In choosing a medication for osteoporosis, a doctor will take into account all aspects of a patient's medical history, the severity of the osteoporosis and guidance from NHS bodies, such as the National Institute for Health and Care Excellence (NICE) in England.
Types of osteoporosis drug
Bisphosphonates slow the working rate of cells responsible for breaking down bone. The goal is to maintain bone density and reduce the risk of a fracture. Bisphosphonates include alendronate, etidronate, ibandronate, risedronate and zolendronic acid. These may be tablets or injections.
Side effects include irritated oesophagus, difficulty swallowing, stomach pain and in rare cases, jaw problems called osteonecrosis.
Strontium ranelatedoesn't just work on stopping bone breaking down, it appears to have an effect on cells that build new bone. It is a powder taken dissolved in water.
Side effects include nausea and diarrhoea, and in rare cases, a severe allergic reaction to the treatment.
Selective (o)estrogen receptor modulators (SERMs) work in a similar way to oestrogen, helping maintain bone density and reduce fracture risk. SERM is available as a daily tablet called raloxifene.
Side effects include hot flushes, leg cramps and blood clots.
Parathyroid hormone (PTH) or teriparetide occurs naturally in the body to regulate calcium in the bone. Thus treatment is given by injection to stimulate growth of new bone (osteoblasts). It is usually only recommended through specialists for people with very low bone density who have tried other treatments, and these have not been successful.
Side effects include nausea and vomiting.
Calcitonin is a thyroid hormone which helps stop bone from breaking down. Calcitonin (or salcatonin) is given as a nasal spray or daily injection.
Side effects include nausea, vomiting and diarrhoea.
Calcium and vitamin D supplementscan benefit older men and women and reduce the risk of hip fracture. Most calcium should come from a healthy diet. The NHS says to aim for 700mg of calcium a day - around a pint of milk. If there's not enough calcium in a person's diet, a GP may recommend proscription dose calcium supplements of 1.2g a day. This would be taken with vitamin D of 800iu.
Hormone replacement therapy (HRT) is often used to help manage a woman's menopause symptoms, but it can also help maintain bone density and reduce risk of fracture. However, it is rarely recommended for osteoporosis because the risks of some cancers and stroke outweigh the benefits for a woman's osteoporosis.
Testosterone treatment for men may be recommended when osteoporosis is as a result of not enough male sex hormones being produced - called hypogonadism.