Do You Need Treatment?
The standard of care for treating osteoporosis has changed since 2008, when treatment recommendations were based solely on a person’s bone mineral density.
Today, treatment recommendations are based on your total osteoporotic fracture risk, as calculated by the
World Health Organization’s Fracture Risk Assessment (FRAX) Tool.
The FRAX tool incorporates your femoral bone mineral density score along with information such as:
- Fracture history
- Parental history of hip fracture
- Smoking status
- Alcohol consumption
- Prescription drug use
- Other disease diagnoses
Based on the information you provide, an estimate of your chances of suffering a hip fracture and other major osteoporotic fracture (spine, forearm, hip or shoulder fracture) in the next 10 years is generated. Our doctors use these results to tailor your treatment plan.
In the U.S., treatment is recommended if a person’s 10-year risk of a hip fracture is 3 percent or greater, or if their 10-year risk of major osteoporotic fracture is 20 percent or more.
Preventing A Second Fracture
The bone health specialists at UC San Diego Health help ensure that anyone who incurs a hip fracture as a result of a fall from a standing height or less will receive a fracture risk assessment, treatment (if necessary), and continued care from an orthopedist and osteoporosis specialist. This service is instrumental in the prevention of secondary and subsequent fractures.
Who Treats Osteoporosis
Several medical specialists can treat osteoporosis including:
Endocrinologists specialize in the branch of medicine that focuses on glands in the body (e.g., ovaries, adrenal glands) that secrete hormones. Hormones help regulate bone cell activity and are thus essential to maintaining skeletal integrity. Hormonal dysfunction can disrupt the creation of new bone and breakdown of old bone, leading to a net loss in bone mass.
Geriatricians regularly treat osteoporosis since age is the single-greatest risk factor for sustaining an osteoporotic fracture.
How Is Osteoporosis Treated?
You can treat osteoporosis through diet and other lifestyle changes. Non-drug treatments include making sure that you:
- Get adequate intake of dietary calcium and vitamin D
- Engage in regular weight-bearing physical activity or resistance training
- Minimize alcohol intake
- Don’t smoke and quit if you do
- Learn fall prevention strategies
- Do exercises that help develop a greater sense of balance
FDA-Approved Drug Therapies for Osteoporosis
The following drug therapies may be recommended in addition to diet and lifestyle changes.
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There are two types of bone cells known to be actively involved in removing old bone and replacing it with new bone: osteoclasts (breaks down bone) and osteoblasts (makes new bone). The most commonly prescribed medications for osteoporosis are antiresorptive drugs, known as bisphosphonates. These drugs limit bone loss by inhibiting osteoclast function. Bisphosphonates don’t rebuild bone but stabilize bone loss.
Some common oral bisphosphonates include:
- Alendronate (e.g., Fosamax)
- Risedronate (e.g., Actonel, Atelvia)
- Ibandronate (e.g., Boniva)
- Zoledronic acid (e.g., Reclast, Zometa)
Zolendronic acid is a newer treatment injected intravenously once a year directly into the bone. It may be preferable for people who cannot swallow pills or who have experienced adverse side effects from oral medications.
What is a bisphosphonate holiday?
The long-term use of drugs that help prevent bone loss (known as bisphosphonates) may damage the structural integrity of the bone matrix structure and has been associated with spontaneous femur and hip fractures. To prevent these rare but potentially debilitating injuries, your physician may suggest a "holiday" from your medication.
Raloxifene (e.g., Evista) is an oral selective estrogen receptor modulator that mimics the bone-building effects of the body’s own estrogen. It is given only to women, improves bone mineral density, and has been shown to prevent spine fractures.
Denosumab (Prolia, Xgeva)
Approved by the FDA in 2010, denosumab (e.g., Prolia, Xgeva) is a human monoclonal antibody. It is an antiresportive drug that acts on a different molecular pathway than bisphosphonates (which are also antiresportive drugs). Specifically, denosumab prevents the maturation of osteoclasts by binding to and inhibiting certain cell surface molecules. The drug is administered subcutaneously in the upper arm (like a vaccine) twice a year.
Approved by the FDA in 2019, romosozumab (Evenity) is a human monoclonal antibody, different from other FDA-approved bone therapeutic drugs in that it both builds bone and reduces bone resorption. It is indicated for the treatment of osteoporosis in postmenopausal women at high risk for fracture. Evenity is administered subcutaneously once monthly for 12 months. Continued therapy with an antiresorptive agent such as alendronate or denosumab following the 12 month period should be considered as this was what was done in the randomized controlled trials.
Abaloparatide is a human parathyroid-related protein that, in April 2017, became the second FDA-approved medication that is classified as an anabolic therapy, shown to directly stimulate osteoblastic formation of new bone. Injected under the skin on a daily basis, this medicine improves bone density and helps to prevent bone fracture in postmenopausal women. It is currently approved by the FDA for use up to two years in postmenopausal women with osteoporosis who are at high risk for fracture.
Teriparatide is a form of the human parathyroid hormone that stimulates the formation of new bone. In 2002, it was the first anabolic therapy for osteoporosis approved by the FDA. The hormone is injected into the body once daily for up to two years and is approved as a second-line treatment of postmenopausal osteoporosis. It can also be prescribed to increase bone mass in men with primary or hypogonadal osteoporosis at high risk of fracture. In 2009, the FDA expanded teriparatide’s indication to include treatment for glucocorticoid induced osteoporosis.
Low-testosterone levels may cause osteoporosis in men. For low-testosterone men, doctors may prescribe testosterone replacement to build bone mass.