Osteoporosis Medication

Osteoporosis Medication:
Clarifying Your Choices

When considering the use of an osteoporosis medication, even before talking about the specific medicines themselves (like a bisphosphonate), it’s important to understand a little about the odds of getting a fracture. A decision to proceed with osteoporosis treatment should be based on real science and the relative risks and benefits of treating or not treating. For a simple explanation of how to understand your risks, see my page onosteoporosis treatment. 

Bisphosphonate pros and cons

With that perspective, we can talk a little about the bisphosphonate prescriptions (medications with such brand names as Fosamax, Actonel, and Boniva). These are currently the most commonly written prescriptions when choosing an osteoporosis medication. These have shown consistent reduction in the number of new and repeat hip and vertebral fractures, with the greatest benefit in patients with the lowest bone density. There have been concerns about side effects: irritation of the esophagus is likely, so patients with known acid reflux may consider a cautious approach. The most feared adverse effect is osteonecrosis of the jaw, but this is extremely rare and occurs most commonly in patients with cancer receiving radiation to the head and neck; it is however untreatable. 

Just say No to HRT

I have been asked many times about hormone replacement therapy as an osteoporosis treatment option. I am not in favor of this, for simple reasons. The research suggests that several years of post-menopausal hormone replacement therapy is necessary for any benefit to bone density, and that the benefit disappears rapidly when HRT is stopped. Major studies have raised big red flags about the safety of HRT, and the increased risk in breast cancer and heart disease with hormone replacement therapy pushes me away from recommending this. 

The bottom line: and let’s talk more…

So what do I recommend as osteoporosis medication then? For some patients, benefits of treatment with bisphosphonates outweigh the risks: someone with a previous fracture, or taking long term steroids (like prednisone), or who is physically frail and likely to fall. When we have another time and space, I’d love to talk with you about natural treatment for osteoporosis, including my favorite prescription: weight bearing exercise. Here’s a brief preview: exercise improves balance and makes falls less likely, it improves bone density, and the simple act of walking for exercise 4 hours per week showed a 41% reduction in hip fracture in one study!

And recent data have suggested that lactoferrin supplements may be an effective way to build bone density naturally.

So, more on natural treatment later. I hope in the meantime, this short review has given you some perspective as you consider how to weigh your options for osteoporosis treatment.


For your health and wellness,



Robert Pendergrast, M.D. 

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