Medicines for osteoporosis

Your health care provider may prescribe certain medicines to help lower your risk of fractures. These medicines can make the bones in your hips, spine, and other areas less likely to break.

Your provider may prescribe medicines when:

• A bone density test shows you have osteoporosis, even if you have not had a fracture before, but your fracture risk is high. Typically, screening is recommended for women 65 years and older and for men older than 70 years. However, your provider may order the bone density scan earlier if you have certain risk factors.
• You have a bone fracture, and a bone density test shows you have a bone density lower than normal, but not osteoporosis.
• You have a bone fracture that occurs without any significant injury.

Bisphosphonates are the main medicines that are used to both prevent and treat bone loss. They are most often taken by mouth. You may take a pill once daily, weekly, or monthly. You also may get bisphosphonates through a vein (IV). Most often this is done once a year. However, a bisphosphonate called zoledronic acid has recently been approved for use once every two years to prevent osteoporosis.

Common side effects of bisphosphonates taken by mouth are heartburn, nausea, and belly pain. When you take bisphosphonates:

• Take them on an empty stomach in the morning with 6 to 8 ounces (oz), or 180 to 240 milliliters (mL), of plain water (not carbonated water or juice).
• After taking the pill, remain sitting or standing for at least 30 minutes.
• Do not eat or drink for at least 30 to 60 minutes.

Rare side effects are:

• Low blood calcium level
• A certain type of leg-bone (femur) fracture
• Damage to the jaw bone
• Fast, abnormal heartbeat (atrial fibrillation)

Your provider may have you stop taking this medicine after about 5 years. Doing so decreases the risk of certain side effects. This is called a medicine holiday.

Raloxifene (Evista) may also be used to prevent and treat osteoporosis. This medicine:

• Reduces the risk of spinal fractures, but not other types of fractures.
• Has a very small risk of blood clots in the leg veins or in the lungs.
• May also help decrease the risk of heart disease and breast cancer.
• Isn't the only selective estrogen receptor modulators (SERMs) used to treat osteoporosis.

Denosumab (Prolia) is a medicine that prevents bones from becoming more fragile. This medicine:

• Is given as an injection every 6 months.
• May increase bone density more than bisphosphonates.
• Is generally not a first-line treatment.
• May not be a good choice for people who have weak immune systems or who take medicines that affect the immune system.

Teriparatide (Forteo) is a bio-engineered form of parathyroid hormone. This medicine:

• May increase bone density and decrease the risk for fractures.
• Is given as an injection underneath the skin at home, often every day.
• May cause side effects such as nausea, dizziness, or leg cramps.
• Had a previous FDA black box warning for a theoretical risk of osteosarcoma that was recently removed. The label still advises against use in people with increased osteosarcoma risk factors.

Estrogen, or hormone replacement therapy (HRT). This medicine:

• Is very effective in preventing and treating osteoporosis.
• Was the most commonly used osteoporosis medicine for many years. Its use decreased because of concern that this medicine caused heart disease, breast cancer, and blood clots.
• Is still a good option for many younger women (50 to 60 years old). If a woman is taking estrogen already, she and her provider must discuss the risks and benefits of doing so.

Romosozumab (Evenity) targets sclerostin, a protein secreted by bone cells that naturally inhibits bone formation. This medicine:

• Is given monthly as an injection under the skin for one year.
• Is effective at increasing bone density.
• May make calcium levels too low.
• May increase the risk of heart attack and stroke.

Below medicines are rarely used for osteoporosis or only for specific situations.

Parathyroid hormone. This medicine:

• Is given as daily shots under the skin. Your provider or nurse will teach you how to give yourself these shots at home.
• Works better if you have never taken bisphosphonates.

Calcitonin is a medicine that slows the rate of bone loss. This medicine:

• Is sometimes used after a bone fracture because it decreases bone pain.
• Is much less effective than bisphosphonates.
• Comes as a nasal spray or an injection.

Contact your provider for these symptoms or side effects:

• Chest pain, heartburn, or problems swallowing
• Nausea and vomiting
• Blood in your stool
• Swelling, pain, redness in one of your legs
• Fast heart beat
• Skin rash
• Pain in your thigh or hip
• Pain in your jaw

Alendronate (Fosamax); Ibandronate; Risedronate (Actonel); Zoledronic acid (Reclast); Raloxifene (Evista); Teriparatide (Forteo); Denosumab (Prolia); Romosozumab (Evenity); Low bone density - medicines; Osteoporosis - medicines

De Paula FJA, Black DM, Rosen CJ. Osteoporosis: basic and clinical aspects. In: Melmed S, Auchus RJ, Goldfine AB, Rosen CJ, Kopp PA, eds. Williams Textbook of Endocrinology. 15th ed. Philadelphia, PA: Elsevier; 2025:chap 29.

Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2019;104(5):1595-1622. PMID: 30907953 pubmed.ncbi.nlm.nih.gov/30907953/.

Weber TJ. Osteoporosis. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 225.

Updated by: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.