Treatment with Osteoporosis Medication

There are many things to think about when choosing the right osteoporosis medicine. You and your healthcare provider may want to look at:

Your sex. Calcitonin (Fortical^® and Miacalcin^®), estrogen and hormone therapies, and estrogen agonists/antagonists (Evista^®) are only approved for women. Some bisphosphonates (Actonel^® , Atelvia^®, Fosamax^® and Reclast^®), denosumab (Prolia^®) and teriparatide (Forteo^®) are approved for both men and women. 

Your age. Some medicines may be more appropriate for younger postmenopausal women while others are more appropriate for older women.

In general, osteoporosis medicines are not recommended for premenopausal women. Certain osteoporosis medicines are approved for the prevention and treatment of osteoporosis in premenopausal women as a result of the long-term use of steroid medicines. In very rare cases, healthcare providers may recommend that some premenopausal women consider taking an osteoporosis medicine if they’ve had a broken bone caused by low bone density or have experienced bone loss from a rare medical condition.

How severe your osteoporosis is. Osteoporosis medicines work in different ways. A person with more severe bone loss or a broken bone may take a different medicine than a person with less bone loss.  Other health problems you may have. Your healthcare provider will consider other health problems you have when recommending a medicine. If you have had breast cancer or blood clots, for example, you should not take estrogen. Also, if your bones have been exposed to radiation treatment, you should not take teriparatide (Forteo^®).

Personal preference. Do you prefer a pill, liquid or IV medicine or one that is given as a nasal spray or an injection? Does it work better for you to take your medicine every day, once a week, once a month, several times a year or even once a year? Do you have negative feelings about a particular drug? Any of these factors could influence your treatment decision. It’s also important to keep in mind that no two people are the same. How well a medicine works, or what side effects it will have, can vary from one person to the next.

Medicines Approved to Prevent and/or Treat Osteoporosis

*Estrogen is also available in other preparations including a vaginal ring, as a cream, by injection and as an oral tablet taken sublingually (under the tongue). The vaginal preparations do not provide much bone protection.

Bone Density and FRAX Results and Treatment

A bone density test is the best way to diagnose osteopororsis and determine a treatment plan. The T-score result on a bone density test falls into three categories: normal density, low density (sometimes called osteopenia) and osteoporosis. The chart below on Bone Density Testing indicates when you should speak with your doctor or other healthcare provider about possible treatment with an osteoporosis medicine.

If your DXA shows that you have low bone density, your healthcare provider will also do a FRAX test. FRAX uses your bone density and additional information about you to predict your risk of breaking a bone in the next ten years. People at high risk of breaking a bone should always speak with their healthcare provider about treatment options. Individuals at highest risk are those who have had previous broken bones of the spine (vertebral fractures) or hip. Almost all people with these types of broken bones need treatment for osteoporosis. People with other fractures may also need treatment.

Bone Density Test and FRAX Results and Treatment

**To help understand low bone density, NOF has presented the T-scores differently than in its clinical guidelines.

Special Note: All medicines have potential side effects. When making a decision about taking a medicine, NOF encourages you to discuss your treatment options with your healthcare provider and to look at both the risks and benefits of taking or not taking a medicine.