What do they do?

When bones are weakened by corticosteroid use or disease, osteoporosis medications can help increase bone density and reduce the risk of fractures over time.

How do they work?

Osteoporosis drugs work in different ways to strengthen bones. For example, bisphosphonates work by slowing the activity of bone-ingesting cells called osteoclasts, while teriparatide works to stimulate the production of bone-forming cells called osteoblasts.  

Who are they for?

Osteoporosis drugs are for people who are at risk of fractures due to fragile bones.

Doctors look at several pieces of information to determine fracture risk. One important piece of information is a history of previous fractures. For many people, a fracture is the first indication of osteoporosis that requires treatment. Another key piece of information the patient’s bone mineral density, as determined by a quick and painless dual-energy X-ray absorptiometry (DEXA) scan of the hips, spine and wrists – the bones most likely to break due to osteoporosis. People should have a DEXA scan at age 65 and at a younger age if they take corticosteroids (such as prednisone) or have rheumatoid arthritis.

For those who have a DEXA scan, results are given as a Tscore, which compares the strength of a person’s bones with the peak bone mass of young adults. If bone density is normal, the Tscore will be at or above -1. A T score ranging from -1.1 to -2.4 indicates osteopenia, a preosteoporosis condition. Osteoporosis is diagnosed if the T score is `-2.5 or lower.

The National Osteoporosis Foundation recommends starting treatment for people whose T score is -2.0 or lower, or for those who have additional risk factors (such as taking a corticosteroid) and a T score lower than -1.5. For patients on bone medications, or for those who remain at risk for osteoporosis, bone density tests may need to be repeated every one to two years. When deciding whether it’s time to prescribe an osteoporosis medication, a doctor also considers a patient’s family history of osteoporosis: lifestyle (calcium intake, exercise, smoking, alcohol use); and other factors, such as age, gender, height and weight.

Increasingly doctors are turning to an online tool called FRAX to determine fracture risk and the need for osteoporosis medications. Developed by the World Health Organization, FRAX integrates the risks associated with bone density at the femoral neck with other factors identified through population studies to evaluate the 10-year probability of hip fracture and 10-year probability of a major osteoporotic fracture. All of the drugs listed in this chart – except for estrogens and raloxifene – can be used by men as well as women.

What’s important to know about the drug class?

Except for estrogens and selective estrogen receptor modulators, osteoporosis medications can be taken by men as well as women In fact, three osteoporosis treatments – alendronate (Fosamax), risedronate (Actonel) and teriparatide injection (Forteo) – have been studied specifically in men and are FDA-approved for use in men at high risk of fracture due to osteoporosis.

Like all medications, those used to treat osteoporosis have risks. For example, estrogens have been associated with an increased risk of breast cancers and cardiovascular disease, and  bisphosphonates have been associated with osteonecrosis of the jaw and atypical fractures of the thigh bone.

Regardless of the drug you use, it is important to follow a bone-healthy lifestyle. Eat plenty of foods rich in calcium, exercise regularly, drink alcohol only in moderation, avoid cigarettes and speak with your doctor about a vitamin D supplement and any medications you are taking that may be harming your bones.

See all osteoporosis drugs.