The Hidden Cost of Osteoporosis Drug Medication
Do the fracture-reducing benefits of osteoporosis drugs outweigh their rare but frightening risks?
Osteoporosis is the “silent thief” of bone. It can weaken your skeleton for years without causing pain, swelling, or any symptoms whatsoever, until an everyday mishap (stepping off the curb wrong) leads to a fracture.
One in two women over age 50 will experience an osteoporosis-related fracture in her lifetime. And these aren’t always minor fractures that heal with time:
- Zoom In: Women have about a ⅙ chance of sustaining a hip fracture, which can lead to a sharp decline in survival and independence.
That’s why drug therapy for osteoporosis exists. But like everything in medicine, the solution isn’t one-size-fits-all.
The Available Osteoporosis Medications
Broadly, osteoporosis drugs fall into two camps: those that slow bone breakdown (anti-resorptives) and those that build new bone (anabolics).
Bisphosphonates like alendronate, risedronate, and zoledronic acid (Fosamax, Actonel, Boniva) are the go-to first choice. These medications stick to your bone surface and put the brakes on cells that resorb bone.
- Science Says: Large studies show they can reduce vertebral fractures by 40–70% and hip fractures by 40–50%.
Denosumab (Prolia) is a monoclonal antibody injection you get every six months that inhibits bone resorption. The FREEDOM trial found it reduced vertebral fractures by 68% and hip fractures by 40%.
Then there are the bone-building medications. Teriparatide and abaloparatide (Forteo and Tymlos) actually stimulate your body to create bone rather than just preventing loss. They’re usually reserved for women at very high fracture risk.
Lastly, romosozumab (Evenity) is a newer option. It builds both bones and decreases resorption.
Benefits vs. Risks
The benefits are clear: fewer fractures, less disability, improved quality of life. But nothing comes free.
Bisphosphonates can cause osteonecrosis of the jaw (bone death) and atypical femoral fractures. While serious, these side effects have received disproportionate attention given how rare they are (less than 1 per 100,000 patients a year).
The bigger day-to-day concern for many women is gastrointestinal side effects.
Then there’s denosumab (brand name Prolia). It works great, but coming off it is tricky. Stopping suddenly has been linked to rapid bone loss and a rebound in fracture risk, so patients need a careful “exit strategy.”
Anabolic therapies are expensive, require daily injections, and you can typically only use them for 18-24 months before the benefits plateau.
As for romosozumab? The FDA warns about the possible increased risk of heart attack and stroke, so it’s not used in women with recent cardiovascular events or who have had a stroke within the past year.
The Bottom Line
The fracture reduction benefits usually outweigh the risks. But the decision must be individualized. There’s still so much we don’t know about osteoporosis medications:
- Zoom In: That includes how long you can stay on a bisphosphonate or the optimal sequence of treatments.
Find a doctor who is willing to dig deep. Don’t just ask: “Should I take a drug for osteoporosis?” but “Which drug, for how long, and what’s our plan to monitor?”
There are doctors who specialize in metabolic bone disease and know the osteoporosis literature inside and out. If you can see one, definitely take advantage of that luxury.
Just remember that bone health doesn’t come from a prescription alone. Nutrition (adequate protein, calcium, and vitamin D), resistance training, balance work, and fall prevention are all equally important pillars. (Oh, and don’t forget, men get osteoporosis too!)
