Medication Options For Osteoporosis

In this article, Naomi Albertson, M.D., reviews some of the commonly used, FDA approved medications for the treatment of osteoporosis and their major risks and benefits.

If I need medications for osteoporosis, what are my choices?

First, the reason to use medications at all is to decrease your risk of fractures (broken bones) and fracture associated morbidity and mortality. Remember, the Bone Health & Osteoporosis Foundation reported that 25% of women and 30-35% of men who sustain an osteoporotic hip fracture will DIE within one year of their diagnosis. An additional 25% of men and women will be unable to continue independent living due to their inability to complete regular activities of daily living…that means you live in a nursing home for the rest of your life!  Treating osteoporosis WILL affect your life expectancy and your QUALITY of life.

The medications used to treat osteoporosis can be broken into two large groups: medications that decrease bone reabsorption (anti-resorptive) and those that build bone (anabolic). There are a few others, but their utility is very specific and beyond the scope of this discussion. In general, if you have low risk osteoporosis you will be counselled regarding use of an anti-resorptive medication. And, if you have high risk (due to use of current bone destructive medications, underlying bone disease or you have already suffered a low velocity fracture) you will likely be counselled regarding use of an anabolic medication (Forteo, teriparatide).  

Anti-resorptive Medications for Osteoporosis and Their Risks

Anti-resorptive medications include the bisphosphonates (i.e. Actonel, Fosamax, alendronate, Boniva, Reclast), and denosumab (Prolia). These medications work by either slowing down or inhibiting development of the cells that resorb bone, osteoclasts. Use of these medications will decrease the risk of fracture in both the hip and vertebrae and increase bone density by up to 7% over 3 years of use. Unfortunately, the entire category carries the same risks which include esophagitis, severe joint/bone aching (more common with intravenous medication options), worsened kidney failure (except denosumab), and atypical fractures of the jaw (ONJ = osteonecrosis of the jaw) and femur (thigh bone). The method of delivery of these medications can be oral taken weekly, or monthly, as an injection every 6 months or as an intravenous infusion every 3 months or annually. These medications are NOT to be used in individuals who have kidney disease, severe esophageal disease or low blood levels of calcium.

Anabolic Medications for Osteoporosis and Their Risks

Currently, there are 2 anabolic medications (teriparatide analogs). These medications are hormone-like and increase bone formation and calcium and phosphate absorption from the intestine and kidneys. In clinical studies they have been shown to decrease vertebral and hip fractures and increase bone density up to 22% over 2 years of use. Both medications are only available as a self-administered injection and are used for 2 years only, due to a potential risk of bone cancer called osteosarcoma. Although osteosarcoma is a very scary side effect, it has not been shown to occur in humans (osteosarcoma was only reported in rats when obtaining FDA approval). These medications, however, are contraindicated for use in anyone with prior bone/skeletal cancer, metabolic bone disease, high blood levels of calcium, Paget’s disease, or prior bone/skeletal radiation for any reason.

If you would like to discuss osteoporosis, or any other sports medicine concerns, injuries, or preventive methods for improved sports performance contact Dr. Albertson at (775) 323-2080.