Treatment Options

If you are diagnosed with osteoporosis or have a high risk of breaking a bone your doctor will prescribe medication to strengthen your bones and help prevent fractures. Prescribed medicine plays an essential role in managing osteoporosis.

Your doctor will also ensure that you:

  • Have adequate calcium, vitamin D and exercise to support your bone health
  • Stop smoking, reduce alcohol intake and change any lifestyle habits that may impact on your bones 
  • 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 as older bone is being 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 (osteoblasts) 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 to treat 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 subsidised by the government under the Pharmaceutical Benefits Scheme (PBS). It is important to take your medicine as directed to ensure you receive the most benefit. 

Osteoporosis medicines can increase bone density and while the increases may appear small this can have a very positive effect on reducing fracture rates. For example medication can increase bone density in the hip by approx. 1-3% and in the spine by 4-8%, over the first 3-4years of treatment. Medication can therefore reduce spinal fractures by around 30-70% and hip fractures by 30-50% (a positive effect can be seen as early as 6 – 12 months after starting treatment).

Osteoporosis medicines are grouped into different 'classes' depending on their 'active ingredient'

Bisphosphonates

Tablets (daily, weekly or monthly): Alendronate (brand name Fosamax, or other generic brands), Risedronate (brand name Actonel, or other generic brands), once yearly intravenous infusion: Zoledronic acid (brand name Aclasta).

  • Bisphosphonates are available on the PBS for people who have already had a fracture caused by osteoporosis, in order to prevent further fractures. They are also subsidised for older people (over 70) who have not had a fracture, but are at greater risk because they have  low bone density.

  • PBS subsidy also applies to people with low bone density who are taking corticosteroids (eg: prednisone or cortisone) at a dose of 7.5 mg for at least 3 months.

Denosumab

6 monthly injection: Denosumab (brand name: Prolia)

Denosumab works in a different way to bisphosphonates but has the same effect of slowing the rate at which bone is broken down, with similar reductions in the risk of fracture.

  • Denosumab is available on the PBS for people who have already had a fracture caused by osteoporosis, in order to prevent further fractures

  • PBS subsidy is also available for older people (over 70) who have not had a fracture, but are at greater risk because they have  low bone density.

Strontium ranelate

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 and a reduction in the risk of spinal and other fractures.
  • Strontium ranelate is available on the PBS for people who have already had a fracture caused by osteoporosis, in order to prevent further fractures.
Selective oestrogen receptor modulators (SERMS)

Daily tablet: Raloxifene (brand name: Evista)

  • This medicine acts on bones in a similar way to that of the hormone oestrogen, slowing bone loss and reducing the risk of spinal fractures in women who have been through menopause.
  • Raloxifene is PBS subsidised for post-menopausal women who have already had a fracture due to osteoporosis, in order to prevent further fractures.
Hormone replacement therapy (HRT)

Active ingredient is the hormone oestrogen. Some HRT treatments also contain progestogen (combined HRT)

  • Even at low doses, HRT helps to slow bone loss, reducing the risk of osteoporosis and fractures in women who have gone through menopause. HRT is safe and effective for most women under the age of 60 who have osteoporosis and who also need hormonal treatment to relieve the symptoms of menopause. It may also be prescribed for women under 60 who are unable to take other osteoporosis medicines. It is particularly useful for women who have undergone early menopause (before 45 years of age).
  • Due to the small increased risk of heart disease, strokes and breast cancer in older women other osteoporosis medicines are more suitable for women over the age of 60.
Teriparatide

Daily injection for 18 months (self-administered): Teriparatide (Brand name: Forteo)

  • This medicine stimulates bone-forming cells, resulting in improved bone strength and structure. It is only prescribed for people with severe osteoporosis when other osteoporosis medicines have not worked and the risk of more fractures is still very high. Teriparatide must be prescribed by a specialist and can only be taken for 18 months. Once the course of teriparatide is finished, another osteoporosis medicine must be started to ensure that the new bone formed is maintained and improved.
  • Teriparatide is PBS subsided only for people who have very low bone density and who have experienced a minimum of two fractures, with at least one new fracture occurring whilst on another osteoporosis medicine.
  • 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 subsidised by the PBS for both men and women. Once the maximum 18-month 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.

Disclaimer: Information provided on this site is meant to complement and not replace advice or information from a health professional.

Author: Osteoporosis Australia Medical & Scientific Advisory Committee
Last updated: 02/05/2015 - 13:51