Osteoporosis

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Catherine Burt Driver, MD
    Catherine Burt Driver, MD

    Catherine Burt Driver, MD

    Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

View the Osteoporosis Slideshow Pictures

Quick GuideOsteoporosis Pictures Slideshow: Are Your Bones at Risk?

Osteoporosis Pictures Slideshow: Are Your Bones at Risk?

Choosing an osteoporosis medication

In choosing a medication for osteoporosis, a physician will consider all aspects of a patient's medical history as well as the severity of the osteoporosis.

If a postmenopausal woman has other menopausal symptoms such as hot flashes and vaginal dryness, HRT will be the proper choice for these menopausal symptoms as well as for the prevention of osteoporosis. After the menopausal symptoms have passed, some other nonestrogen prescription medication will be considered for the longer term.

If the prevention and treatment of osteoporosis is the only issue under consideration, then bisphosphonates such as alendronate, ibandronate, or risedronate are more effective than menopausal hormone therapy in preventing osteoporotic fractures and less likely to be associated with substantial adverse effects. So far, bisphosphonates are the most well-studied and effective category of prescription medication for treating postmenopausal osteoporosis.

A few serious esophageal conditions preclude the use of oral bisphosphonates, specifically esophageal stricture or achalasia. In these two conditions, it is likely that the bisphosphonate tablets will be retained in the esophagus and lead to esophageal inflammation, ulceration, and scarring. Caution often is advised for people with dysphagia (trouble swallowing) because the dysphagia may be a manifestation of a problem in the esophagus that will cause the bisphosphonate tablets to get stuck. Caution also is advised when there is gastritis, duodenitis, or ulcers because of the possibility that the bisphosphonate will aggravate the inflammation associated with these conditions. Any worsening of gastrointestinal symptoms should be reported immediately, but the vast majority of people tolerate bisphosphonates without symptoms when the prescribing directions are followed carefully. Fortunately, GERD or heartburn, which are common, are not reasons for withholding bisphosphonates but they are considered when selecting optimal treatment for an individual. Prescribing directions should be followed carefully. Moreover, intravenous bisphosphonates, such as zoledronate (Reclast) or injectable denosumab (Prolia), may be given to those with esophageal strictures, achalasia, dysphagia, or gastrointestinal side effects from oral bisphosphonates.

In patients with GERD or who have symptoms of heartburn, risedronate may prove to cause less irritation to the esophagus than alendronate, but now intravenous bisphosphonates, such as zoledronate may be preferred.

Calcitonin is a weaker antiresorptive medication than bisphosphonates. It is reserved for patients who cannot take or will not consider taking other medications. Raloxifene also is a weaker medication for improving bone density or preventing fractures as compared to estrogen or bisphosphonates. In patients with moderate to severe osteoporosis, it is advisable to use the more potent antiresorptive medications (bisphosphonates). In addition, the safety and effectiveness of more than three years of raloxifene, or more than 24 months of teriparatide, have not been well studied.

Estrogen replacement and raloxifene differ in their side effects and also in their effects on cholesterol levels. For example, raloxifene does not raise the "good" HDL cholesterol but estrogen replacement does. Both estrogen and raloxifene lower the "bad" LDL cholesterol.

Medically Reviewed by a Doctor on 11/9/2015
VIEW PATIENT COMMENTS
  • Osteoporosis - Symptoms

    What were your symptoms at the onset of your osteoporosis?

    Post View 28 Comments
  • Osteoporosis - Treatment

    What kinds of treatment, including medication or supplements, have you tried for your osteoporosis?

    Post View 4 Comments
  • Osteoporosis - Share Your Experience

    Do you or a relative have osteoporosis? Please share your experience.

    Post View 1 Comment
  • Osteoporosis - Risk Factors and Causes

    Do you have any risk factors for osteoporosis? What are they?

    Post View 2 Comments
  • Osteoporosis - Lifestyle Changes

    What lifestyle changes (diet, exercise, quitting smoking or alcohol) have you made to manage your osteoporosis?

    Post View 1 Comment
  • Osteoporosis - Hormone Therapy Experience

    Have you been prescribed hormone therapy to treat your osteoporosis? What was your experience?

    Post
  • Osteoporosis - Medications

    What medications have been prescribed to treat your osteoporosis?

    Post View 3 Comments
  • Osteoporosis - Complications

    Have you had any complications related to your osteoporosis? If so, what were they?

    Post View 2 Comments

Health Solutions From Our Sponsors