Osteoporosis is a disease that causes bones to become weak and brittle. In osteoporosis, bones may fracture easily, causing chronic pain, deformity, and loss of height and mobility. There are now more treatments for osteoporosis than ever before. Osteoporosis treatments fall into three main categories: medications, surgeries, and lifestyle changes.

Types of Treatments for Osteoporosis

Most treatments are appropriate for primary osteoporosis. Secondary osteoporosis, which is caused by another health condition or a medication, may be treated in accordance with its specific cause. Read more about types of osteoporosis.

Your doctor may prescribe calcium and vitamin D supplements along with your osteoporosis medication. Many osteoporosis drugs are not effective – and may cause problems – if there are low levels of calcium and vitamin D in your body.

Some osteoporosis treatments are approved for women only. Many osteoporosis medications are not approved for use in women who have not yet entered menopause. Your doctor can help you find the osteoporosis treatment that is best for you.

Medications for Osteoporosis

Prolia (Denosumab)

A newer treatment on the market, Prolia is a biologic drug — a genetically engineered antibody, or protein used by the immune system to identify and neutralize substances. Prolia is believed to work by limiting the number of osteoclasts — the cells that break down bone — thereby limiting the breakdown and resorption of bone. Prolia is administered once every six months by injection.

Common side effects of Prolia include:

• Bone or muscle pain
• Urinary tract infections
• Cold symptoms

Rare but serious side effects of Prolia can include:

• Upper leg fractures
• Severe rashes and skin infections
• Osteonecrosis (bone death) of the jaw, especially after dental surgery

Bisphosphonates

Bisphosphonates are one of the most common classes of drugs prescribed for osteoporosis. Bisphosphonate drugs include:

• Alendronate (also known as alendronic acid and sold under the brand name Fosamax)
• Boniva (ibandronate)
• Reclast (zoledronic acid)
• Risedronate, sold under the brand names Actonel and Atelvia

Bisphosphonates are believed to work in cases of osteoporosis by reducing the activity of osteoclasts. Some bisphosphonates are taken orally, while others are injected intravenously. Dosing schedules vary widely, with different formulations taken each week, once a month, or even once a year.

Common side effects of bisphosphonates include bone or muscle pain and, for those taken orally, gastrointestinal problems. Rare but serious side effects of bisphosphonates can include osteonecrosis (bone death) of the jaw, especially after dental surgery.

Hormonal Treatments

Sold under the brand names Fortical and Miacalcin, calcitonin is a synthetic version of a hormone secreted by the thyroid gland. Calcitonin is believed to work by reducing the activity of osteoclasts, the cells that break down bone. Calcitonin can also improve bone pain after a fracture. Calcitonin can be taken via intranasal spray or by subcutaneous or intramuscular injection. Rarely, calcitonin can increase the risk for developing certain types of cancer.

Forteo (teriparatide) is a synthetic version of parathyroid hormone (or PTH). Forteo is believed to work by stimulating the activity of osteoblasts, the cells that build bone. Forteo is taken daily by injection.

Tymlos (abaloparatide) is an anabolic hormone believed to work in cases of osteoporosis by stimulating the body to build up bones. Tymlos is taken daily by injection.

For some people, hormone replacement therapy (HRT) may provide an effective way to prevent or treat osteoporosis. HRT replaces the estrogens and progesterone that have a protective effect on bone density before a person goes through menopause. The most common ways to receive HRT are via oral medication:

• Topical creams
• Vaginal ring
• Transdermal patch applied to the skin

Side effects include an increased risk of blood clots and heart disease.

Raloxifene, sold under the brand name Evista, is a selective estrogen receptor modulator (SERM). Raloxifene is believed to work by mimicking the effects of estrogen, which helps protect bone density. Raloxifene is a tablet taken daily.

Duavee is a combination drug composed of a mixture of estrogens and bazedoxifene (another SERM), both of which are believed to work by protecting bone density. Duavee is taken orally once a day.

Surgeries To Repair Fractures

Spinal surgery may become necessary in cases of osteoporosis where a vertebral compression fracture is causing severe pain or deformity that a back brace can not resolve. There are two main types of surgery for vertebral compression fractures: vertebroplasty and kyphoplasty. Both techniques are guided by X-ray imaging and may involve a small incision or a needle only.

In vertebroplasty, the surgeon injects a highly specialized cement mixture into the collapsed vertebra. When the cement hardens, the vertebra will be stabilized. Stabilization prevents painful friction, further collapse, and the development of deformity.

Kyphoplasty is similar to vertebroplasty, but the surgeon first inserts a small balloon into the compressed vertebra and inflates it to create space. They then inject the bone cement.

In those who experience hip fractures, hip repair or replacement surgery are usually necessary. The technique and materials used to repair or replace the hip will depend on the type of fracture. Hip surgery requires a long, slow recovery. It may take a year to recover from hip surgery, and some people never regain full mobility. The risk of death increases in the year following hip surgery.

Wrist fractures may require only a cast or splint to heal, but more complex fractures may necessitate surgery to repair.

Lifestyle Changes

Diet and Nutrition

For people with osteoporosis, nutrition can help build stronger bones, maintain a healthy weight, and avoid developing complications such as diabetes and heart disease. People with osteoporosis need more of some nutrients than other people.

Make sure to eat plenty of foods with calcium and vitamin D to fight osteoporosis. Foods rich in vitamin D include:

• Tuna
• Mackerel
• Salmon
• Egg yolks
• Fortified products such as some milk, soy milk, orange juice, and cereal

Calcium is present in:

• Dairy products
• Dark leafy greens such as kale
• Sardines
• Fortified soy milk and orange juice

Some foods and beverages can interfere with calcium absorption. Consume these products in moderation and with care. Legumes (beans, dried peas, peanuts), nuts, and some seeds contain chemicals called phytates that can lower calcium absorption. Extremely salty foods can cause the body to lose calcium. Make sure you get sufficient protein in your diet, but avoid getting too much. Some popular high-protein diets can have a negative effect on bone mass. Too much alcohol and caffeine (especially colas) can have a negative effect on bone mineral density as well.

Exercise

People with osteoporosis, especially those who have experienced fractures, may avoid exercise for fear of falling or causing additional fractures. However, staying physically active can help those with osteoporosis strengthen bones, prevent falls, decrease the risk for fractures, and improve balance and flexibility.

Your doctor can help guide you toward activities that are safe and effective for your condition. For example, activities that involve jumping, bending, or twisting may be dangerous for those with a high risk for fractures. Weight-bearing exercises strengthen bones and muscles. Weight-bearing activities can range from rapid walking to stair-climbing, using an elliptical machine, dancing, or lifting weights. Even bearing your own body weight or lifting very light weights can build bones. Many weight-bearing exercises can be done in a seated position.

Improving balance and flexibility can help you avoid falls. Regular stretching is good for flexibility. Exercises that focus on balance and flexibility include tai chi and yoga.

Daily activities such as shopping, gardening, or walking a pet can also provide safe, valuable exercise.

Other Changes

If you are living with osteopenia or osteoporosis, quitting smoking is one of the best things you can do to protect your bones. Smoking has been proven to decrease bone density, raise the risk for fractures, and slow bone healing.

If you are at a high risk for fractures, consider fall-proofing your home. If you are unsteady walking, consider using a cane or walker outside the house to avoid falls.

Condition Guide

• Osteoporosis — An Overview
• Osteoporosis Symptoms
• Osteoporosis — The Path to Diagnosis
• Types of Osteoporosis
• What Causes Osteoporosis?