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Patient education: Medicines for osteoporosis (The Basics)

Patient education: Medicines for osteoporosis (The Basics)

What do osteoporosis medicines do? — If you have osteoporosis or a high risk of breaking a bone, the medicines your doctor prescribes can:

Reduce bone loss

Increase bone density or keep it about the same

Reduce the chances that you will break a bone

For the medicines to work, you must also take in enough calcium and vitamin D. Your doctor or nurse will tell you how much calcium and vitamin D you need each day. Many people need supplements to get enough.

Which medicines might I need? — There are many different osteoporosis medicines. Your doctor will work with you to choose the best one for you.

The list below gives basic information on osteoporosis medicines. The table lists the names of some common osteoporosis medicines (table 1).

For more detailed information about your medicines, ask your doctor or nurse for the patient drug information handout from UpToDate. It explains how to use each medicine, describes its possible side effects, and lists other medicines or foods that can affect how it works.

Bisphosphonates — Most people being treated for osteoporosis take these medicines first. If they do not work well enough or cause side effects that are too troublesome, there are other options.

Bisphosphonates come as a pill or a shot. Most people take 1 pill every week. If your doctor prescribes a bisphosphonate pill, you must take the medicine exactly as directed. If you don't, the medicine can irritate your throat or stomach. For most bisphosphonate pills, you must:

Take the pill first thing in the morning, before you eat or drink anything.

Drink an 8-ounce glass of water with the pill, but don't eat or drink anything else for 30 minutes or 1 hour (depending on which pill you take).

Avoid lying down for 30 minutes after taking the pill. You must sit or stand during that time.

There is 1 bisphosphonate pill, delayed-release risedronate (brand name: Atelvia), that is taken in a different way from the others. It is taken after breakfast with 4 ounces of water.

"Estrogen-like" medicines — Medicines called selective estrogen receptor modifiers ("SERMs") act like the hormone estrogen. Estrogen helps prevent bone loss.

After menopause, when monthly periods stop, the body has less estrogen. SERMs can act like estrogen to stop bone loss. Some of them also reduce the risk of breast cancer in women at high risk. SERMs are only for people who have gone through menopause.

Hormone medicines — These medicines are sometimes called "menopausal hormone therapy" ("MHT"). After menopause, the body has lower levels of certain hormones. Some people take MHT to treat bothersome symptoms related to this, such as hot flashes. MHT can also protect against osteoporosis.

Hormones are not used often to treat osteoporosis in people who have gone through menopause. This is because other medicines usually work much better. But people who take MHT for hot flashes will have the extra benefit of preventing osteoporosis.

People who have not gone through menopause but have problems with their periods might take hormones in birth control pills or a patch.

Some males get osteoporosis because their bodies do not make enough of a hormone called "testosterone." If this happens, doctors can give testosterone to prevent or treat the osteoporosis.

PTH or PTHrP analog — Both of these are artificial forms of hormones the body makes naturally. PTH stands for "parathyroid hormone," and PTHrP stands for "parathyroid hormone-related protein." Both tell the body to make new bone. They are usually only for people with severe osteoporosis.

Romosozumab — This is a medicine that blocks a protein in the body. The protein usually stops new bone from being formed. Blocking the protein lets the body make new bone. Romosozumab is usually only for people with severe osteoporosis.

Denosumab — This blocks a different protein in the body. The protein usually causes bone to break down. By blocking the protein, denosumab reduces bone loss and the chance of breaking a bone. If other osteoporosis medicines cause bad side effects or do not help, your doctor might give you denosumab. It might also be a good choice for people with kidney problems.

When you stop taking denosumab, your bone density goes down again very quickly. Some people might be at higher risk for breaking a bone when this happens. If you stop denosumab, your doctor will prescribe a different osteoporosis medicine to prevent rapid bone loss.

How long do I need to take osteoporosis medicines? — If you remain at high risk for breaking a bone, you can safely take osteoporosis medicines for many years. If you are no longer at high risk for breaking a bone, you might be able to stop your medicine for a year or more. If you do stop the medicine, your doctor will check your bone density to make sure that you are not losing too much bone. You might need to start an osteoporosis medicine again later.

What else should I know about medicines for osteoporosis? — Some people have heard that taking bisphosphonates or denosumab for a long time can increase the risk of breaking certain bones. This is true, but it happens very rarely. Your chances of breaking a bone from osteoporosis are much higher than your chances of breaking one because you take bisphosphonates or denosumab.

Some people are at higher risk for breaking a bone after stopping denosumab. When denosumab is stopped, your doctor will prescribe a different osteoporosis medicine.

If you take osteoporosis medicines, your doctor will do regular exams and tests to see how well the medicines are working. If they are not working well, you might need a different medicine.

More on this topic

Patient education: Osteoporosis and osteopenia (low bone mass) (The Basics)
Patient education: Bone density testing (The Basics)
Patient education: Calcium and vitamin D for bone health (The Basics)

Patient education: Osteoporosis prevention and treatment (Beyond the Basics)
Patient education: Bone density testing (Beyond the Basics)
Patient education: Calcium and vitamin D for bone health (Beyond the Basics)

This topic retrieved from UpToDate on: Jun 02, 2024.
Disclaimer: This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms. 2024© UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
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