If you are diagnosed with osteoporosis or have a high risk of fracture your doctor will prescribe a medicine to strengthen your bones and help prevent fractures. Prescribed medicine plays an essential role in the management of osteoporosis.
Your doctor will also ensure that you
- have adequate calcium, vitamin D and exercise to support your bone health
- make changes to lifestyle habits that can impact on your bones (stop smoking, reduce alcohol intake)
- are monitored for any conditions/medications that affect bone health.
How do osteoporosis medicines work?
Bone is constantly ‘turned over’ – new bone is formed at the same time older bone is broken down. In osteoporosis the finely tuned balance between this production and breakdown of bone is lost and more bone is lost than is formed.
Most osteoporosis medicines work by making the cells that break down bone (osteoclasts) less active, while allowing the cells that form new bone (osteblasts) to remain active. This reduces bone loss and increases bone strength gradually over time.
Types of Medicine
In Australia there are a range of medicines available for osteoporosis. Your doctor will determine the appropriate treatment for your situation and take into consideration any other medical conditions. In many cases, but not all, these medicines are subsided by the government under the Pharmaceutical Benefits Scheme (PBS). It is important to take medicine as directed to ensure you receive the most benefit and to reduce the risk of side effects.
Osteoporosis medicines are grouped into different ‘classes’ depending on their ‘active ingredient’
Tablets (weekly or monthly): Alendronate (brand name Fosamax), Risedronate (brand name: Actonel) Once yearly intravenous infusion: Zoledronic acid (brand name: Aclasta).
- These medicines can increase bone density by approximately 4-8% in the spine and 1–3% in the hip, over the first 3-4 years of treatment. This may appear small, however they have a very positive effect on fracture rates eg: bisphosphonates have been shown to reduce spinal fractures by 30 – 70% and hip fractures by 30 – 50% (a positive effect can be seen as early as 6 – 12 months after starting treatment).
- PBS subsidy applies to men and women with osteoporosis and fractures, and older people (over 70) with low bone density. It also applies to people taking corticosteroids (eg: prednisone or cortisone) at a dose of 7.5 mg for at least 3 months.
6 monthly injection: Denosumab (brand name: Prolia)
- This medicine works in a different way to bisphosphonates but has the same effect of slowing the rate at which bone is broken down. The treatment can reduce spinal fractures by two thirds and has a significant effect on hip fractures and other fracture types.
- Denosumab is available for women, and for men receiving certain prostate treatment.
- PBS subsidy applies to post menopausal women with osteoporosis and a fracture or women over 70 with low bone density.
Sachet dissolved in water daily: strontium ranelate (brand name: Protos)
- This medicine is absorbed into the bone in a similar way to calcium. It both increases bone formation and reduces bone loss resulting in denser and stronger bones over time. It reduces the risk of spinal fracture and also reduces the risk of other fractures in people with low bone density.
- Strontium ranelate is available for use by both men and post menopausal women for the treatment of severe (established) osteoporosis
- PBS subsidy applies to post menopausal women with severe (established) osteoporosis and a fracture or women over 70 with low bone density
- Patients with significant risk factors for cardiovascular events should only be treated with strontium ranelate after careful consideration by their doctor
Selective oestrogen receptor modulators (SERMS)
Daily tablet: Raloxifene (brand name: Evista)
- This medicine acts like the hormone oestrogen in the bones, helping reduce bone loss and is most effective in reducing spinal fractures.
- PBS subsidy applies to postmenopausal women with established osteoporosis and a fracture.
Hormone replacement therapy (HRT)
Active ingredient is the hormone oestrogen. Some HRT treatments also contain progestogen – this is known as combined HRT
- HRT, even at low doses, helps to slow bone loss, reducing the risk of osteoporosis and fractures
- HRT is of greatest benefit to women under 60 who are at risk of fracture (and are unable to take osteoporosis medicine). It is particularly useful for women who have undergone early menopause (before 45 years of age).
- Above 60 the risk of heart disease, stroke, blood clots and breast cancer increases. HRT is thought to increase these risks so other osteoporosis medicines are more suitable for women over 60.
Daily injection for 18 months (self administered): Teriparatide (Brand name: Forteo)
- This medicine stimulates bone-forming cells (osteoblasts) resulting in improved bone strength and structure.
- Is restricted to people who have tried other treatments but continue to have very low bone density and further fractures. It is prescribed by a specialist and is available for both men and women. Once the course of the treatment is finished another osteoporosis medicine will need to be used so the new bone produced by using teriparatide is maintained and improved.
Tips for taking osteoporosis medicine
Take medicine as directed
- For patients with osteoporosis, bone loss may have taken place over many years and it takes time to re-build bone strength. Using the right medicine in the right way is critical for your bone health.
- Most osteoporosis medicine is prescribed for many years and patients around Australia have benefited from the long-term use of osteoporosis medicine in slowing bone loss and reducing risk of fracture
- Talk to your doctor if you have any queries or concerns about your medicine.
- Review the Consumer Medicine Information (CMI) provided with your prescription about the benefits and any possible side effects of your medicine