Osteoporosis and Bone Health

Doctor explaining osteoporosis and bone health

Know your bones

Are you over the age of 65? Are you a female? Have you broken a bone? Are you getting shorter? If you have answered yes to any of these questions, you may be at risk for Osteoporosis and may need to work on your bone health.

Osteoporosis is a silent disease because no one can feel their bones weakening. Usually the first sign of Osteoporosis is breaking a bone, getting shorter, or a curve of their upper spine.  Osteoporosis means porous bone. Usually bone looks like honeycomb, but people with Osteoporosis have bigger holes in their honeycomb, which makes their bones less dense and easier to break if they fall.

Osteoporosis affects about 54 million Americans, with a male:female radio of 1:4. The most common osteoporotic fractures occur in the hip, spine, or wrist, but the ankle, shoulder and foot are likely as well.

There are many disease and medication risk factors that can contribute to Osteoporosis as shown in the table below. This list is not all inclusive.

Diseases/conditions Medications
Diabetes Proton pump inhibitors (PPI) like Nexium, Prevacid, Prilosec
Hyperthyroidism/Hyperparathyroidism SSRIs like Lexpro, Prozac, Zoloft
Premature menopause Steroids like cortisone or prednisone
Rheumatoid arthritis, multiple sclerosis, lupus, ankylosing spondylitis Antiseizure medications like Dilantin or phenobarbital
Weight loss surgery, celiac disease, Inflammatory bowel disease Methotrexate
Stroke, Parkinson’s disease Lithium
Breast or prostate cancer Heparin
Leukemia, lymphoma, multiple myeloma, sickle cell disease Cancer chemotherapy drugs
COPD, chronic kidney disease, HIV Depo-Provera


A DEXA scan (Dual Energy Xray Absorptiometry) is performed to determine the level of Osteoporosis.

Blood work is also done to check the level of vitamin D, calcium, blood cell counts, liver function, and PTH (parathyroid). These labs are performed wherever the patient normally gets their labs done.

Treatment is determined by multiple factors including number and type of fractures, T score from DEXA scan, FRAX calculation, and patient history. There are many different medications used to treat Osteoporosis in addition to diet and exercise. They fall into 2 different categories: antiresorptive or anabolic medications. Antiresorptive medications slow the breakdown of bone. Anabolic medications stimulate the rate of bone formation.  Each medication has side effects though. Below is a table that summarizes the medications.

Anti-resorptive How it is administered Side effects Indicated for
Oral Bisphosphonates (Fosamax, Boniva, Actonel) Daily or weekly oral pill Increased GERD/acid reflux, gastric ulcers, Osteonecrosis of jaw (ONJ), atypical femur fractures Men and women
Reclast (Zoledronic acid) Once a year IV infusion ONJ, Increased GERD/acid reflux, gastric ulcers, atypical femur fractures Men and women
Prolia (Denosumab) Injection into shoulder every 6 months ONJ, Muscle and back pain, Increased risk of fracture when stopped, not used in patients with low blood calcium Men and women
Evista (Raloxifene) Daily oral pill Leg cramps, hot flashes, not used in people with DVT or PE Women
Calcitonin Injection varies Nausea, vomiting, flushing Women
Anabolic How it is administered Side effects Indicated for
Tymlos (Abaloparatide) Daily injection into abdomen for 18months Dizziness, headache, nausea, high urine calcium, fatigue, osteosarcoma (bone tumor)- seen in rats Women
Forteo (Teriparatide) Daily injection into abdomen for 24months Dizziness, nausea, headache, high blood calcium, osteosarcoma (bone tumor)- seen in rats. Not used in patients with Paget’s disease Men and women
Evenity (Romosozumab-aqqg) Monthly injection into arm for 12 months Cardiovascular events like stroke or heart attack, Women


In our office we mainly use Prolia, Tymlos or Evenity to treat Osteoporosis, but will discuss all options with our patients. Once someone has built their bones up by completing Tymlos or Evenity, we like to maintain the bone density with an antiresorptive medication like Prolia.

On top of any prescribed medication, we recommend all patients to take Calcium and vitamin D. Calcium and vitamin D is best from the food you eat, but can be taken as a supplement if unable to get the recommended amount in your diet. If taking a calcium supplement, only take 500mg at a time to ensure it will all be absorbed.

Calcium Vitamin D (men and women)
Women 50 and younger 1000mg daily 49 and younger 400-800IU daily
Women 51 and older 1200mg daily 50 and older 800-1000IU daily
Men 70 and younger 1000mg daily
Men 71 and older 1200mg daily


Exercise is important for strong bones as well. Weightbearing exercises and muscle strengthening are the best way to increase bone density. Examples of weightbearing exercises include dancing, jogging, jumping rope, stair climbing, fast walking, elliptical machines, stair-step machines, low or high impact aerobics. Examples of muscle strengthening exercises include lifting weights, using exercise bands, or lifting your own body weight. Yoga has also been studied as a way to improve balance, flexibility and strength. Physical therapy can also help people learn which exercises are safe to do.

The goal of treatment is to reduce the risk of fractures, so if you haven’t fractured, then the medication is working. You may not feel any different after taking medications. You will only be able to determine if the medication is working after a repeat DEXA bone density scan. With antiresorptive medications, your bone density should stay the same or get better. With anabolic medications, your bone density should get better. There is not a specific amount the medications will increase your bone density. It will vary from person to person.

For more information you can go to www.nof.org/patients.