The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
The main bisphosphonates approved for the treatment of osteoporosis are: Alendronate
sodiumIbandronateZoledronic acid, which is administered through an IV
Other bisphosphonates include
Among postmenopausal women with osteoporosis, bisphosphonates can provide the following health benefits: Reduced bone lossIncreased bone density in the spine and hipReduced risk of spine and hip fractures
Bisphosphonates that are taken by mouth should be taken on an empty stomach. Therefore, it is recommended that you take it first thing in the morning with a full glass of water, at least 30 minutes before eating, drinking, or taking other medications. To minimize side effects, remain in an upright position for at least 30 minutes after taking this medication.
Possible side effects for bisphosphonates include: HeartburnNausea or vomitingDiarrheaConstipationBone, joint, or muscle pain (rare)Jaw bone damage (rare)
Increased risk of an unusual
thigh bone fracture
Common brand names include: PremarinOgenEstraceEstradermEstratab
ERT has been used for both the prevention and treatment of osteoporosis. ERT has been shown to reduce bone loss, increase bone density in the spine and hip, and reduce the risk of spine and hip fractures in postmenopausal women. ERT is available as a pill or skin patch.
Although ERT may cut the risk of osteoporosis, it’s important to note that recent research shows a strong association between longer-term ERT or HRT use and a significantly increased risk of invasive
heart attacks, and blood clots. Be sure to discuss all of the health risks and benefits of hormone therapy with your doctor to determine if it is right for you.
Common brand names include: ActivellaFemhrtOrtho-PrefestPremphasePrempro
Combined HRT has been used for both the prevention and treatment of osteoporosis. Combined HRT has been shown to reduce bone loss, increase bone density in the spine and hip, and reduce the risk of spine and hip fractures in postmenopausal women. Combined HRT is available as a pill.
Although combined HRT may cut the risk of osteoporosis, it’s important to note that recent research shows a strong association between longer-term ERT or HRT use and a significantly increased risk of invasive breast cancer, strokes, heart attacks, and blood clots. Be sure to discuss all of the health risks and benefits of hormone therapy with your doctor to determine if it is right for you.
is one of a class of drugs called selective estrogen receptor modulators (SERMs). It helps prevent bone loss at the spine, hip, and total body and may increase bone mass. This medication may also reduce the risk of spinal fractures, and there is some evidence that it can also reduce the risk of breast cancer. Raloxifene is available as a pill and should be taken once a day, with or without meals.
Possible side effects include: Hot flashesHeadacheNausea and vomitingDiarrheaJoint painLeg painSleep problems
Increased risk of blood clots and
(rare side effects)
is a naturally occurring hormone that slows bone loss, increases bone density, and reduces the risk of spinal fractures. It may also help reduce or relieve the pain of bone fractures. Calcitonin is approved by FDA for women who are at least five years past menopause. It is available as an injection or a nasal spray.
Possible side effects associated with the injected form of calcitonin include: Allergic reactionFlushing of the face and handsUrinary frequencyNauseaSkin rash
Nasal calcitonin may cause a runny nose.
Denosumab, given as an injection, is a type of monoclonal antibody. The medication works by targeting cells called osteoclasts, which break down bone. Denosumab is intended for postmenopausal women who have osteoporosis and are at a high risk for
Common side effects include: Back painPain in the extremitiesPain in muscles, tendons, ligaments, and bonesHigh cholesterol levelsBladder infections
Teriparatide is given as an injection from a pen. It is a man-made form of parathyroid hormone, which stimulates bone growth. Teriparatide is indicated for people with osteoporosis who are at high risk for fractures or are taking corticosteroids..
Common side effects include: Neck painHeadacheWeaknessNausea and vomitingHigh blood pressureLightheadedness and faintingRashSweating
If you are taking medications, follow these general guidelines: Take the medication as directed. Do not change the amount or the schedule. Ask what side effects could occur. Report them to your doctor.Talk to your doctor before you stop taking any prescription medication.Plan ahead for refills if you need them.Do not share your prescription medication with anyone.Medications can be dangerous when mixed. Talk to your doctor if you are taking more than one medication, including over-the-counter products and supplements.
NIH Osteoporosis and Related Bone Diseases National Resource Center
website. Available at:
http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/overview.asp. Updated June 2015. Accessed May 19, 2016.
Treatment. National Osteoporosis Foundation website. Available at:
https://www.nof.org/patients/treatment. Accessed May 19, 2016.
6/4/2010 DynaMed Plus Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T113815/Osteoporosis: FDA approves new injectable osteoporosis treatment for postmenopausal women. US Food and Drug Administration website. Available at:
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm214150.htm. Updated April 23, 2013. Accessed May 19, 2016.
10/25/2010 DynaMed Plus Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T113815/Osteoporosis: US Food and Drug Administration. Possible increased risk of thigh bone fracture with bisphosphonates. US Food and Drug Administration website. Available at:
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm229171.htm. Updated April 19, 2013. Accessed May 19, 2016.
3/11/2013 DynaMed Plus Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T113815/Osteoporosis: Reid IR, Black DM, Eastell R, et al. Reduction in the risk of clinical fractures after a single dose of zoledronic Acid 5 milligrams.
J Clin Endocrinol Metab. 2013;98(2):557-563.
Last reviewed May 2016 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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