What is osteoporosis medicine?

Osteoporosis medicines work by strengthening your bones. Your doctor will prescribe this if you have a diagnosis of osteoporosis — a long-term (chronic) disease that makes your bones more likely to break from minor injuries or falls. These medicines may also be used to prevent further weakening of your bones if you have osteopaenia, a condition that can progress to osteoporosis.

Your bones are constantly being built and broken down by different types of bone cells. From around 50 years of age, your bones break down faster than they build. If you’ve been through menopause, your bones will also lose strength more quickly, because you have less of the hormone oestrogen.

How do osteoporosis medicines work?

Osteoporosis medicines work on slowing the rate of bone breakdown, or increasing new bone formation:

• Bisphosphonates and denosumab work by slowing the cells that break down bones.
• Hormone therapy uses oestrogen-like effects to reduce bone breakdown after menopause.
• Romosozumab acts on a substance made by bone cells — it works by interrupting the process of bone loss and increasing the rate that new bone cells are made.
• Teriparatide acts in a similar way to your natural parathyroid hormone, to increase new bone formation by bone-producing cells.

You will need a prescription from your doctor before you can take any of these medicines.

What types of osteoporosis medicine might I be prescribed?

You can take osteoporosis medicines as a tablet, patch (on the skin), injection (under the skin) or infusion (into the vein).

The main types of osteoporosis medicines available include:

• bisphosphonates, a group of medicines that includes:
  • alendronate (1 tablet every week)
  • risedronate (1 tablet every week or month — depending on the dose your doctor prescribes)
  • zoledronic acid (infusion — once yearly)
• denosumab (injection — once every 6 months)

If you have been through menopause, depending on your situation your doctor might prescribe menopausal hormone therapy, such as:

• oestrogen (tablets or patches can be used to replace oestrogen if you have been through menopause)
• selective oestrogen receptor modulators (SERMs) raloxifene (daily tablet)

If you have severe osteoporosis, depending on your situation your specialist may prescribe:

• romosozumab (injection —once monthly)
• teriparatide (injection — once daily)
• strontium (tablet once daily)

Your doctor will work with you to consider the best option for your circumstances.

If you take a bisphosphonate tablet, there are important dosing instructions. For example, the alendronate once weekly formulation should be taken in the morning, swallowed whole (not chewed or sucked) with a full glass of water, at least 30 minutes before the first food, drink and medicine of the day (including antacids, calcium, iron or other supplements). Do not lie down for at least 30 minutes after the dose and not until after you’ve eaten food. Other medicines have different instructions — ask your pharmacist how to take your medicines.

Does osteoporosis medicine have any side effects or risks associated with it?

Bisphosphonates may cause gastrointestinal (tummy) problems. Your doctor and pharmacist will give you clear instructions on how to reduce your chance of side effects. Be sure to take your medicines exactly as they recommend and check with them if you are unsure. If you find it difficult to take your bisphosphonate tablets, ask your doctor if an intravenous infusion is a good option for you.

Very rarely, bisphosphonates can cause bone loss in the jaw. They may also very rarely cause atypical (unusual) fractures in other bones. Be sure to keep up your regular dental care, including visits to the dentist and teeth cleaning, to help keep your mouth and jaw healthy.

Denosumab may increase your risk of skin infections and cause low calcium levels if you have severe kidney disease.

If you take menopause hormonal therapy and still have a uterus, you will need to take progestogen to reduce your risk of endometrial cancer.

When should I see my doctor?

Your doctor needs to review your osteoporosis medicine regularly, so be sure to book regular GP visits. If you are taking medicines that increase your chance of bone loss of the jaw, your doctor will review your bone health every 5 to 10 years.

See your doctor if you have:

• stomach pain while taking a bisphosphonate
• red and painful skin (cellulitis) if you take denosumab

You should see your doctor if you have had a fall and are concerned that you may have a broken bone.

Make sure your doctor knows if you are diagnosed with any new medical conditions such as blood clots, kidney disease, cancer or heart disease, since you may need to change your medicine.

Are there any alternatives to this medicine?

Calcium can help improve your bone health, so it’s important to have a high-calcium diet and take a supplement if you need one.

Vitamin D is also key to bone health, and a mix of safe sun exposure and supplements can help ensure you have enough.

Weight-bearing exercise and strength training helps to keep your bones strong and improves your balance. Exercise also reduces your risk of osteoporosis, falls and broken bones.

Resources and support

• Healthy Bones Australia has information for all Australians about bone health.
• Learn more about how menopause affects your bones by visiting Jean Hailes.