Medications That Boost Bone Health

With the many health concerns facing postmenopausal women, it’s easy to overlook bone health. After all, weak bones don’t cause any symptoms. But one out of every two women will suffer a bone fracture in her lifetime as a result of osteoporosis—and broken bones, especially hip bones, can lead to loss of independence, restricted mobility, and earlier death.

That’s why it’s important to find out if you have osteoporosis, and if you do, to talk to your health-care provider about medications that can help reduce your fracture risk.

Criteria for Osteoporosis

Osteoporosis is a condition characterized by low bone density, which makes the bones brittle, weak, and more vulnerable to fracture.

“A person is considered a candidate for osteoporosis medications if they meet one or more of three criteria,” explains Alana Serota, MD, an osteoporosis expert at the Weill Cornell- affiliated Hospital for Special Surgery.

“Osteoporosis is diagnosed if a dualenergy X-ray absorptiometry (DXA) scan results in a T-score of -2.5 or below at any one of these locations: lumbar spine, total hip, femoral neck (where the head and the shaft of the thigh bone meet), or a specific section of the radius (one of the bones in your forearm),” says Dr. Serota.

The Fracture Risk Assessment Tool (FRAX) estimates your risk for breaking a bone in the next 10 years. Medication should be considered if the FRAX score reveals that the 10-year probability of a hip fracture is 3 percent or greater or the 10-year probability of a major osteoporosis-related fracture is 20 percent or greater. Some of the factors used to calculate a FRAX score include age, sex, use of certain prescription drugs, history of a previous fracture, smoking status, alcohol consumption, and bone mineral density.

Finally, medication may be appropriate if a woman has suffered a fragility fracture, which is a fracture that results from minimal trauma, such as a fall from a standing height or lower, or no identifiable trauma.

Medication Options

Bones are in a constant process of resorption (breakdown) and formation (buildup). Each of the two main types of osteoporosis medications addresses one part of the process.

“Antiresorptive medications work by slowing down the rate at which bone is broken down; they include bisphosphonates, a RANK ligand inhibitor, selective estrogen receptor modulators (SERMs), and estrogen,” explains Dr. Serota.

Bisphosphonates include alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel), and zoledronic acid (Reclast); SERMs include bazedoxifene (Duavee) and raloxifene (Evista). Denosumab (Prolia) is the only RANK ligand inhibitor currently available.

“Osteoanabolic, or bone‑growing, drugs are the other main type,” says Dr. Serota. These drugs stimulate bone formation, increasing bone mass and strengthening bones. They include abaloparatide (Tymlos), teriparatide (Forteo), and romosozumab (Evenity).

Deciding on a Medication

“The factors we consider when determining which medication is best include the starting bone mineral density, trabecular bone score [based on information obtained from a DXA image of the lumbar spine], fracture history, age, and prior treatment,” says Dr. Serota. “Each woman’s circumstances must be evaluated when choosing a medication.”

Another decision involves the delivery method of the medication: Some medications are available in pill form and are taken on a weekly or monthly basis, while others are administered via injection or infusion every three, six, or 12 months.

“Risks associated with medications vary by delivery system,” notes Dr. Serota. “For example, injectable bisphosphonates do not cause gastrointestinal symptoms (nausea, heartburn), like some oral medications do.”

Boost Bones with Lifestyle

Medication is only one element in a treatment plan for osteoporosis. Diet and exercise are key components of a program that supports bone health.

Getting an adequate amount of calcium from your diet is important. Foods that contain calcium include dairy products, especially milk and yogurt, and many plant-based foods, including spinach, broccoli, kale, beans (white, kidney, pinto, garbanzo), almonds, sesame seeds, chia seeds, and tofu made with calcium sulfate. Beverages often fortified with calcium include nondairy milks and orange juice.

Strong bones also require vitamin D, which increases the absorption of calcium in your digestive tract and promotes bone growth. Vitamin D is found in some species of fish, such as salmon, herring, sardines, and tuna, as well as egg yolks, and mushrooms that are exposed to ultraviolet light. Foods commonly fortified with vitamin D include cereals, orange juice, and dairy and nondairy milks.

“If you cannot get enough calcium or vitamin D from your diet, you will need to take supplements. Ask your doctor what types and dosages are appropriate for you,” says Dr. Serota.

Dr. Serota also emphasizes that exercise helps slow the rate of bone loss and decreases the risk of falls and fractures. She recommends a program called, “Too Fit to Fracture: Managing Osteoporosis Through Exercise,” which provides exercise recommendations for people who have osteoporosis or vertebral fractures. The program explains different types of exercises (such as strength training and exercises for balance, posture, and flexibility), gives exercise instructions, guides you in creating an activity plan, and gives information on how to prevent spine fractures. You can access this free resource at Osteoporosis Canada’s website: https://bonefit.ca/resources/tftf/.

Screening Guidelines

All women ages 65 and older are advised to have a DXA scan. DXAs are also recommended for postmenopausal women younger than age 65 who have risk factors for low bone mass, such as low body weight, prior fracture, taking medications that increase osteoporosis risk (see What You Should Know for information), or having a disease associated with bone loss, such as celiac disease, inflammatory bowel disease, rheumatoid arthritis, anorexia, and hyperparathyroidism.

“If you are at high risk for low bone mass and younger than 65, you may be prescribed medication to prevent further decline in your bone mass,” notes Dr. Serota. “This is particularly important if you are taking a drug that rapidly damages bone or increases fracture risk, such as aromatase inhibitors [used to treat breast cancer] and glucocorticoids [antiinflammatory steroid drugs].”

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