Osteoporosis is a condition in which the bones become more fragile due to bone deterioration or low bone mass. Osteoporotic fractures can arise with minimal trauma, such as a strain, bump, or fall. Fractures from osteoporosis commonly occur in the spine, hips, and arms. These fractures can be debilitating, leading to a decreased quality of life and an increased risk for other diseases.  

Fortunately, you can reverse the loss of bone density with lifestyle changes and treatments that may slow, maintain or even increase your bone density – helping you get back to what matters most. 

How to diagnose osteoporosis 

Your doctor will ask questions about your past medical history, including prior fracture history. Additionally, a DEXA scan may be ordered to evaluate your bones for osteoporosis. This scan is covered by most private insurances and Medicare since it is considered preventive care. It is performed every 2 years for at-risk individuals.  

Treatment options for osteoporosis 

If you or a loved one has recently been diagnosed with osteoporosis, it is important to know that you have options. To slow or stop bone loss and to prevent fractures, your provider may recommend:  

• Proper nutrition 
• Not smoking
• Exercise
• Fall prevention to help prevent fractures 

Osteoporosis medications 

When lifestyle treatment options do not provide enough relief to keep you moving comfortably, consider talking with an orthopaedic specialist about the latest medications. 

Healthy bones continuously break down and rebuild. As you age, especially after menopause, bones break down more quickly. Because bone rebuilding cannot keep pace, bones deteriorate and become weaker. 

Most osteoporosis medications work by reducing the rate at which your bones break down. Others work by speeding up the bone-building process. Both strengthen bone and reduce your risk of fractures. 

Antiresorptive medications (to prevent bone breakdown) 

• Fosamax (Alendronate): This is often the first choice in treating osteoporosis due to its long track record of safety and effectiveness. It belongs to a drug group known as bisphosphonates. It stops cells known as osteoclasts from breaking down your bones. This drug is taken by mouth once a week for 5 years followed by a “drug holiday” to prevent side effects. It helps prevent spine fractures, especially in post-menopausal women. 
• Actonel/Atelvia (Risedronate): Similar to Fosamax. Some patients tolerate this drug better due to fewer GI side effects.  
• Reclast (Zoledronic acid): This intravenous bisphosphonate is given once a year as a 30-minute infusion. This is an option for patients with esophageal motility disorders. Although effective, it is often not the first choice due to the increased risk of atypical fractures with long-term use. This drug is often preferred if multiple myeloma is associated with the diagnosis.   
• Evista (Raloxifene): Known as a selective estrogen receptor modulator, this drug is best for post-menopausal women at increased risk of breast cancer because it helps prevent and treat osteoporosis, as well as certain types of breast cancer.  
• Prolia (Denosumab): This drug stops a protein called RANKL that causes bone breakdown. It is given every 6 months as a relatively painless subcutaneous injection, the same way an insulin shot is given. This is a great option for those who cannot tolerate oral pills, those with severe kidney disease, and those who have severe osteoporosis. It is essential to not miss any injections, as doing so can undo benefits from prior Prolia injections. 

Anabolic medications (to promote new bone formation) 

• Forteo (Teriparatide)/Tymlos (Abaloparatide): This drug works like a parathyroid hormone, a natural hormone in your body that when given regularly stimulates bone production. It is a subcutaneous injection, given daily. Max duration is 2 years due to the increased risk of side effects. These drugs are best for severe osteoporosis (T-score 3.5 or less). 
• Evenity (Romosozumab): Indicated for those with low cardiac risk and severe osteoporosis, this drug inhibits a protein called sclerostin, which helps your body build new bone. It also prevents cells called osteoclasts from breaking down bones. It is given as 2 injections at the same time subcutaneously, once a month for 12 months.