For patients at high risk, drug treatments are needed to effectively reduce the risk of broken bones due to osteoporosis. 

Today there is a wider variety of osteoporosis treatment options than ever before. The type of treatment you are prescribed will depend on your individual risk profile. This includes the risk for a specific type of fracture (spine versus hip), other medical conditions, or medications you may take. Finally, cost and cost-effectiveness considerations, insurance plans and reimbursement policies will undoubtedly also influence your doctor’s recommendations of therapeutic options.

Treatments have been shown to reduce the risk of hip fracture by up to 40%, vertebral fractures by 30-70% and, with some medications, reduce the risk for non-vertebral fractures by 15-20%. 

There are two main types of treatment: anti-resorptive agents reduce bone destruction and therefore preserve bone mineral density (BMD), while anabolic agents stimulate bone formation, thereby increasing BMD.

Medically approved drug therapies for the treatment of osteoporosis and prevention of fractures include:

• Bisphosphonates (alendronate, risedronate, ibandronate, zoledronic acid)
• Raloxifene and bazedoxifene 
• Teriparatide and abaloparatide
• Denosumab
• Romosozumab
• Menopausal Hormone Therapy (MHT)*

Not all of these drugs are available in every country. 

*MHT (oestrogen with or without progestin) is not a primary treatment for osteoporosis but has been shown to increase BMD and lower fracture risk in women after menopause. MHT is only recommended for younger postmenopausal women for the treatment of menopausal symptoms, with no contra-indications to its use, and for a limited period of time of approximately 10 years.

Overall, the common medically approved therapies have been shown to be safe and effective. There are potential side effects with any medication, and it is important to be aware of these. Each type of medication has different mechanisms of action and a distinct profile of side effects. For people at high risk of fracture, the benefit of a treatment in decreasing the risk of fracture far outweighs the rare occurrence of serious side effects. If you have any concerns, don’t stop taking medication without discussing with your doctor.

Like all medication, osteoporosis treatments can work only if they are taken properly. As reported for other chronic diseases, up to half of patients with osteoporosis stop their treatment after only one year. If you have been prescribed osteoporosis medication, you should keep in mind that by adhering to your treatment, you can benefit from larger increases in BMD, lose less bone mass, and reduce your fracture risk. 

Unlike when you take medication for an infection, you will not be able to tell if the osteoporosis treatment is effective. That’s why good communication between you and your doctor is important. Again, if you have any questions or concerns, don’t stop medication without discussing options with your doctor.  Stopping the treatment will increase your chances of having a fracture, which can have life-changing consequences.

In addition to drug therapy, calcium and vitamin D supplements can be prescribed to ensure maximum effectiveness of your medication. You should be aware that attention to lifestyle factors (including risk factors, nutrition and exercise) must go hand in hand with any drug treatment prescribed.

Practical and emotional support is important for anyone on osteoporosis treatment. This can be provided by health professionals, osteoporosis patient support groups, family and friends. Such support will help you manage your osteoporosis, and lessen any feelings of isolation and depression (experienced by many patients with severe osteoporosis). Contact your local osteoporosis society to find support and to ask about local support groups.