A number of medications are available to help slow bone loss and maintain bone mass, including:
• Bisphosphonates. Much like estrogen, this group of drugs can inhibit bone breakdown, preserve bone mass, and even increase bone density in your spine and hip, reducing the risk of fractures. Examples of these medications include alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel) and zoledronic acid (Reclast).
Bisphosphonates may be especially beneficial for men, young adults and people with steroid-induced osteoporosis. They're also used to prevent osteoporosis in people who require long-term steroid treatment for a disease such as asthma or arthritis.
Side effects, which can be severe, include nausea, abdominal pain, difficulty swallowing and the risk of an inflamed esophagus or esophageal ulcers. Bisphosphonates that can be taken once a week or once a month may cause fewer stomach problems. If you can't tolerate oral bisphosphonates, your doctor may recommend periodic intravenous infusions of bisphosphonate preparations.
There have also been reports of serious side effects with bisphosphonates, such as osteonecrosis of the jaw, irregular heartbeats and visual disturbances. Discuss the potentials risks and benefits of these medications with your doctor, and let your dentist know if you're taking any medications prior to any dental surgery.
• Raloxifene (Evista). This medication belongs to a class of drugs called selective estrogen receptor modulators (SERMs). Raloxifene mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen, such as increased risk of uterine cancer and, possibly, breast cancer. Hot flashes are a common side effect of raloxifene, and you shouldn't use this drug if you have a history of blood clots. This drug isn't currently recommended for use in men, though a small study found that it may also be helpful for preserving bone density in men.
• Calcitonin. A hormone produced by your thyroid gland, calcitonin reduces bone resorption and may slow bone loss. It may also prevent spine fractures, and may even provide some pain relief from compression fractures. It's usually administered as a nasal spray and may cause nasal irritation in some people who use it, but it's also available as an injection. Because calcitonin isn't as potent as bisphosphonates, it's normally reserved for people who can't take other drugs.
• Teriparatide (Forteo). This powerful drug, an analog of parathyroid hormone, treats osteoporosis in postmenopausal women and men who are at high risk of fractures. It works by stimulating new bone growth, while other medications prevent further bone loss. Teriparatide is given once a day by injection under the skin on the thigh or abdomen. Long-term effects are still being studied, so therapy is recommended for two years or less.
Estrogen, especially when started soon after menopause, can help maintain bone density. However, the use of hormone therapy can increase your risk of blood clots, endometrial cancer, breast cancer and possibly heart disease. Because of concerns about its safety and because other treatments are available, hormone therapy is generally not a first-choice treatment anymore.
In addition to medications or hormones, physical therapy programs may help you build bone strength and improve your posture, balance and muscle strength, making falls less likely.