Medications for Osteoporosis

Osteoporosis is a bone disease in which bone density and quality are reduced, making bones fragile and far more likely to fracture. Bones are living tissue that are constantly being broken down and rebuilt; in osteoporosis, bone loss outpaces bone formation, leaving bones porous and weak. The condition is most common in older adults — especially postmenopausal women, as the drop in estrogen after menopause accelerates bone loss — but can also affect men and younger people with certain risk factors. Risk factors include aging, female sex, low calcium and vitamin D intake, smoking, heavy alcohol use, physical inactivity, small body frame, and long-term use of medications such as corticosteroids. Osteoporosis itself causes no pain until a fracture occurs; the spine, hip, and wrist are the most commonly fractured sites.

Hip and spinal fractures caused by osteoporosis can lead to chronic pain, loss of height, stooped posture (kyphosis), and significant disability — hip fractures in particular are associated with high rates of complications and mortality in older adults. Prevention and treatment combine adequate calcium and vitamin D intake, weight-bearing exercise, and fall prevention strategies with medication. Bisphosphonates (such as alendronate and risedronate) are the most commonly prescribed class and work by slowing the activity of cells that break down bone. Other options include SERMs (selective estrogen receptor modulators) such as raloxifene, denosumab (a biologic that reduces bone breakdown), and anabolic agents such as teriparatide or romosozumab that stimulate new bone formation. The medications listed below are among the most commonly prescribed for treating and preventing osteoporosis.