Treating osteoporosis involves treating and preventing fractures, and using medicines to strengthen bones.
Although a diagnosis of osteoporosis is based on the results of your bone density scan, the decision about what treatment you need, if any, is based on a number of other factors including your:
- risk of breaking a bone
- previous injury history
If you've been diagnosed with osteoporosis because you've had a broken bone, you should still receive treatment to try to reduce your risk of further broken bones.
You may not need or want to take medicine to treat osteoporosis.
To achieve this, your healthcare team will ask you about your diet and may recommend that you make changes or take supplements.
Medicines for osteoporosis
A number of different medicines are used to treat osteoporosis (and sometimes osteopenia).
Bisphosphonates slow the rate that bone is broken down in your body. This maintains bone density and reduces your risk of a broken bone.
There are a number of different bisphosphonates, including:
- alendronic acid
- ibandronic acid
- risedronic acid
- zoledronic acid
They're given as a tablet or injection.
Always take bisphosphonates on an empty stomach with a full glass of water. Stand or sit upright for 30 minutes after taking them. You'll also need to wait between 30 minutes and 2 hours before eating food or drinking any other fluids.
Bisphosphonates usually take 6 to 12 months to work, and you may need to take them for 5 years or longer.
You may also be prescribed calcium and vitamin D supplements to take at a different time to the bisphosphonate.
The main side effects associated with bisphosphonates include:
- irritation to the foodpipe
- swallowing problems
- stomach pain
Osteonecrosis of the jaw is a rare side effect linked with the use of bisphosphonates, although most frequently with high-dose intravenous bisphosphonate treatment for cancer and not for osteoporosis.
In osteonecrosis, the cells in the jaw bone die, which can lead to problems with healing. If you have a history of dental problems, you may need a check-up before you start treatment with bisphosphonates. Speak to your doctor if you have any concerns.
Read more about bisphosphonates for treating osteoporosis.
Selective oestrogen receptor modulators (SERMs)
SERMs are medicines that have a similar effect on bone as the hormone oestrogen. They help to maintain bone density and reduce the risk of fracture, particularly of the spine.
Raloxifene is the only type of SERM available for treating osteoporosis. It's taken as a daily tablet.
Side effects associated with raloxifene include:
Read more about raloxifene for treating osteoporosis.
Parathyroid hormone is produced naturally in the body. It regulates the amount of calcium in bone.
Parathyroid hormone treatments (such as teriparatide) are used to stimulate cells that create new bone. They're given by injection.
While other medicines can only slow down the rate of bone thinning, parathyroid hormone can increase bone density. However, it's only used in a small number of people whose bone density is very low and when other treatments are not working.
Nausea and vomiting are common side effects of the treatment.
Read more about teriparatide for treating osteoporosis.
Calcium and vitamin D supplements
For most healthy adults, the recommended amount of calcium is 700 milligrams (mg) of calcium a day, which most people should be able to get from a varied diet that contains good sources of calcium.
However, if you have osteoporosis, you may need more calcium, usually as supplements. Ask your GP for advice about taking calcium supplements.
Vitamin D helps the body absorb calcium. All adults should have 10 micrograms of vitamin D a day.
From about late March/early April to the end of September, most people should be able to get all the vitamin D they need from sunlight on their skin.
But since it's difficult to get enough vitamin D from food alone, everyone (including pregnant and breastfeeding women) should consider taking a daily supplement containing 10 micrograms of vitamin D during the autumn and winter.
For more information, read about who should take vitamin D supplements.
HRT (hormone replacement therapy)
HRT has also been shown to keep bones strong and reduce the risk of breaking a bone during treatment.
However, HRT is not specifically recommended for treating osteoporosis and is rarely used for this purpose.
This is because HRT slightly increases the risk of developing certain conditions – such as breast cancer, endometrial cancer, ovarian cancer, stroke and venous thromboembolism – more than it lowers the risk of osteoporosis.
Discuss the benefits and risks of HRT with your GP.
Read more about the risks of HRT.
In men, testosterone treatment can be useful when osteoporosis is caused by low levels of male sex hormones.
Treating a broken bone caused by osteoporosis
The Strong Bones After 50 patient booklet from the Royal College of Physicians has advice for people who have broken a bone after a fall, and their families and carers.
It explains what a fragility fracture is, and what type of treatment you can expect.