What is osteoporosis medicine?

Osteoporosis medicines are used to strengthen your bones.

Your doctor will prescribe medicines if you have a diagnosis of osteoporosis. Osteoporosis is a chronic (long-term) disease that causes your bones to break more easily after injuries or falls. Osteoporosis is more common in females than males.

These medicines may also be used to stop your bones from getting weaker if you have osteopenia, a condition that can progress to osteoporosis.

Your bones are always 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 faster, because your body makes less of the hormone oestrogen.

To get osteoporosis medicines, you will need a prescription from your doctor. You will also need a bone density scan to get a diagnosis of osteoporosis.

How do osteoporosis medicines work?

Some osteoporosis medicines work by slowing the rate of bone breakdown. Others work by increasing the formation of new bone.

• Bisphosphonates and denosumab slow 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 bone loss process and increasing the rate that new bone cells are made.
• Teriparatide acts in a similar way to your natural parathyroid hormone — it increases new bone formation by bone-producing cells.

What types of osteoporosis medicine might I be prescribed?

You can take osteoporosis medicines as:

• a tablet
• a patch (on the skin)
• an injection (under the skin)
• an infusion (into the vein)

Bisphosphonates and denosumab

Bisphosphonate medicines include:

• 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 is an injection. It needs to be given strictly every 6 months to keep working.

Don't stop taking your medicines without getting advice from your doctor.

Hormone therapy

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

• oestrogen (tablets or patches can be used to replace oestrogen after menopause)
• raloxifene (daily tablet)

Other medicines

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 talk with you to understand your preferences and overall health. They will consider the best medicine to use for your situation.

How do I take osteoporosis medicines?

If you take a bisphosphonate tablet, there are important dosing instructions.

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.

What are the side effects or risks of osteoporosis medicine?

Bisphosphonates may cause gastrointestinal (digestive system) problems. Your doctor and pharmacist will give you clear instructions about how to reduce your chance of side effects. Always take your medicines exactly as recommended. Ask questions if you are not sure about something.

If you find it difficult to take your bisphosphonate tablets, ask your doctor if an injection or infusion would be a good option for you.

Very rarely, bisphosphonates can cause bone loss in the jaw. They may also very rarely cause unusual fractures in other bones. Be sure to keep up your regular dental care. Visit your dentist for regular check-ups and teeth cleaning, to help keep your mouth, teeth and jaw healthy.

Denosumab may increase your chance of skin infections. It can also cause low calcium levels if you have severe kidney disease.

Ask your doctor about side effects when you start a new medicine.

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 if you take denosumab — this could be cellulitis

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

Tell your doctor if you are diagnosed with any new medical conditions such as:

• blood clots
• kidney disease
• cancer
• heart disease

A new diagnosis may mean your doctor needs to change your osteoporosis medicine.

Are there any alternatives to this medicine?

Weight-bearing exercise and strength training helps to keep your bones strong and improve your balance. Exercise also helps reduce your risk of:

• osteoporosis
• falls
• broken bones

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

Protein is important to maintain bone health and for slowing down bone loss. It's important to make sure you have enough protein in your diet.

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

Vitamin K is also important for bone health and can be found in green leafy vegetables such as kale and spinach.

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.
• Read the Consumer Medicines Information.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.