Know the pros and cons of common osteoporosis medications

May 16, 2019

Providence Optimal Aging Team

[5 MIN READ]

It’s a serious diagnosis, but not an uncommon one. Millions of people — most of them women — have osteoporosis or are at risk for developing it. The National Osteoporosis Foundation estimates that one in two women will break a bone due to osteoporosis. One in four men age 50 and older are also likely to break a bone from osteoporosis.

This common condition is no laughing matter — despite the many parodies of the “I’ve fallen and I can’t get up” commercial. But here’s the good news: Many treatments available today can slow, or even stop, the disease’s progression.

Knowing the pros and cons of your medication options can help you make decisions as you develop a treatment plan with your doctor that is based on your bone density or other health conditions that may be contributing to bone deterioration.

Here, we dive into the options available and what you should consider for each treatment.

Bisphosphonates

Bisphosphonates are the most common medications for osteoporosis. They work by slowing down the rate your bones break down and lose calcium.

Research has proven that these medicines can help prevent fractures in people with osteoporosis and slow the bone-thinning process. Doctors may also use bisphosphonates to help with weakened bones caused by cancer treatment.

You may have heard of the most popular brands listed below:

Actonel®—A tablet you take daily, weekly, monthly or twice-monthly
Boniva®—Either an oral tablet you take monthly or an intravenous (IV) injection you get every three months
Fosamax® (or Fosamax Plus D™)—An oral tablet or solution you take daily or weekly
Reclast®—An IV treatment you get once and then every two years after that
Atelvia™—An oral tablet you take weekly
Binosto®—An oral effervescent tablet you take weekly

These may also be available as generic prescriptions so be sure to discuss your list of medications with your doctor so you are clear on what you are taking.

Pros of taking bisphosphonates

It dramatically reduces a woman’s chance for fractures caused by osteoporosis.
It reduces the risk of hip and spine fractures by 35%.
It helps prevent fractures even after you’re no longer taking the medication.
There are several different forms of this medicine, so you and your doctor can find the right one for your needs.

Cons of taking bisphosphonates

You may experience an upset stomach and heartburn.
A small number of patients can develop jawbone problems (jaw necrosis), especially patients taking high-dose bisphosphonates.
For a small percentage of patients, bisphosphonates can cause a broken thigh bone (atypical femur fracture), but this risk decreases once patients stop taking the medicine.
Recent research shows that the bone benefits of bisphosphonates max out after five years and most patients don’t see added benefits if they take the medication for longer.
To reduce the incidence of acid reflux, you will need to stay upright and awake for 30 minutes after you take the medicine.

Denosumab

Denosumab, which includes the brand-name drugs Prolia and Xgeva, is a shot you get every one to six months. It stops the cells that break down your bones and decreases your risk of bone loss and fractures.

Your doctor may prescribe denosumab if bisphosphonates don’t work for you or if you can’t take bisphosphonates because of another medication you’re on. However, recent research shows that denosumab isn’t necessarily better than bisphosphonates when preventing fractures.

Like bisphosphonates, doctors may prescribe denosumab to help treat bones weakened by cancer treatment.

Pros of taking denosumab

It can help increase bone mass in men who are undergoing prostate cancer treatment or women undergoing certain breast cancer treatments.
It’s a highly effective osteoporosis treatment for postmenopausal women who can’t take bisphosphonates.
It can decrease spine fractures by nearly 70% and hip fractures by 40%.
It doesn’t require taking a pill or tablet every day.

Cons of taking denosumab

It only comes in an injectable form (your doctor will help you decide whether you can do the shots yourself).
It may lower your calcium levels.
It may cause skin infections at the injection site.
It may cause muscle and joint pain or skin problems.

Hormone therapy

A major cause of osteoporosis in women is estrogen loss. Estrogen is a female hormone that affects many parts of the body, including the reproductive tract, menstrual cycle, blood vessels, hair, skin, breasts, and bones. As women age and go through menopause, their estrogen levels drop, which means the bones can lose some strength and protection from lack of estrogen.

If you’re postmenopausal, your doctor may recommend hormone therapy. These medicines are designed to boost your body’s hormone levels or mimic hormones to help strengthen bones.

While doctors usually prescribe hormone therapies for women, some men with osteoporosis may also benefit from certain hormone therapies.

There are a variety of different hormone treatments for osteoporosis, including:

Menopausal hormone therapy which can include estrogen replacement alone or a combination of estrogen and progesterone.
Medications like Evista® that can mimic estrogen and reduce bone loss without some of the risks of natural estrogen.
Synthetic hormones like Fortical® and Miacalcin® that can slow bone breakdown and increase bone density.
Parathyroid hormone therapy like Forteo® which can treat both men and women with osteoporosis and stimulate bone growth.

These may also be available as generic prescriptions so be sure to discuss your list of medications with your doctor so you are clear on what you are taking.

Pros of hormone therapy

It can be an effective alternative if bisphosphonates or denosumab don’t work for you.
There are a wide variety of hormone therapy options and forms of medications available.
For menopausal women, some hormone therapies can reduce menopause symptoms.
Some hormone treatments can help your body grow new bone if your bone density is low or you’ve already had broken bones.
Increases bone density in the spine and hip and reduces the risk of hip and spine fractures.

Cons of hormone therapy

In rare cases, it may increase your risk of certain cancers.
You may need to take additional medicines after completing hormone treatment to maintain the medicine’s bone-strengthening benefits.
Side effects can include dizziness, fainting and lightheadedness.
It may cause blood clots or stroke.
It may cause weight or mood changes.

--

Find a doctor

With so many osteoporosis treatments available today, be sure to talk with your doctor about which one is best for you. They will be able to look at your health history and bone density needs while you weigh the pros and cons together.

If you need a primary care doctor who understands osteoporosis and its range of treatment options, the experts at Providence are here to help. You can find a doctor that’s right for you in our provider directory.

Through Providence Express Care Virtual, you can also access a full range of healthcare services.