Alendronate (Fosamax); Ibandronate (Boniva); Risedronate (Actonel); Zoledronic acid (Reclast); Raloxifene (Evista); Teriparatide (Forteo); Low bone density - medicines; Osteoporosis - medicines

Osteoporosis is a disease that causes bones to become brittle and more likely to fracture (break). With osteoporosis, the bones lose density. Bone density measures the amount of bone tissue that is in your bones.

A diagnosis of osteoporosis means you are at risk of bone fractures even if you do not have a severe bone injury.

Your doctor may prescribe medicines to help lower your risk of fractures. These medicines make the bones in your hips, spine, and other areas denser.

Your doctor is more likely to prescribe medicines if:

• A bone density test shows you have osteoporosis, even if you do not have a fracture.
• You have a bone fracture, and a bone density test shows you have thinner than normal bones but not osteoporosis.
• You have a bone fracture that occurs without any significant injury.

Bisphosphonates are the main drugs that are used to both prevent and treat bone loss. They are most often taken by mouth. You may take a pill either once a week or once a month.

Common side effects of bisphosphonates are heartburn, nausea, and pain in the belly. When you take bisphosphonates:

• Take them on an empty stomach in the morning with 6 - 8 ounces of plain water (not carbonated water or juice).
• Remain sitting or standing after taking the pill for at least 30 minutes.
• Do not eat or drink for at least 30 - 60 minutes.

Less common side effects of bisphosphonates are:

• Low blood calcium level
• A certain type of leg-bone fracture
• Damage to the jaw bone
• Fast, abnormal heart beat (atrial fibrillation)

Your doctor may have you stop taking this medicine after about 5 years. Doing so decreases the risk of certain side effects. This is called a “drug holiday.”

You also may get bisphosphonates through a vein (IV). Most often this is done once a year.

If you are at high risk for fractures, your doctor may ask you to take parathyroid hormone.

• This medicine is given through daily shots under the skin. Your doctor or nurse will teach you how to give yourself these shots at home.
• Parathyroid hormone works better if you have never taken bisphosphonates.

Calcitonin is a medicine that slows the rate of bone loss. It:

• Is sometimes used after a bone fracture because it decreases bone pain
• Is less effective than bisphosphonates
• Comes as a nasal spray or an injection

Raloxifene (Evista) may also be used to prevent and treat osteoporosis.

• It can reduce the risk of spinal fractures but not other types of fractures.
• The most serious side effect is a very small risk of blood clots in the leg veins or in the lungs.
• This drug may also help decrease the risk for heart disease and breast cancer.

Estrogen and hormone replacement therapy (HRT) were once often used to prevent osteoporosis, but they are rarely used anymore.If a woman is taking estrogen already, she and her doctor must discuss the risks and benefits of doing so.

Call your health care provider for these symptoms or side effects:

• Chest pain, heartburn, or problems swallowing
• Nausea and vomiting
• Blood in your stool
• Swelling, pain, redness in one of your legs
• Fast heart beat

Lewiecki EM. In the clinic. Osteoporosis. Ann Intern Med. 2011 Jul 5;155(1):ITC1-1-15; quiz ITC1-16.

Park-Wyllie LY, Mamdani MM, Juurlink DN, Hawker GA, Gunraj N, Austin PC, et al. Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA. 2011 Feb 23;305(8):783-9.

National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2010.