Drug treatments for bone health

Osteoporosis can be treated with various drugs. Your doctor may prescribe a treatment to reduce bone loss and the risk of fracture. Bone loss happens when old bone is broken down faster than new bone is made.

Bisphosphonates are a type of drug commonly given to people with osteoporosis or people having a cancer treatment that may cause bone loss. They are usually given as tablets or capsules taken daily, weekly or monthly. They work to make the existing bone stronger by preventing bone loss.

Side effects of bisphosphonates can include; indigestion, a sore throat, inflamed gullet, pains in the muscles and flu-like symptoms.

Rarely bisphosphonate treatment can cause damage to the bone tissue in the jaw (osteonecrosis) making teeth loose and causing gum problems. For this reason it’s important to let your dentist know before you start a course of bisphosphonates.

Other treatments for osteoporosis may include calcium and vitamin D supplements, denosumab, raloxifene, parathyroid hormone or hormone replacement therapy (HRT). HRT is usually given to women in the form of oestrogen replacement, or men as testosterone replacement.

If you need specialist advice for your osteoporosis your doctor may refer you to a specialist team.

Drug treatments

There are different drug treatments that can help people with osteoporosis. They can reduce bone loss and the risk of fractures.


Bisphosphonates

These are commonly given to people with osteoporosis to prevent fractures. They may also be used to prevent bone loss caused by cancer treatments – in particular hormonal therapy. They’re also used to prevent or treat cancer that has spread to the bone (secondary cancer in the bone or bone metastases).

Bisphosphonates work by slowing down the osteoclasts, which slows down bone loss. Although bisphosphonates don’t help replace lost bone, they can stop further bone loss, and this helps to make the existing bone stronger. There are a number of different bisphosphonates used to treat osteoporosis, including:

Bisphosphonates are usually given as tablets or capsules when they’re used to treat bone loss and osteoporosis. They may be given daily, weekly or sometimes monthly. Occasionally bisphosphonates are given by injection into a vein (intravenously) or as an infusion.

You should take your tablets or capsules on an empty stomach with a glass of water, usually first thing in the morning. Stay upright for 30–60 minutes after taking the tablet or capsule. This helps the drug move quickly into the stomach and reduces the risk of the drug staying in the throat or gullet where it can cause irritation.

Side effects of bisphosphonates

Side effects include:

  • indigestion
  • a sore throat or inflamed gullet
  • pains in the muscles and joints
  • flu-like symptoms, which usually settle after the first dose.

A rare side effect of bisphosphonate treatment is osteonecrosis of the jaw. It happens when healthy bone tissue in the jaw becomes damaged and dies. This can cause loosening of the teeth and problems with the way the gums heal. The risk of developing osteonecrosis is low if you are taking bisphosphonates to treat osteoporosis. It’s more likely to happen when bisphosphonates are given to treat cancers that have spread to the bones (secondary bone cancer). This is because higher doses of bisphosphonates are used to treat secondary bone cancer.

Before you start taking bisphosphonates, you should let your dentist know. If you haven’t been to the dentist for six months or you have dentures that don’t fit well, you should arrange a check-up. This is because you should avoid having any dental extractions (removal of a tooth or root) or implants during bisphosphonate treatment. It’s fine to have fillings, gum treatments or a scale and polish.

If your dentist decides you need to have a dental extraction while you’re taking bisphosphonates, tell your doctor before you have any treatment. Your doctor may stop your bisphosphonates while you have the extraction and until the tooth socket has fully healed.


Calcium and vitamin D supplements

If you’re having cancer treatments that are known to increase your risk of osteoporosis you may need to take calcium and vitamin D supplements. Your GP will tell you if you need to take supplements. They will usually organise a FRAX or QFracture assessment or a bone mineral density scan before deciding whether you need to take them.

Your GP may prescribe combined calcium and vitamin D tablets or vitamin D tablets alone, to be taken alongside bisphosphonate treatment. You can buy both calcium and vitamin D supplements without a prescription from many chemists, but always check what dose to take with your GP.


Denosumab (Prolia®)

Denosumab may be used to reduce bone loss in:

  • women who’ve gone through the menopause and have an increased risk of fractures because of osteoporosis
  • men with prostate cancer who have a higher risk of bone loss because of treatments (such as hormonal therapy) that lower the level of testosterone in the body.

Denosumab is normally used in specific circumstances. For example, it’s given when bisphosphonate drugs such as alendronic acid can’t be tolerated or are likely to cause too many side effects.

Denosumab is given once every six months as an injection just under the skin (a subcutaneous injection). If you have denosumab, your doctor may advise you to take calcium and vitamin D supplements.

Denosumab can cause some side effects. These include:

  • skin, urine and chest infections
  • constipation
  • pain in the arms or legs
  • a rash.

Rarely, denosumab can also cause osteonecrosis of the jaw so you will need to be careful about dental treatment.


Raloxifene (Evista®)

Raloxifene is used to prevent and treat osteoporosis in women who have been through the menopause. The drug mimics some of the helpful effects of oestrogen, reducing the breakdown of bone and the risk of fractures.

It’s used only for women who can’t tolerate bisphosphonates. Women with breast cancer who are treated with tamoxifen shouldn’t take raloxifene. This is because it may interfere with tamoxifen.

Raloxifene is taken daily as a tablet.


Parathyroid hormone (PTH)

PTH is a naturally occurring hormone that’s produced by the parathyroid glands, which are attached to the thyroid gland in the front of the neck. PTH stimulates bone formation and helps the body absorb calcium.

There’s a synthetic version of PTH called teriparatide (Forsteo®), which can be injected just under the skin (a subcutaneous injection). You have it every day for a maximum of 24 months.

It’s more likely to be given to people who have broken bones caused by severe osteoporosis. It can’t be given to people with certain types of cancer, for example people who have cancer that has spread to their bones.


Hormone Replacement Therapy (HRT)

Oestrogen replacement

Oestrogen helps protect women’s bones. Some cancer treatments may lower the levels of oestrogen in the body, and HRT can be used to replace the oestrogen. Young women who haven’t been through the menopause may be advised to have HRT to protect their bones and help with menopausal symptoms if:

  • they have an early menopause due to cancer treatment
  • they don’t already have risk factors for breast or ovarian cancer, such as a family history.

HRT is not suitable for women with breast cancer. This is because the HRT contains oestrogen, which could encourage breast cells to grow. Some doctors also think HRT shouldn’t be given to women with ovarian cancer or womb cancer. 

If HRT is suitable, it may be given until a woman reaches the normal age of menopause (usually about 50), and sometimes for a few years afterwards. HRT is not recommended for elderly women who have been through the menopause. This is because the risks of developing other health problems (such as heart problems, stroke and breast cancer) outweigh any benefits.

Testosterone replacement

If a man under 60 has a low testosterone level because of cancer treatment, he can be given testosterone to get the level back to normal. This helps increase bone density.

Other hormone replacement

There are different types of hormone replacement therapy for both men and women. They can be given as tablets, injections, gels or patches applied to the skin.


Specialist referral

If your GP or hospital doctor thinks you need specialist advice for osteoporosis, they may refer you to a hospital team that specialises in it. These teams include doctors, nurses and physiotherapists, who work closely with occupational therapists and pain specialists.

Back to Bone health

Bone health

The human body is made up of more than 200 bones, it is important to keep them healthy.

Looking after your bones

There are changes that you can make to your diet and way of life to improve your bone health.