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Treating osteoporosis

elderly couple taking medication pillsTreatment for osteoporosis depends on the results of bone density scans, age, gender, medical history and severity. Treatment most commonly involves lifestyle changes and medications. The aim is to increase bone density and reduce the risk of bone fracture. Treatment can also include taking calcium and vitamin D supplements.

To help decide which treatment is suitable, you or your doctor can use the Fracture risk assessment calculation tool (FRAX). This shows your risk of having a fracture because of osteoporosis in the next ten years. The FRAX score uses your risk factors for osteoporosis and the result of a bone density scan (DXA) if you've had one.

Supplements for osteoporosis

Some people have difficulty getting enough calcium from food sources, so your doctor may recommend calcium supplements. There is some disagreement over using calcium supplements, as some studies have shown they increase the risk of heart problems, particularly in older adults.

Taking calcium supplements slows bone loss, but doesn't usually stop it completely (loss of bone calcium is common in older ages).

It's best to discuss calcium supplements with your doctor.

Your body makes most of the vitamin D it needs in your skin when exposed to sunlight. Vitamin D is essential for having healthy bones and muscles.

Some people, such as those who spend a lot of time indoors and those with dark skin, have difficulty producing enough vitamin D. If you're at risk of having low levels of vitamin D or if you have osteoporosis, your doctor may recommend you take vitamin D tablets such as colecalciferol.

See How to get your daily vitamin D for more information.

Medications for osteoporosis

Medicines for osteoporosis work by slowing or stopping bone loss or rebuilding bone. The main types of medication used to treat osteoporosis are:

Bisphosphonates

These medicines work on your bone‑making cells to slow bone loss. They also help to restore some bone that has been lost. They've been shown to reduce the fracture rate in people with osteoporosis.

Examples of bisphosphonate medication used to treat osteoporosis include alendronate (Fosamax) and risedronate tablets.

Bisphosphonates are usually given with calcium and vitamin D supplements. A common side effect of these medications is nausea and indigestion.

An alternative to tablets is zoledronic acid, which you take as an injection. You only need an injection once a year.

Hormone replacement therapy (HRT)

HRT used to be a treatment for osteoporosis in women with low oestrogen levels (usually due to menopause). This treatment increases bone density and reduces fracture rates. But it can have side effects, so the risks and benefits need to be weighed up for each woman. Older postmenopausal women are particularly vulnerable to these risks.

HRT is used less often today but still has a role in some circumstances. Men with low testosterone levels may also benefit from testosterone replacement.

Selective estrogen receptor modulators (SERMs)

An example of a SERM is raloxifene. It has been shown to reduce the number of fractures in the spinal column. It works by copying the effects of oestrogen on bone, so increases bone density. Postmenopausal women who can't take oestrogen might need a SERM.

Other medications

Other medications to treat osteoporosis include denosumab and teriparatide. They are generally only used if other treatment options haven't been successful.

  HealthInfo recommends the following pages

On the next page: Self‑care for osteoporosis

Adapted from Health Navigator by HealthInfo clinical advisers. Endorsed by Fracture Liaison Service, Canterbury DHB. Page created May 2020.

Page reference: 41726

Review key: HIOSP-24517