Medications are a common way to manage osteoporosis and they can play a key role in reducing fracture risk and maintaining quality of life. Although this can be true, it’s important to note that they are not the only option available – and they’re not always right for everyone.
The most important thing is that you have all the information you need to make the decision that’s right for you and your health. This fully referenced guide focuses on the medications currently available in the UK – how they work, their benefits and risks, and what to consider when weighing up your choices.
Medications are a common way to manage osteoporosis and they can play a key role in reducing fracture risk and maintaining quality of life. Although this can be true, it’s important to note that they are not the only option available – and they’re not always right for everyone.
The most important thing is that you have all the information you need to make the decision that’s right for you and your health. This fully referenced guide focuses on the medications currently available in the UK – how they work, their benefits and risks, and what to consider when weighing up your choices.
Bisphosphonates, including Alendronic acid (Fosamax), Risedronate (Actonel), Ibandronate (Bonviva), Zoledronic acid (Aclasta), slow down the rate at which bone is broken down by blocking the activity of osteoclasts (cells that break down bone)1. This helps to maintain or increase bone density.
How they’re taken:
They are proven to reduce the risk of hip, spine, and other fractures, and are generally well-studied and affordable. But, they often cause gastrointestinal issues and must be taken with care e.g. maintaining an upright posture for 30 minutes2. Long term use (>5 years) may increase risk of rare side effects like atypical femoral fractures3 and jaw osteonecrosis4.
Bisphosphonates, including Alendronic acid (Fosamax), Risedronate (Actonel), Ibandronate (Bonviva), Zoledronic acid (Aclasta), slow down the rate at which bone is broken down by blocking the activity of osteoclasts (cells that break down bone)1. This helps to maintain or increase bone density.
How they’re taken:
They are proven to reduce the risk of hip, spine, and other fractures, and are generally well-studied and affordable. But, they often cause gastrointestinal issues and must be taken with care e.g. maintaining an upright posture for 30 minutes2. Long term use (>5 years) may increase risk of rare side effects like atypical femoral fractures3 and jaw osteonecrosis4.
Denosumab is a monoclonal antibody that blocks a protein (RANKL) involved in bone breakdown5. It’s administered by injection every 6 months by a healthcare professional.
Denosumab is generally suitable for people who cannot tolerate bisphosphonates, as it has no gastrointestinal side effects. Things to consider include:
Denosumab is a monoclonal antibody that blocks a protein (RANKL) involved in bone breakdown5. It’s administered by injection every 6 months by a healthcare professional.
Denosumab is generally suitable for people who cannot tolerate bisphosphonates, as it has no gastrointestinal side effects. Things to consider include:
SERMs, such as Raloxifene (Evista), mimic oestrogen to slow the breakdown of bone. It’s usually taken daily as an oral tablet.
Because of the way it works, Raloxifene is only an option for post-menopausal women. It will usually only be offered if you’ve already tried another drug treatment, or if other drugs aren’t suitable for you.
SERMs do not act as oestrogen in the breast or the uterus, and so do not increase your risk of developing breast or endometrial cancer. In fact, Raloxifene has been shown to lower the risk of breast cancer by up to 30%10.
It can reduce spinal fracture risk, but does not reduce the risk of hip fractures11. It’s also not suitable for those at risk of blood clots or stroke12.
SERMs, such as Raloxifene (Evista), mimic oestrogen to slow the breakdown of bone. It’s usually taken daily as an oral tablet.
Because of the way it works, Raloxifene is only an option for post-menopausal women. It will usually only be offered if you’ve already tried another drug treatment, or if other drugs aren’t suitable for you.
SERMs do not act as oestrogen in the breast or the uterus, and so do not increase your risk of developing breast or endometrial cancer. In fact, Raloxifene has been shown to lower the risk of breast cancer by up to 30%10.
It can reduce spinal fracture risk, but does not reduce the risk of hip fractures11. It’s also not suitable for those at risk of blood clots or stroke12.
Parathyroid hormone analogues such as Teriparatide (Forsteo) and Romosozumab (Evenity – newly approved), stimulate new bone formation by acting as a potent stimulator of bone remodelling13. Teriparatide mimics parathyroid hormone, while Romosozumab also has an antiresorptive effect14.
Teriparatide is administered by daily injection for up to 2 years, and Romosozumab is administered by a healthcare professional as a monthly injection for 12 months.
These drugs are highly effective for those with severe osteoporosis or multiple fractures; they build up bone rather than just preventing loss. However, they are usually expensive and only offered if other treatments fail. Teriparatide is not recommended for people with a history of bone cancer or certain metabolic disorders such as Paget’s disease15.
Parathyroid hormone analogues such as Teriparatide (Forsteo) and Romosozumab (Evenity – newly approved), stimulate new bone formation by acting as a potent stimulator of bone remodelling13. Teriparatide mimics parathyroid hormone, while Romosozumab also has an antiresorptive effect14.
Teriparatide is administered by daily injection for up to 2 years, and Romosozumab is administered by a healthcare professional as a monthly injection for 12 months.
These drugs are highly effective for those with severe osteoporosis or multiple fractures; they build up bone rather than just preventing loss. However, they are usually expensive and only offered if other treatments fail. Teriparatide is not recommended for people with a history of bone cancer or certain metabolic disorders such as Paget’s disease15.
HRT replaces oestrogen in postmenopausal women, which helps to maintain bone density. HRT comes in tablet form, as well as patches, creams, gels, vaginal rings and coils, allowing for personalised treatment based on individual preferences.
To find out more about HRT, read our blogs Debunking HRT myths, or Menopause and osteoporosis.
HRT replaces oestrogen in postmenopausal women, which helps to maintain bone density. HRT comes in tablet form, as well as patches, creams, gels, vaginal rings and coils, allowing for personalised treatment based on individual preferences.
To find out more about HRT, read our blogs Debunking HRT myths, or Menopause and osteoporosis.
The best treatment avenue for you depends on:
Medications can be an effective way to manage osteoporosis, but it’s important to reiterate they are not the only option. Some people choose to focus on lifestyle changes, diet, supplements, or weight-bearing exercise, or use these approaches alongside medication.
If you have been diagnosed or are at risk, please do not hesitate to speak to your healthcare provider about the best approach for you.
The best treatment avenue for you depends on:
Medications can be an effective way to manage osteoporosis, but it’s important to reiterate they are not the only option. Some people choose to focus on lifestyle changes, diet, supplements, or weight-bearing exercise, or use these approaches alongside medication.
If you have been diagnosed or are at risk, please do not hesitate to speak to your healthcare provider about the best approach for you.
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