Treatments for Osteoporosis and Osteopenia
If you’ve been diagnosed with osteoporosis or osteopenia, treatment can help make your bones stronger, slow further bone loss, and lower your risk of breaking a bone.
Your treatment plan will depend on the results of your DEXA scan, a quick and painless scan that uses a very small amount of radiation to measure the mineral content of certain bones — such as the hip, spine, and wrist.
If your risk of breaking a bone isn’t high, your doctor will likely recommend lifestyle changes, like more exercise. If you have a high fracture risk, medicine is almost always part of the treatment plan.
Lifestyle changes to treat osteoporosis and osteopenia
Changing your diet to eat more food rich in calcium – and eating more prunes – plus adding weight-bearing exercises to your workouts can help strengthen your bones.
Get enough calcium
The amount of calcium you need depends on your age and sex assigned at birth:
people aged 19 to 50 need 1,000 mg a day
women aged 51 to 70 need 1,200 mg a day
men aged 51 to 70 need 1,000 mg a day
people aged 71 and older need 1,200 mg 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 canned sardines, salmon, soybeans, and vegetables like kale, broccoli, collard greens, and bok choy. Dried figs also have a lot of calcium. 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. The two most reliable ways to boost your vitamin D levels are to get more direct sunlight exposure and take vitamin D3 supplements. Eating foods rich in vitamin D can help, but doesn’t raise your levels as much as the other two. The National Institutes of Health recommend adults aged 19 to 70 get 600 IU (international units) per day and adults aged 71 and older get 800 IU per day. Still, if you have dark 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, as well as cod liver oil.
Before you take any vitamin D supplements, talk to your doctor about all the medicines and other supplements you’re taking because vitamin D supplements can interact with some medicines. If you have kidney stones, kidney disease, high blood calcium levels (hypercalcemia), heart disease, or liver disease, vitamin D supplements may make these conditions worse. If you’re taking diuretics or water pills — medicines that make you pee more often — a vitamin D supplement may increase the calcium level in your blood, which can create kidney stones.
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.
Eat more prunes
A study found that eating about four to 12 prunes every day can help preserve bone density. Why? Prunes contain compounds called polyphenols, which help protect plum trees from insects and disease. In people, these beneficial compounds seem to reduce the inflammation processes that lead to bone loss. Prunes also contain vitamin K, and low vitamin K levels have been linked to low bone density.
Exercise regularly
Weight-bearing and strength-training 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.
Wear a vibrating belt
In 2024, the U.S. Food and Drug Administration (FDA) approved the Osteoboost belt to treat osteopenia in post-menopausal women. The approval was based on a small study which found that women who used the device regularly maintained more bone strength in the spine over 12 months. Women who didn’t use the device lost 2.84% of their bone strength over the course of the year. Women who wore the Osteoboost belt at least three times a week for 30 minutes lost only 0.5%.
Osteoboost works by simulating some of the effects of exercise in the spine and hips. The light vibrations produce signals that are similar to what happens when muscles contract, stimulating bone-building cells. Osteoboost requires a doctor’s prescription and isn’t covered by insurance or Medicare. The device is eligible for reimbursement under FSA/HSA accounts with proof of prescription.
Limit or avoid alcohol
Research shows that heavy drinking dramatically affects bone health and increases the risk of osteoporosis. In the study, the researchers defined heavy drinking as three or more alcoholic drinks per day.
Don’t smoke, or quit if you do
Smoking — including vaping — speeds up bone loss in a number of ways. Smoking restricts the blood supply to bones and the nicotine in cigarettes slows the production of bone-forming cells so they make less bone. Also, smoking decreases the amount of calcium your body absorbs. Older smokers are 30%-40% more likely to break a hip than their non-smoking counterparts.
Medicine to treat osteoporosis and osteopenia
When deciding which 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.
Bisphosphonates
Bisphosphonates are the most commonly prescribed medicine to treat osteoporosis and are usually the first type of medicine your doctor will recommend. 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.
There are a number of bisphosphonate medicines. Some are used to increase bone strength in people with cancer. The 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 daily or 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
*Zometa is another brand name for zoledronic acid. It's used to reduce bone complications and bone pain caused by advanced-stage breast cancer that has spread to the bone.
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.
In rare cases, bisphosphonates also may cause 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.
SERMs (selective estrogen receptor modulators)
Evista (chemical name: raloxifene), a pill taken once a day, 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. The recommended dose is different for people with cancer and Prolia and Xgeva aren’t interchangeable.
There are several Prolia biosimilars approved by the FDA: Bildyos (chemical name: denosumab-nxxp), Boncresa (chemical name: denosumab-mobz), Bosaya (chemical name: denosumab-kyqq), Enoby (chemical name: denosumad-qbde), Jubbonti (chemical name: denosumab-bddz), Stoboclo (chemical name: denosumab-bmwo), and Ponlimsi (chemical name: denosumab-adet).
Because Prolia can cause extremely low blood calcium levels,your doctor will monitor your calcium and vitamin D levels while you’re receiving it.
Like many medicines, Prolia may cause side effects. Rare but serious side effects to watch for include atypical femur fracture and osteonecrosis of the jaw.
If the common medicines for osteoporosis don't work well enough, your doctor might recommend:
Teriparatide (brand names: Bonsity, Forteo) or abaloparatide (brand name: Tymlos), medicines similar to the parathyroid hormone that stimulate new bone growth. They’re given by daily injection under the skin. You can only receive these medicines for two years.
Romosozumab (brand name: Evenity), a medicine that blocks the sclerostin protein. Blocking this protein stimulates bone formation and slows bone breakdown. It’s given as an injection every month at your doctor's office. You can only receive romosozumab for one year.
After you stop taking any of these newer medicines, you usually take another osteoporosis drug to maintain the new bone growth.
The National Osteoporosis Foundation offers a complete list of osteoporosis medicines.