There are several different types of bone density medications on the market and they all work in different ways. While these medications may increase your bone density, they come with frustrating (and sometimes serious) side effects.
1. Bisphosphonates (like Fosamax, Bonica, Actonel, Atelvia, and Reclast)
Bisphosphonates are a drug class that work by slowing the breakdown of the bone. There are several different ways to take bisphosphonates:
- Pills: Pill bisphosphonates consist of alendronate (like Fosamax), ibandronate (like Boniva), or risedronate (like Actonel or Atelvia). Depending on which pill you’re prescribed, you could be taking them every day, every week, or every month.
- Injections: This form is called ibandronate (like Boniva). Injections are usually taken once every three months.
- Infusions: Zoledronic acid (like Reclast) is given as an intravenous infusion. Infusions are often taken once a year.
Bisphosphonate pills may not be a good option you're prone to a sensitive stomach or heartburn. After taking them, you can be discouraged from ingesting anything else, laying down, or even bending over for 30-60 minutes to avoid the medicine coming back up. IV bisphosphonates can cause a mild flu-like experience after your first infusion.
The most well-known potential risks of bisphosphonate are those to your thigh bone and your jaw. The medication can cause a fracture in the middle of the bone that begins slowly and worsens over time.
Another concern is the risk for what’s called osteonecrosis, or “bone death,” in the jaw (7, 8).
This happens when your jawbone struggles or fails to heal after dental work. These side effects are more likely to occur in patients who are taking bisphosphonates to treat cancer in the bones, or in those who have been taking high doses of bisphosphonates long term.
These risks increase with long-term use, doctors advise against taking them for more than five years, and some even suggest intermittent breaks from the drugs to lower their risk.
2. Teriparatide (like Forteo) and Abaloparatide (like Tymlos)
These two drugs work by building up your bones. They are synthetic versions of a hormone that increases density.
Teriparatide and Abaloparatide are often prescribed if you have vertebral fractures and very low bone density. Unfortunately, when you take these drugs, you’ll need to give yourself an injection every day.
3. Calcitonin (like Miacalcin and Fortical)
Calcitonin is the oldest osteoporosis medication option, dating back to the ‘80s.
This hormone binds to the cells that normally break down bones, which helps prevent you from losing more bone density. While it’s been found to reduce spinal fractures, calcitonin isn’t known to be very effective for other types of fractures, so it’s not a very effective defense against osteoporosis.
Calcitonin also comes along with potential side effects like joint pain, stomach pain, muscle cramps, shaking hands, weight changes, and trouble sleeping.
4. Denosumab (like Prolia)
Denosumab is a monoclonal antibody that prevents the cells that break down your bones from forming. It’s taken as an injection twice a year. Unfortunately, denosumab comes with a major commitment: If you stop taking it, you’re likely to experience a swift drop in bone density and an abrupt risk of fractures (9).
5. Romosozumab (like Evenity)
Romosozumab is also a monoclonal antibody, and is usually given to those who have already suffered a fragility fracture (a fracture caused by a fall from standing height or lower).
It works by blocking a protein in your body that inhibits bone formation, freeing your system to build bone more easily. Romosozumab is given as an injection every month, but it loses its effectiveness after just one year. It also increases your risk for a heart attack or stroke (10).
6. Raloxifene (like Evista)
This medication is a selective estrogen receptor modulator (SERM). It’s often used to prevent or treat breast cancer, but it can also help treat osteoporosis. It does this by acting as estrogen in the body, which decreases how quickly your bone mass turns over (11).
It helps reduce fracture risk for people with osteoporosis in their spine. However, it comes with potential side effects, including an increased risk of dangerous blood clots in the leg like deep vein thrombosis (DVT) or pulmonary embolism (PE). In one study, raloxifene was associated with a 62% increase in the risk of experiencing either DVT or PE (12).
