Osteoporosis is a common condition in which your bones become porous and fragile, increasing the risk of fractures. It can affect anyone, but it’s seen most frequently in older post-menopausal women. For many years, treatments with the hormone estrogen were used to prevent further bone loss in women with osteoporosis. But with new advances in osteoporosis treatment, there are now many other options available.
We know the female hormone estrogen plays a role in building new bone and maintaining bone density. After menopause, women’s bodies experience a sharp drop in estrogen levels. This impacts the body’s ability to rebuild bone efficiently. Eventually, this may result in a loss of bone mass and lead to the development of osteoporosis.
Knowing the relationship between estrogen and osteoporosis, it makes sense that treating post-menopausal women with estrogen (or a combination of estrogen and another hormone, progesterone) would be effective for slowing the rate of bone loss. This is also called hormone replacement therapy, or HRT. Studies show that these treatments do indeed help reduce the risk of fractures in women. In the past, this was the primary form of treatment for osteoporosis.
However, data from a large study called the Women’s Health Initiative also revealed some risks associated with hormone therapy. This includes increased risks of breast cancer, stroke, and blood clots. For this reason, your doctor may recommend trying other medications to treat osteoporosis first, before using estrogen. If you can’t tolerate other osteoporosis treatments or you require estrogen to help manage your menopausal symptoms, your doctor may consider estrogen therapy, but it’s generally recommended to use the smallest therapeutic dose for the shortest time frame necessary.
Rather than simply slowing the rate of bone loss, researchers have discovered that using other hormones can actually help stimulate new bone formation. Parathyroid hormone and parathyroid hormone-related protein are both closely involved in the bone remodeling process, in which old bone is broken down and replaced by newer, healthier bone. Synthetic (manmade) versions of these hormones have been developed for use in postmenopausal women (and some men) who have very low bone density. They are given as an injection and can be used as an osteoporosis treatment for up to two years. Teriparatide (Forteo) and abaloparatide (Tymlos) are two currently approved drugs in this class.
Much research has gone into understanding how the cells within your bones function. This has led to the development of many additional non-hormonal treatments for osteoporosis, including:
Bisphosphonates: This is the most common type of medication used to treat osteoporosis. They slow down the rate at which your bones are broken down, giving bone-forming cells more time to rebuild. Some come in pill form, such as alendronate (Binosto, Fosamax) and risedronate (Actonel, Atelvia), which may be taken once a week or once a month. Ibandronate (Boniva) is given as a monthly pill or as an injection every three months. Zoledronic acid (Reclast) is given as an intravenous treatment once a year.
Selective estrogen receptor modulators (SERMs): These medications have similar effects to estrogen in terms of maintaining bone density but don’t carry the same risks. Raloxifene (Evista) is an example.
Biologics: Compared to most drugs, which are made from chemicals, biologics are created from components of living things. Denosumab (Prolia) is the first biologic approved to treat osteoporosis. It blocks cells in your body that break down bone. It’s given as an injection every six months. Other biologics are being studied for future use in osteoporosis treatment.
If you have osteoporosis or are at high risk of developing it, talk to your doctor about what treatments are appropriate for you. With the right treatment, you can protect your bones, allowing you to live an active and healthy life.
