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.
If a postmenopausal woman has other menopausal symptoms, such as hot flushes and vaginal dryness, menopausal hormone therapy can be considered for these menopausal symptoms as well as for the prevention of osteoporosis. The Committee on the Safety of Medicines has advised that hormone replacement therapy (HRT) should not be considered first line therapy for long term prevention of osteoporosis in women over 50 years of age. HRT is of most benefit for the prophylaxis of postmenopausal osteoporosis if started early in menopause and continued for up to five years, but bone loss resumes (possibly at an accelerated rate) on stopping HRT. After the menopause symptoms have passed, some other non-oestrogen prescription osteoporosis medication will be considered for the long-term.
Women who are 75 or over may not need a bone scan to diagnose osteoporosis before treatment is given.
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 ranelate doesn'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 as 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 supplements can 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 fracture risk of fracture. However, it is rarely recommended as 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.