Pros and Cons of Osteoporosis Medications

When you are diagnosed with osteoporosis or at high risk, your doctor will prescribe medication for treatment or prevention. Are you getting the right medication for you?

Factors you will want to consider are:

  1. Your doctor’s advice
  2. Side effects
  3. Does the drug have a good success record?
  4. How you prefer taking medication (pills, liquid, injections, or spray etc.)
  5. Cost
  6. How the drug works for you.

To help you with this process, the pros and cons of well-known osteoporosis medications are summarized below:

Teriparatide (Forteo)

Pros: activates bone- building cells, increases bone density, and reduces spinal fractures for patients with severe osteoporosis

Cons: requires a daily injection into the leg or stomach; more expensive than other options; may cause dizziness, nausea and leg cramps; cannot be taken for more than 18 to 24 months

Ralozifene (Evista)

Pros: for postmenopausal women not taking hormone therapy; decreases rate of bone loss; prevents spinal fractures; provides benefits of estrogen without other estrogen effects; may reduce breast cancer risk

Cons: may increase hot flashes and increase risk of blood clots

Bisphosphonates (Fosamax, Bonival, Actonel, Reclast)

Pros: these drugs slow bone breakdown and prevent spinal fractures; are prescribed to men and women for prevention and treatment; tablets or injections are available; variety of dosing schedules (e.g. daily, weekly, monthly). Reclast® is an exception in that it is only available to postmenopausal women as a yearly injection. Fosamax® and Actonel® have been effective in preventing hip fractures as well as spinal fractures.

Cons: Common side effects are nausea, stomach pain, and loose bowel movements. With Fosamax® and Actonel® there is a low risk of ulcers in the esophagus and a rare risk of jaw breakdown after dental work.

Calcitonin (Fortical, Miacalcin)

Pros: slows bone breakdown; prevents spinal fractures; helps control pain; available to men and women with osteoporosis; choice of synthetic or natural hormone

Cons: taken as an injection or nasal spray; studies show that it may not be as effective as some drugs in increasing bone density; side effects can include nasal dryness and swelling.

Hormone Therapy (HT)

Pros: for postmenopausal women; used for prevention and treatment; also relieves symptoms of menopause; increases bone density and prevents spine fractures

Cons: long-term use can increase risk of breast cancer, heart disease, and stroke; alternatives are explored before this option is chosen for osteoporosis; other side effects include depression, headaches, breast tenderness, and weight gain.

Careful Medication Choice is an Important Part of Osteoporosis Management

Your choice of medication is a personal decision in consultation with your doctor. Medication is an important part of osteoporosis management. There are four other very important ways to manage osteoporosis, which work with medication to strengthen bones and prevent fractures. They are:

  • Regular exercise
  • Balanced diet with calcium and vitamin D supplements
  • Avoiding or reducing smoking, caffeine and alcohol
  • Taking steps to prevent falls and fractures