For all of these medications, be sure to ask your doctor or pharmacist what side effects to watch for, and be sure to report these to your health care provider. Many persons stop their osteoporosis medications, although many could be helped by switching to a different medication. None of these medications can help if they are not taken!

Bisphosphonates

These are nonhormonal medication used to prevent and treat osteoporosis. It is well tolerated by most people and reduces risk of all osteoporotic fractures by ~50%.Given to help slow down bone loss and decrease the risk of fracture by slowing bone turnover (cycles of breaking down and building up of bone at the microscopic level).

• Alendronate (Fosamax) once-weekly tablets
• Risendronate (Actonel) once-weekly tablets
• Ibandronate (Boniva) once-monthly tablets: also available as intravenous injection once every 3 months

Calcitonin

This is a naturally occurring hormone produced by cells in the thyroid gland. It may stabilize bone mass or relieve pain caused by fractures. This medication can help prevent spinal fractures but not hip fractures. Some doctors use it to help control pain for short periods of time after a spinal fracture.

• Calcimar is given daily as a subcutaneous injection, usually by the patient
• Miacalcin is a nasal spray which is administered once daily

Selective Estrogen Receptor Modulators (SERMS)

This medication mimics estrogen’s beneficial effects on bone by decreasing spine fractures, but does not appear to have adverse effects on the breasts or uterus. This medication modestly increases bone mass and reduces spine fractures. Side effects include hot flashes and an increased risk of blood clots. It should not be used in women with a history of blood clots or during periods of immobilization.

• Raloxifene(Evista) once daily tablet

Teriparatide (Forteo)

A new daily injectable medication that uses a form of parathyroid hormone to help stimulate bone formation and helps prevent spine and hip fractures. The drug is approved only for postmenopausal women at high risk for osteoporotic fracture, must be given by subcutaneous injection every day, and is very expensive.

Estrogen or Hormone Replacement Therapy (HRT)

The use of estrogen is currently very controversial. Some women take these medications short-term after menopause to treat bothersome hot flashes and other symptoms. Although estrogens improve bone density and can help prevent fractures, these drugs are not recommended for bone health. This is because the overall negative health effects of estrogens outweigh the favorable health benefits; the other medications listed above are recommended for osteoporosis if a medication is needed.

Phyto-estrogens

These natural substances comprise an alternative therapy being studied for its effect on bone mineral density. The precursors of these substances are found in soybean products, seeds, berries and whole-grain cereal foods. Intestinal bacteria then convert them to hormone-like compounds.