Treatment Overview

The process of bone thinning (osteoporosis) is a natural part of aging. But if you receive treatment early, you may be able to stop or slow the progress of bone loss. Treatment is important to:

• Prevent broken bones.
• Maintain or increase your bone thickness.
• Relieve pain caused by fractures and changes to bones.
• Keep your ability to function physically.

Treatment for osteoporosis includes eating a diet rich in calcium and vitamin D, getting regular weight-bearing exercise, and taking medicine to reduce bone loss and increase bone thickness. Even small changes in diet, exercise, and medicine can help prevent spine and hip fractures. Adults who adopt healthy habits can slow the progress of osteoporosis.

See a picture of healthy bone versus bone weakened by osteoporosis.

Initial treatment

If you have been diagnosed with osteoporosis, your doctor likely will recommend lifestyle and diet changes. Eat foods rich in calcium and vitamin D, which are needed for keeping bones healthy and strong.

Your bones need vitamin D to absorb calcium. Getting more vitamin D may help prevent falls in older people who are low in vitamin D.⁶ And some studies show that taking vitamin D may reduce the chances of breaking a bone.⁷ Talk to your doctor about measuring your vitamin D to be sure you are getting enough. The best source of vitamin D is exposure to sunlight. Vitamin D is also added to milk, some calcium supplements, and many multivitamin supplements.

For more information on taking calcium, see:

Osteoporosis: Taking Calcium and Vitamin D.

Exercises, including weight-bearing exercise (walking, jogging, stair climbing, dancing, or lifting weights), aerobics, and resistance exercises are all effective in increasing bone mineral density and strength of the spine. Walking also increases bone mineral density of the hip. And exercise increases strength and balance so you are less likely to fall. Start out at an exercise level that you are comfortable with and work up gradually. To be most effective, weight-bearing exercises should be done for 30 minutes most days of the week, and resistance exercises 2 to 3 days a week. If you stop exercising, your bones weaken and may be more likely to break.

Along with exercise and diet, your doctor will recommend that you not smoke and limit alcohol to no more than 2 drinks a day for men and no more than 1 drink a day for women. For more information on quitting smoking, see the topic Quitting Smoking.

In some cases, medicines are prescribed to protect against bone loss. These medicines include raloxifene (Evista), bisphosphonates such as risedronate (Actonel) and alendronate (Fosamax), and parathyroid hormone (Forteo). It's important to get enough calcium and vitamin D and take prescribed medicine for the disease. You need calcium and vitamin D to build strong, healthy bones. For more information on taking bisphosphonates, see:

Osteoporosis: Should I Take Bisphosphonate Medicines?

If you take corticosteroids longer than 6 months for asthma or other conditions, you may be at greater risk for steroid-induced osteoporosis. If you begin to have bone loss, you may need to take osteoporosis medicines, such as bisphosphonates, while you are taking steroids.

In some cases, hormone replacement therapy (HRT) or estrogen replacement therapy (ERT) is given to women to slow bone loss from osteoporosis. But hormone therapy can also increase the risk of other conditions, including stroke and breast cancer. Many experts recommend that long-term hormone replacement therapy only be considered for women with a significant risk of osteoporosis that outweighs the risks of taking HRT or ERT.

Ongoing treatment

After you have been diagnosed with bone loss, whether it is mild or severe, you will need to have regular follow-up tests to monitor the disease. Osteoporosis is a progressive disease: both men and women lose a little bit of bone each year after age 30.⁸ It is never too late to build and then maintain healthy habits that can slow the progression of the disease.

• Eat a nutritious diet and be sure you are getting adequate amounts of calcium and vitamin D. Both are needed for building healthy, strong bones.

Osteoporosis: Taking Calcium and Vitamin D

• Get regular exercise. Weight-bearing exercises, such as walking, jogging, stair climbing, dancing, or lifting weights, keep bones healthy by working the muscles and bones against gravity.

When you have osteoporosis, it is especially important to protect yourself from falling. When bones lose mass and become more brittle, they lose strength and break more easily. Women of European and Asian ancestry are more likely to have osteoporosis than those with African ancestry. To reduce your chances of breaking bones, take steps to prevent falls, such as having your vision and hearing checked regularly and wearing slippers or shoes with a nonskid sole. Exercises that improve balance and coordination, such as tai chi, can also reduce your risk of falling.

If your tests show continuing bone loss, your doctor likely will recommend that you take medicine to increase bone density and decrease your risk of spine and hip fractures. These medicines include bisphosphonates, such as risedronate (Actonel) or alendronate (Fosamax). It's important to get enough calcium and vitamin D and take prescribed medicines for osteoporosis. For more information about taking bisphosphonates, see:

Osteoporosis: Should I Take Bisphosphonate Medicines?

Calcitonin may be prescribed for women who are more than 5 years beyond menopause and who cannot take bisphosphonate medicines, or for men who are not receiving testosterone treatment..

Raloxifene (Evista) may be prescribed for women, especially if you are 55 to 65 years old. Raloxifene can cause hot flashes. So it is not often used in early menopause (45 to 55 years) when hot flashes are frequent.

In some cases, hormone replacement therapy (HRT) or estrogen replacement therapy (ERT) is given to women to slow bone loss from osteoporosis. But hormone therapy can also increase the risk of other conditions, including stroke and breast cancer. Many experts recommend that long-term hormone replacement therapy only be considered for women with a significant risk of osteoporosis that outweighs the risks of taking HRT or ERT.

Treatment if the condition gets worse

It is never too late to build and then keep healthy habits that can slow bone thinning.

• Eat a nutritious diet and be sure you are getting adequate amounts of calcium and vitamin D. Both are needed for building healthy, strong bones.

Osteoporosis: Taking Calcium and Vitamin D

• Get regular exercise. Weight-bearing exercises, such as walking, jogging, stair climbing, dancing, or lifting weights, keep bones healthy by working the muscles and bones against gravity.

Medicines called bisphosphonates, such as alendronate (Fosamax) or zoledronic acid (Reclast), may be used to slow the rate of bone loss and increase bone thickness and strength. This will reduce the risk of broken bones. For more information on bisphosphonates, see:

Osteoporosis: Should I Take Bisphosphonate Medicines?

In some cases, hormone replacement therapy (HRT) or estrogen replacement therapy (ERT) is given to women to slow bone loss from osteoporosis. But hormone therapy can also increase the risk of other conditions, including stroke and breast cancer. Many experts recommend that long-term hormone replacement therapy only be considered for women with a significant risk of osteoporosis that outweighs the risks of taking HRT or ERT.

If your osteoporosis is severe or you continue to have bone loss while taking a bisphosphonate:

• You may need to take both a bisphosphonate medicine and hormone therapy. Studies show that taking both medicines results in increased bone mass when compared to taking either alone.⁹
• Your doctor may prescribe teriparatide (Forteo) or denosumab (Prolia).

It's important to get enough calcium and vitamin D and take prescribed medicines for osteoporosis.

Compression fractures resulting from osteoporosis can cause significant back pain that lasts for several months. Treatments available to relieve your pain include:

• Nonprescription acetaminophen (such as Tylenol).
• Nonprescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin. If you take NSAIDs regularly, your doctor may recommend that you also take a medicine such as a proton pump inhibitor (PPI) to protect your digestive system. But there is also a chance that PPIs can help cause osteoporosis. Talk to your doctor about taking NSAIDs and PPIs for long periods of time.
• A pain reliever such as a narcotic, which may be prescribed on a short-term basis.
• Other medicines such as calcitonin (Calcimar or Miacalcin) to help reduce pain from spinal fractures.
• A back brace or corset to support the spine.
• Surgery, which may be recommended if the nerves are compressed.

If you experience a fractured bone related to osteoporosis, treatment to slow your bone thinning becomes very important. If you have had a spinal fracture, you are at risk of having another.²

What to think about

It's important to get enough calcium and vitamin D and take prescribed medicines for osteoporosis. For more information on taking calcium and vitamin D, see:

Osteoporosis: Taking Calcium and Vitamin D.