are two approved for osteoporosis, which promote bone formation The hope is that these therapies will lower the risk for fractures, which is the ultimate goal of treatment. Common Osteoporosis Medication The most commonly used osteoporosis drugs are bisphosphonates, which slow bone loss by slowing the bone breakdown part of the bone remodeling cycle. (2,3) Bisphosphonates include:alendronate (Fosamax)risedronate (Actonel)ibandronate (Boniva)zoledronic acid (Reclast) All of these drugs are approved for postmenopausal women, and all but Boniva are also approved for men. Common side effects of bisphosphonates include gastrointestinal issues, such as nausea, heartburn, and stomach pain.The drugs may also cause muscle, bone, and joint pain, and bisphosphonates given intravenously (by IV) may cause flu-like symptoms. If these symptoms arise, it is usually during infusion, but they generally resolve one to two days afterward. In very rare cases, atypical fractures of long bones, such as the thighbone, have been reported by patients who have taken bisphosphonate therapy for more than five years. However, the risk is extremely low. Additionally, bisphosphonates have — in rare cases — been associated with jawbone deterioration (osteonecrosis). Your doctor may advise you to complete any significant dental work prior to starting bisphosphonate therapy. Other Osteoporosis Drugs Other medication for osteoporosis includes:calcitonin (Fortical)Estrogen agonists or antagonists, also called selective estrogen receptor modulators (SERMs), such as raloxifene (Evista) and bazodocifene (Duavee)Parathyroid hormone-related protein (PTHrP) analogs (anabolic agents), including teriparatide (Forteo) and abaloparatide (Tymlos)denosumab (Prolia)romosozumab (Evenity) Calcitonin, raloxifene, bazodocifene, abaloparatide, and romosozumab are approved only for post-menopausal women, while teriparatide and denosumab are also approved for men at high risk of fracture. In some cases, these drugs are used only in certain populations (peri- or post-menopausal women and women at high risk of breast cancer, for example) or only in people for whom other osteoporosis treatments haven’t worked. Evenity has a black box warning because of data linking the drug to an increased risk of cardiovascular adverse events. (4,5) Hormone Therapy for Osteoporosis At one time, hormone therapy was the only approved treatment for osteoporosis in women. It fell out of favor after the hormone therapy arms of the Women’s Health Initiative (WHI) study were stopped early in 2002 and 2004 because of safety concerns. Early analyses appeared to link combined estrogen and progestin with an increased risk of breast cancer and cardiovascular disease and more harm than benefit overall in postmenopausal women. Estrogen alone appeared related to an increased risk of stroke and no benefit for coronary artery disease. (6) But later analyses have not found the same risks associated with hormone therapy. For example, a follow-up study published in 2017 found that neither estrogen plus progestin taken for a median of 5.6 years, nor estrogen alone taken for a median of 7.2 years, was associated with increased risk of all-cause, cardiovascular, or cancer mortality during a cumulative follow-up of 18 years. (7) If you have persistent menopausal symptoms or cannot take other medication for osteoporosis, your doctor may recommend hormone therapy for osteoporosis. (8) All medications have risks and benefits that patients should discuss with their doctor. When the benefits clearly outweigh the risks, then patients, in conjunction with their doctors, should consider medical treatment. Stem Cell Treatment the Subject of Research A 2016 study found that infusions of stem cells shed by babies into their mother’s amniotic fluid may help treat rare bone conditions, as well as osteoporosis. (9) Scientists investigated whether stem cells collected from human amniotic fluid and given to mice through infusions could help strengthen weak bones in mice. They discovered that they could, and that the stem cells released growth factors that made the mice’s bone cells multiply and mature more effectively. The treatment led to 78 percent fewer fractures in animals that were bred to have a brittle bone disorder, according to researchers, who hope to begin a clinical trial in humans soon. Additionally, in a 2016 study, researchers in Toronto infused stem cells from healthy mice into other mice that had osteoporosis. Researchers reported that the mice with osteoporosis grew stronger skeletons, and that their bones regained the healthy coral-like appearance that osteoporosis destroys. (10) However, it should be noted that while animal studies can be promising, that does not always translate to efficacy in humans. Further studies are needed to show safety and efficacy in humans. NEWSLETTERS Sign up for our Chronic Pain Newsletter SubscribeBy subscribing you agree to the Terms of Use and Privacy Policy. Editorial Sources and Fact-Checking Welcome to FRAX. FRAX Fracture Risk Assessment Tool.Osteoporosis. Mayo Clinic. August 21, 2021.Medication and Treatment Adherence. Bone Health & Osteoporosis Foundation. September 7, 2018.Saag KG, Petersen J, Brandi ML, et al. Romosozumab or Alendronate for Fracture Prevention in Women With Osteoporosis. The New England Journal of Medicine. October 12, 2017.Safety Scare Prompts FDA to Reject Amgen’s Romosozumab. Fierce Biotech. July 17, 2017.Women’s Health Initiative. National Heart, Lung, and Blood Institute.Manson JE, Aragaki AK, Rossouw JE, et al. Menopausal Hormone Therapy and Long-Term All-Cause and Cause-Specific Mortality. Journal of the American Medical Association. September 12, 2017.Menopausal Hormone Therapy in the Prevention and Treatment of Osteoporosis. UpToDate. October 21, 2021.Ranzoni AM, Corcelli M, Hau K-L, et al. Counteracting Bone Fragility With Human Amniotic Mesenchymal Stem Cells. Scientific Reports. December 20, 2016.Kiernan J, Hu S, Grynpas MD, et al. Systemic Mesenchymal Stromal Cell Transplantation Prevents Functional Bone Loss in a Mouse Model of Age-Related Osteoporosis. Stem Cells Translational Medicine. March 17, 2016.Show Less The Latest in Osteoporosis New Guidance for Osteoporosis Management in Older Women ReleasedTargeted pharmacologic therapies for prevention may make sense for women at high risk of fracture.By Becky UphamSeptember 13, 2021 Study Finds Osteoporosis Is Underdiagnosed and Undertreated in MenA very small percentage of older men with bone fractures had recent bone mineral density testing.By Brian P. DunleavyNovember 12, 2020 New Guidelines Released for Osteoporosis Therapy During the COVID-19 PandemicBone health experts emphasize the importance of continuing drug therapies and provide recommendations for those who must miss a treatment.By Becky UphamMay 12, 2020 For Postmenopausal Women More Physical Activity May Mean Fewer Hip FracturesA large study finds that older women who spend more time being active have fewer hip fractures.By Becky UphamOctober 28, 2019 Statins Are Associated With a Higher — or Lower — Risk of Osteoporosis Depending on the DoseA new study finds that low daily doses of these cholesterol-lowering medications are associated with lower osteoporosis risk, while higher doses are associated...By Don RaufOctober 4, 2019 To Prevent Fractures Get the Order of Osteoporosis Drugs Right Study SaysNew research suggests that bisphosphonate use before taking Prolia could reduce fracture risk after discontinuation.By Becky UphamJune 20, 2019 Study Shows a Higher Than Expected Risk for OsteoporosisNutrition and physical activity are linked to men's and women's loss of bone density at younger ages.By Becky UphamJune 5, 2019 New Osteoporosis Drug Evenity Approved by the FDAThe bone-building therapy offers new treatment benefits, but also new risks.By Becky UphamApril 16, 2019 New Osteoporosis Guidelines Issued for Postmenopausal WomenNew guidelines encourage medication for women at high risk of fracture but permit ‘drug holidays’ for some.By Shari RoanMarch 26, 2019 Reclast Zoledronate Prevents Fractures in Women With OsteopeniaNew study results open up a treatment option for older women at risk for bone fracture.By Brian P. DunleavyDecember 27, 2018 MORE IN Estrogen Types Replacement Therapies and Side Effects Vitamin D Supplements Don t Lower Risk of Fractures Study Finds New Statement for Management of Osteoporosis in Post-Menopausal Women Released