Medicines for Osteoporosis

What it is

Osteoporosis means the bones have lost density and quality, so they become more fragile and break more easily — sometimes after only a minor bump or fall, and occasionally without obvious injury. It usually causes no symptoms until a fracture happens, often at the wrist, hip or spine; spinal fractures can lead to height loss and a stooped posture. Bone strength naturally declines with age, and the drop in oestrogen after the menopause makes women particularly vulnerable, but it can also follow long-term steroid use and certain other conditions. Because a hip fracture in particular can seriously affect independence, the aim of care is to find people at risk before a major break and to strengthen the skeleton against future fractures.

How it is treated

The first step is to assess a person's risk of breaking a bone, using a recognised fracture-risk tool together with a bone-density (DXA) scan where appropriate, so that treatment is directed at those who will benefit most. Good bone nutrition underpins everything: ensuring the diet provides enough calcium and that vitamin D is replete, since bone-protecting medicines work best on a sound nutritional base. When treatment is needed, a bisphosphonate is usually the first-line bone-protecting medicine; alternatives such as an injectable treatment, a medicine for selected post-menopausal women, or — for severe disease under specialist care — a bone-building treatment, are used where bisphosphonates are unsuitable or not enough. The practical way these medicines are taken matters: oral bisphosphonates, for example, are taken on an empty stomach with plenty of water while sitting or standing upright, to help them work and to reduce irritation. Treatment is reviewed periodically to check it is still needed and working.