Table of ContentsView AllTable of ContentsMedicationsIndicationsLifestyle Changes
Table of ContentsView All
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Table of Contents
Medications
Indications
Lifestyle Changes
If you’ve been diagnosed with osteopenia (low bone density), your healthcare provider may have recommended treatment. This might include a prescription drug, such as abisphosphonate, to help slow bone loss and preventosteoporosis. It might also involve avitamin D supplementif you are deficient, as well as lifestyle changes to reduce your risk of injury.
This article will discuss medications and treatment options available to help strengthen your bones if you have osteopenia and prevent osteoporosis.
Terry Vine / Getty Images
Osteopenia Medications
A number of different medications are FDA-approved for thetreatment of osteoporosis. These same medications, discussed below, are also used to slow bone loss or increase bone density in select people with osteopenia.
Biphosphonates
Available biphosphonates include:
Possible side effects of bisphosphonates include:
An uncommon but severe side effect isosteonecrosis (bone cell death) of the jaw. People who have gum disease or poor dental hygiene, have a dental device, or require procedures such as a tooth extraction are at greatest risk. Other uncommon side effects includeatrial fibrillationand atypical femur fractures.
Selective Estrogen Recept Modulators
Selective estrogen receptor modulators (SERMS) are medications that can have both estrogen-like and anti-estrogen effects, depending on the part of the body they act on.
Evista (raloxifene) and Soltamox (tamoxifen) are hormone therapies approved for the prevention of osteoporosis in postmenopausal women. These drugs are also thought to reduce the risk of breast cancer.
Like estrogen (as in hormone replacement therapy) their action on bone increases bone mineral density and reduces the risk of vertebral (spinal) fractures. They may also reduce the risk of hip fractures, but more research is needed.
Possible side effects of SERMS include:
Serious but rare side effects include deep vein thrombosis and pulmonary emboli.
Hormone Replacement Therapy
Whilehormone replacement therapy(HRT) was once referred to as nearly a miracle drug to prevent osteoporosis in women, it is no longer approved for this indication. In addition, studies finding an increased risk of breast cancer, heart disease, and strokes in women taking HRT have resulted in these medications being used much less frequently.
As with any medication, you must weigh the risks and benefits of any medication you use. For young women who have had surgical menopause and are suffering from life-limiting hot flashes, HRT may be a good option. Yet, even in this setting, the goal of treatment with HRT should not be a reduction in osteoporosis risk.
Denosumab
Prolia (denosumab) is amonoclonal antibodythat prevents the formation of osteoclasts, cells which cause the breakdown of bone.
Denosumab can reduce the risk of osteoporosis and fractures in women who are on aromatase inhibitors (drugs for postmenopausal breast cancer), or men who are on androgen deprivation therapy forprostate cancer.Denosumab is also used for people with any type of cancer that has spread to their bones to reduce the risk of fractures.
Possible side effects of denosumab include:
Serious but rare side effects include low calcium levels, osteonecrosis, and serious infections.
Calcitonin
Calcitonin is a man-made version of a hormone that regulates bone metabolism and helps change the rate at which the body reabsorbs bone.
Possible side effects of the nasal spray include:
Parathyroid Hormone and Derivatives
Forteo is the only medication that can actually stimulate the body to grow new bone. Use is currently restricted to only 2 years.Tymlos (abaloparatide) is similar and is a synthetic version of a portion of parathyroid hormone.
Possible side effects of Forteo include:
Although rare, Forteo can cause increased levels of calcium in the blood.
When Is Osteopenia Medication Prescribed?
Treatment for osteopenia can be beneficial for people with low bone density who have had a fragility fracture or who are particularly at risk for them. But, the decision to medicate is somewhat controversial for people with osteopenia who have not had a fragility fracture or do not have other risk factors.
Not every person with osteopenia has experienced a fragility fracture. According to one study, approximately 72% of people with osteopenia in their 60s have had a spinal fragility fracture, compared to 68% of people with normal bone density, and 86% of people with osteoporosis.
FDA-approved medications for the prevention of osteoporosis can be prescribed to people with osteopenia. While these medications are effective, some have serious side effects. For this reason, many healthcare providers hesitate to prescribe osteoporosis medications unless they are absolutely necessary.
The decision to treat osteopenia with medications is highly individual and will depend on several factors, including:
How Is 10-Year Fracture Risk Calculated?
What Your Osteoporosis T-Score Says About Your Risk
Managing Osteopenia With Lifestyle Changes
Whether or not you choose to use medications for osteopenia, there are things you can do to reduce your risk of fractures:
Supplements for Bone Health: Essential Vitamins & Minerals
Summary
There are several medications which can be effective in reducing bone loss, but these all come with the risk of side effects. The decision to medicate is highly individual and depends on individual risk factors, including age, sex, T-score, and 10-year fracture risk.
If you have been diagnosed with osteopenia have a careful discussion with your healthcare provider. It’s important to be your own advocate in your care, especially in a situation such as this in which treatment options must be carefully individualized.
23 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Iqbal SM, Qamar I, Zhi C, Nida A, Aslam HM.Role of bisphosphonate therapy in patients with osteopenia: A systemic review.Cureus. 2019;11(2):e4146. doi:10.7759/cureus.4146Hadji P, Aapro MS, Body JJ, et al.Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG.J Bone Oncol. 2017;7:1-12. doi:10.1016/j.jbo.2017.03.001Harvard Health Publishing.Osteopenia: When you have weak bones, but not osteoporosis.American College of Rheumatology.Bisphosphonate therapy.National Osteoporosis Foundation.Side effects of bisphosphonates (Alendronate, Ibandronate, Risedronate and Zoledronic Acid).American Cancer Society.Hormone therapy for breast cancer.Kim K, Kim Y, Kim KC.The efficacy of selective estrogen receptor modulators monotherapies in postmenopausal women with osteopenia.J Bone Metab. 2022 Aug;29(3):175-183. doi:10.11005/jbm.2022.29.3.185Gagné L, Maizes V.Selective estrogen receptor modulators. In:Integrative Medicine.Fourth edition, 2018. doi:B978-0-323-35868-2.00036-0An KC.Selective estrogen receptor modulators.Asian Spine J. 2016;10(4):787-91. doi:10.4184/asj.2016.10.4.787Stevenson J.Prevention and treatment of osteoporosis in women.Post Reprod Health. 2023 Mar;29(1):11-14. doi:10.1177/20533691221139902Hanley DA, Adachi JD, Bell A, Brown V.Denosumab: mechanism of action and clinical outcomes.Int J Clin Pract. 2012;66(12):1139-46. doi:10.1111/ijcp.12022American Cancer Society.Hormone therapy for prostate cancer.Prolia.Important safety information.Tu KN, Lie JD, Wan CKV, et al.Osteoporosis: A review of treatment options.P T. 2018;43(2):92-104.MedlinePlus.Calcitonin Salmon Nasal Spray.Johns Hopkins Arthritis Center.Teriparatide (Forteo®).American College of Rheumatology.Teriparatide (Forteo).Lee J, Chang G, Kang H, et al.Impact of bone mineral density on the incidence of age-related vertebral fragility fracture.J Korean Med Sci. 2020 May;35(17):e116. doi:10.3346/jkms.2020.35.e116UCF Health.How to treat osteopenia.City of Hope.Boost your bone health.Memorial Sloan Kettering Cancer Center.Improving your bone health.National Institute of Arthritis and Musculoskeletal and Skin Diseases.Calcium and vitamin D: Important for bone health.Al-Bashaireh A, Haddad L, Weaver M, Chengguo X, Kelly D, Yoon S.The effect of tobacco smoking on bone mass: An overview of pathophysiologic mechanisms.J Osteoporosis. 2018 Dec;2018(1):1-17. doi:10.1155/2018/1206235Additional ReadingRosen, H.Patient education: Osteoporosis prevention and treatment (Beyond the Basics).UpToDate.Eriksen, E.Treatment of Osteopenia.Reviews in Endocrinology and Metabolic Disorders. 2012. 13(3):209-223.Kasper, Dennis L.., Anthony S. Fauci, and Stephen L.. Hauser. Harrison’s Principles of Internal Medicine. New York: Mc Graw Hill education, 2015. Print.
23 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Iqbal SM, Qamar I, Zhi C, Nida A, Aslam HM.Role of bisphosphonate therapy in patients with osteopenia: A systemic review.Cureus. 2019;11(2):e4146. doi:10.7759/cureus.4146Hadji P, Aapro MS, Body JJ, et al.Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG.J Bone Oncol. 2017;7:1-12. doi:10.1016/j.jbo.2017.03.001Harvard Health Publishing.Osteopenia: When you have weak bones, but not osteoporosis.American College of Rheumatology.Bisphosphonate therapy.National Osteoporosis Foundation.Side effects of bisphosphonates (Alendronate, Ibandronate, Risedronate and Zoledronic Acid).American Cancer Society.Hormone therapy for breast cancer.Kim K, Kim Y, Kim KC.The efficacy of selective estrogen receptor modulators monotherapies in postmenopausal women with osteopenia.J Bone Metab. 2022 Aug;29(3):175-183. doi:10.11005/jbm.2022.29.3.185Gagné L, Maizes V.Selective estrogen receptor modulators. In:Integrative Medicine.Fourth edition, 2018. doi:B978-0-323-35868-2.00036-0An KC.Selective estrogen receptor modulators.Asian Spine J. 2016;10(4):787-91. doi:10.4184/asj.2016.10.4.787Stevenson J.Prevention and treatment of osteoporosis in women.Post Reprod Health. 2023 Mar;29(1):11-14. doi:10.1177/20533691221139902Hanley DA, Adachi JD, Bell A, Brown V.Denosumab: mechanism of action and clinical outcomes.Int J Clin Pract. 2012;66(12):1139-46. doi:10.1111/ijcp.12022American Cancer Society.Hormone therapy for prostate cancer.Prolia.Important safety information.Tu KN, Lie JD, Wan CKV, et al.Osteoporosis: A review of treatment options.P T. 2018;43(2):92-104.MedlinePlus.Calcitonin Salmon Nasal Spray.Johns Hopkins Arthritis Center.Teriparatide (Forteo®).American College of Rheumatology.Teriparatide (Forteo).Lee J, Chang G, Kang H, et al.Impact of bone mineral density on the incidence of age-related vertebral fragility fracture.J Korean Med Sci. 2020 May;35(17):e116. doi:10.3346/jkms.2020.35.e116UCF Health.How to treat osteopenia.City of Hope.Boost your bone health.Memorial Sloan Kettering Cancer Center.Improving your bone health.National Institute of Arthritis and Musculoskeletal and Skin Diseases.Calcium and vitamin D: Important for bone health.Al-Bashaireh A, Haddad L, Weaver M, Chengguo X, Kelly D, Yoon S.The effect of tobacco smoking on bone mass: An overview of pathophysiologic mechanisms.J Osteoporosis. 2018 Dec;2018(1):1-17. doi:10.1155/2018/1206235Additional ReadingRosen, H.Patient education: Osteoporosis prevention and treatment (Beyond the Basics).UpToDate.Eriksen, E.Treatment of Osteopenia.Reviews in Endocrinology and Metabolic Disorders. 2012. 13(3):209-223.Kasper, Dennis L.., Anthony S. Fauci, and Stephen L.. Hauser. Harrison’s Principles of Internal Medicine. New York: Mc Graw Hill education, 2015. Print.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Iqbal SM, Qamar I, Zhi C, Nida A, Aslam HM.Role of bisphosphonate therapy in patients with osteopenia: A systemic review.Cureus. 2019;11(2):e4146. doi:10.7759/cureus.4146Hadji P, Aapro MS, Body JJ, et al.Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG.J Bone Oncol. 2017;7:1-12. doi:10.1016/j.jbo.2017.03.001Harvard Health Publishing.Osteopenia: When you have weak bones, but not osteoporosis.American College of Rheumatology.Bisphosphonate therapy.National Osteoporosis Foundation.Side effects of bisphosphonates (Alendronate, Ibandronate, Risedronate and Zoledronic Acid).American Cancer Society.Hormone therapy for breast cancer.Kim K, Kim Y, Kim KC.The efficacy of selective estrogen receptor modulators monotherapies in postmenopausal women with osteopenia.J Bone Metab. 2022 Aug;29(3):175-183. doi:10.11005/jbm.2022.29.3.185Gagné L, Maizes V.Selective estrogen receptor modulators. In:Integrative Medicine.Fourth edition, 2018. doi:B978-0-323-35868-2.00036-0An KC.Selective estrogen receptor modulators.Asian Spine J. 2016;10(4):787-91. doi:10.4184/asj.2016.10.4.787Stevenson J.Prevention and treatment of osteoporosis in women.Post Reprod Health. 2023 Mar;29(1):11-14. doi:10.1177/20533691221139902Hanley DA, Adachi JD, Bell A, Brown V.Denosumab: mechanism of action and clinical outcomes.Int J Clin Pract. 2012;66(12):1139-46. doi:10.1111/ijcp.12022American Cancer Society.Hormone therapy for prostate cancer.Prolia.Important safety information.Tu KN, Lie JD, Wan CKV, et al.Osteoporosis: A review of treatment options.P T. 2018;43(2):92-104.MedlinePlus.Calcitonin Salmon Nasal Spray.Johns Hopkins Arthritis Center.Teriparatide (Forteo®).American College of Rheumatology.Teriparatide (Forteo).Lee J, Chang G, Kang H, et al.Impact of bone mineral density on the incidence of age-related vertebral fragility fracture.J Korean Med Sci. 2020 May;35(17):e116. doi:10.3346/jkms.2020.35.e116UCF Health.How to treat osteopenia.City of Hope.Boost your bone health.Memorial Sloan Kettering Cancer Center.Improving your bone health.National Institute of Arthritis and Musculoskeletal and Skin Diseases.Calcium and vitamin D: Important for bone health.Al-Bashaireh A, Haddad L, Weaver M, Chengguo X, Kelly D, Yoon S.The effect of tobacco smoking on bone mass: An overview of pathophysiologic mechanisms.J Osteoporosis. 2018 Dec;2018(1):1-17. doi:10.1155/2018/1206235
Iqbal SM, Qamar I, Zhi C, Nida A, Aslam HM.Role of bisphosphonate therapy in patients with osteopenia: A systemic review.Cureus. 2019;11(2):e4146. doi:10.7759/cureus.4146
Hadji P, Aapro MS, Body JJ, et al.Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG.J Bone Oncol. 2017;7:1-12. doi:10.1016/j.jbo.2017.03.001
Harvard Health Publishing.Osteopenia: When you have weak bones, but not osteoporosis.
American College of Rheumatology.Bisphosphonate therapy.
National Osteoporosis Foundation.Side effects of bisphosphonates (Alendronate, Ibandronate, Risedronate and Zoledronic Acid).
American Cancer Society.Hormone therapy for breast cancer.
Kim K, Kim Y, Kim KC.The efficacy of selective estrogen receptor modulators monotherapies in postmenopausal women with osteopenia.J Bone Metab. 2022 Aug;29(3):175-183. doi:10.11005/jbm.2022.29.3.185
Gagné L, Maizes V.Selective estrogen receptor modulators. In:Integrative Medicine.Fourth edition, 2018. doi:B978-0-323-35868-2.00036-0
An KC.Selective estrogen receptor modulators.Asian Spine J. 2016;10(4):787-91. doi:10.4184/asj.2016.10.4.787
Stevenson J.Prevention and treatment of osteoporosis in women.Post Reprod Health. 2023 Mar;29(1):11-14. doi:10.1177/20533691221139902
Hanley DA, Adachi JD, Bell A, Brown V.Denosumab: mechanism of action and clinical outcomes.Int J Clin Pract. 2012;66(12):1139-46. doi:10.1111/ijcp.12022
American Cancer Society.Hormone therapy for prostate cancer.
Prolia.Important safety information.
Tu KN, Lie JD, Wan CKV, et al.Osteoporosis: A review of treatment options.P T. 2018;43(2):92-104.
MedlinePlus.Calcitonin Salmon Nasal Spray.
Johns Hopkins Arthritis Center.Teriparatide (Forteo®).
American College of Rheumatology.Teriparatide (Forteo).
Lee J, Chang G, Kang H, et al.Impact of bone mineral density on the incidence of age-related vertebral fragility fracture.J Korean Med Sci. 2020 May;35(17):e116. doi:10.3346/jkms.2020.35.e116
UCF Health.How to treat osteopenia.
City of Hope.Boost your bone health.
Memorial Sloan Kettering Cancer Center.Improving your bone health.
National Institute of Arthritis and Musculoskeletal and Skin Diseases.Calcium and vitamin D: Important for bone health.
Al-Bashaireh A, Haddad L, Weaver M, Chengguo X, Kelly D, Yoon S.The effect of tobacco smoking on bone mass: An overview of pathophysiologic mechanisms.J Osteoporosis. 2018 Dec;2018(1):1-17. doi:10.1155/2018/1206235
Rosen, H.Patient education: Osteoporosis prevention and treatment (Beyond the Basics).UpToDate.Eriksen, E.Treatment of Osteopenia.Reviews in Endocrinology and Metabolic Disorders. 2012. 13(3):209-223.Kasper, Dennis L.., Anthony S. Fauci, and Stephen L.. Hauser. Harrison’s Principles of Internal Medicine. New York: Mc Graw Hill education, 2015. Print.
Rosen, H.Patient education: Osteoporosis prevention and treatment (Beyond the Basics).UpToDate.
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