Treating Osteoporosis and Osteopenia

Treating Osteoporosis and Osteopenia

Doctors commonly recommend certain lifestyle changes and medicine to treat osteoporosis and osteopenia.
 

Doctors commonly recommend certain lifestyle changes and medicine to treat osteoporosis and osteopenia.

 

Lifestyle changes to treat osteoporosis and osteopenia

Get enough calcium. The amount of calcium you need depends on your age and sex assigned at birth:

  • women and men age 19 to 50 need 1,000 milligrams a day

  • women age 51 to 70 need 1,200 milligrams a day

  • men age 51 to 70 need 1,000 milligrams a day

  • women and men age 71 and older need 1,200 milligrams a day

Food, rather than supplements, is the best source of calcium. Dairy products, including milk, cheese, and yogurt, are high in calcium. Other good sources are:

  • salmon with bones

  • sardines

  • kale

  • broccoli

  • calcium-fortified juices and breads

  • dried figs

If it’s difficult for you to get enough calcium from food, you may want to ask your doctor about taking a calcium supplement.

Get enough vitamin D. Vitamin D helps your body absorb calcium. You can get some vitamin D from being in sunlight. The amount of vitamin D you need depends on a number of factors, including:

  • age

  • ethnicity

  • the latitude at which you live

  • the season of the year

  • how much sun exposure you get

The National Institutes of Health recommend adults age 19 to 70 get 600 IU (international units) per day and adults age 71 and older get 800 IU per day. Still, if you have darker skin or get very little sun exposure, you may need more vitamin D a day, either from food or from a supplement.

Foods rich in vitamin D include:

  • vitamin D-fortified milks and cereals

  • wild-caught fatty fish such as salmon, tuna, and mackerel

  • cod liver oil

If you take a vitamin D supplement, most experts recommend taking the D3 (cholecalciferol) form rather than the D2 (ergocalciferol) form.

Because vitamin D is a fat-soluble vitamin, your body absorbs it best when you take the supplement with a meal or snack that includes some fat.

Exercise regularly. Weight-bearing and muscle-strengthening exercises help you build and maintain bone density and can help your bones stay healthy throughout your life. Balance exercises can help reduce your risk of falling, especially as you get older. It’s a good idea to try doing a combination of weight-bearing and muscle-strengthening exercises for at least 30 minutes a day. You also can try doing weight-bearing and muscle-strengthening exercises one day, and balance exercises the next.

Limit or avoid alcohol. Research shows that heavy drinking dramatically affects bone health and increases the risk of osteoporosis.

Don’t smoke, or quit if you do. Tobacco use weakens bones.

 

Medicine to treat osteoporosis and osteopenia

When deciding which osteoporosis medicine to recommend, your doctor has to consider a number of factors, including:

  • Your sex assigned at birth: Some medicines are approved for both women and men and some are approved for women only.

  • Your age: Some medicines are best for younger post-menopausal women and others are best for older women.

  • Your bone density: Different osteoporosis medicines work in different ways. Medicine for someone with extremely low bone density or who has broken multiple bones, is different from medicine for someone with bone density that’s just a bit lower than normal.

  • Other health conditions you may have: If you’ve been diagnosed with breast cancer, you should not take osteoporosis medicines that contain estrogen.

  • Your preferences: It may be easier for you to receive an injection once a month or once a year than to take a pill every day. 

Many types of medicines can treat osteoporosis. 

Bisphosphonates

Bisphosphonates limit the activity of certain bone cells, called osteoclasts, which break down and reabsorb minerals such as calcium from bones. Limiting the osteoclasts allows the osteoblasts — the bone-building cells — to work more effectively. Bisphosphonates that treat osteoporosis are:

  • alendronate (brand names: Fosamax, Binosto): available as a tablet or liquid, in doses taken daily or weekly

  • risedronate (brand names: Actonel, Atelvia): available as a tablet, in doses taken daily, weekly, monthly, or twice a month

  • ibandronate (brand name: Boniva): available as a tablet taken monthly or as an injection every three months

  • zoledronic acid (brand name: Reclast): available as an IV infusion once a year or once every two years

People must take oral bisphosphonates in the form of tablets or liquid in a specific way to avoid serious harm to the esophagus (the passageway between the mouth and the stomach: 

  • You take a bisphosphonate with six to eight ounces of plain or tap water on an empty stomach at least 30 minutes (for alendronate and risedronate) or 60 minutes (for ibandronate) before your first food or beverage of the day.

  • You can’t lie down for at least 30 minutes (for alendronate and risedronate) or 60 minutes (for ibandronate) after you take the bisphosphonate.

  • You must wait 30 minutes (for alendronate and risedronate) or 60 minutes (for ibandronate) after you take the bisphosphonate before you eat, drink (except for plain water), or take other medicines.

It’s important to know that the zoledronic acid IV infusion may cause serious kidney problems. Kidney problems after a zoledronic acid infusion are more likely in people who:

  • have existing kidney problems

  • take a diuretic (a medicine that removes water from the body)

  • are dehydrated when they receive the infusion or become dehydrated afterward

  • take other medicines that can cause kidney problems

  • are older

You should drink at least two glasses of water within a few hours of receiving a zoledronic acid infusion.

The bisphosphonates also may cause rare but serious side effects:

  • Atypical femur fracture. The femur is the large leg bone that runs from your hip to your knee. An atypical fracture means that the bone breaks in an uncommon spot. Although research suggests the risk of an atypical femur fracture goes up the longer you take a bisphosphonate, these fractures are rare.

  • Osteonecrosis of the jaw. A condition in which the cells in the jaw bone start to die.

SERM (selective estrogen receptor modulator)

Evista (chemical name: raloxifene) is a SERM used to:

  • reduce the risk of hormone receptor-positive breast cancer if you’re post-menopausal and receiving treatment for osteoporosis but haven’t been diagnosed with breast cancer

  • treat and reduce the risk of osteoporosis if you’re post-menopausal

Targeted therapy

Prolia (chemical name: denosumab) is a type of targeted therapy called a RANKL inhibitor. Like the bisphosphonates, RANKL inhibitors limit the activity of osteoclasts, which break down and reabsorb minerals such as calcium from bones. Limiting the osteoclasts allows the osteoblasts — the bone-building cells — to work more effectively.

Prolia is used to:

  • treat osteoporosis in post-menopausal women with a high risk of breaking a bone

  • increase bone density in women with a high risk of breaking a bone who are taking an aromatase inhibitor after surgery for early-stage breast cancer

  • treat osteoporosis caused by steroid treatment in women and men with a high risk of breaking a bone

  • treat osteoporosis in men with a high risk of breaking a bone

  • increase bone density in men with a high risk of breaking a bone who are being treated with hormonal therapy for stage I to stage III prostate cancer

Prolia is given as an injection under the skin of the upper arm, upper thigh, or abdomen every six months.

Under the brand name Xgeva, denosumab is used to reduce the risk of bone complications and bone pain in people diagnosed with metastatic breast cancer that has spread to the bones.

Like many medicines, Prolia may cause side effects, some of them serious. Rare but serious side effects include:

  • Atypical femur fracture.

  • Osteonecrosis of the jaw.

  • Extremely low blood calcium levels. Your doctor monitors your calcium and vitamin D levels while you’re receiving Prolia.

  • Infection, especially skin infections. Tell your doctor right away if you notice any signs of infection, especially redness, swelling, and painful areas on your skin.

  • Rash. Let your doctor know if you develop any type of scaly, itchy, or red patches on your skin.

  • Bone and joint pain. Prolia may cause severe bone, joint, or muscle pain. Tell your doctor if you have any of these side effects.

The National Osteoporosis Foundation offers a complete list of osteoporosis medicines.

Written by: Jamie DePolo, senior editor

Reviewed by 1 medical adviser
 
Brian Wojciechowski, MD
Crozer Health System, Philadelphia area, PA
Learn more about our advisory board

— Last updated on September 23, 2022, 8:04 PM

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