If you're undergoing osteoporosis treatment, you're taking a step in the right direction for your bone health. But perhaps you have questions about your therapy. Is the medication you're taking the best one for you? How long will you have to take it? Why does your doctor recommend a weekly pill when your friend takes a pill only once a month?
Which medications are commonly used for osteoporosis treatment?
Bisphosphonates are the most common medications prescribed for osteoporosis treatment. These include:
- Alendronate (Fosamax)
- Risedronate (Actonel)
- Ibandronate (Boniva)
- Zoledronic acid (Reclast)
Hormones, such as estrogen, can play a role in osteoporosis prevention and treatment. However, there has been some concern about potential side effects tied to the use of hormone therapy. Current recommendations say to use the lowest dose of hormones for the shortest period of time.
Still, women who have reasons — such as menopausal symptoms — to consider using hormones can weigh the benefit of improved bone health into their decision.
Some hormonelike medications also are approved for preventing and treating osteoporosis, such as raloxifene (Evista).
Denosumab (Prolia, Xgeva) is a newer medication shown to reduce the risk of osteoporotic fracture in women and men. Unrelated to bisphosphonates, denosumab might be used in people who can't take a bisphosphonate, such as some people with reduced kidney function.
Teriparatide (Forteo) is typically reserved for men and postmenopausal women who have very low bone density, who have had fractures or whose osteoporosis is caused by steroid medication. Teriparatide has the potential to rebuild bone.
Abaloparatide (Tymlos) is the newest osteoporosis medication. Like teriparatide, it has the potential to rebuild bone. In a research trial comparing these two treatments, abaloparatide appeared to be as effective as teriparatide but was less likely to cause an excess of calcium.
How do most osteoporosis medications work?
With the exception of teriparatide, osteoporosis medications slow bone breakdown. Healthy bones continuously break down and rebuild.
As you age — especially after menopause — bones break down faster. Because bone rebuilding cannot keep pace, bones deteriorate and become weaker.
Osteoporosis medications basically put a brake on the process. These drugs effectively maintain bone density and decrease the risk of breaking a bone as a result of osteoporosis.
How do you know if you're taking the right bisphosphonate?
Drugs in the bisphosphonate class are more alike than they are different. They all help maintain bone density. And, all bisphosphonates have been shown to reduce the chance of a fracture.
The decision to take one drug over another often is based on:
- Preference
- Convenience
- Adherence to the dosing schedule
- Cost, including whether or not the drug is a "preferred" option on your insurance company's list of acceptable medications (formulary)
- Coughing
Your doctor might recommend a monthly dose of medication if it's going to be better tolerated or better accepted. But if you're likely to forget to take your medicine on a monthly schedule, you might do better-taking medication once a week.