What can you take for osteoporosis besides Fosamax?

According to the Bone Health and Osteoporosis Foundation, over 10 million Americans have osteoporosis, a condition that weakens bones. When seeking treatment, many patients and doctors consider alternatives to the bisphosphonate medication Fosamax, begging the question, “What can you take for osteoporosis besides Fosamax?” This guide covers a range of effective and FDA-approved alternatives, including other bisphosphonates, hormone-related therapies, anabolic agents, and lifestyle adjustments.

Quick Summary

Several alternative medications are available for osteoporosis treatment, including bisphosphonates like Reclast, the injection Prolia, and bone-building drugs such as Evenity and Forteo. Hormone-related therapies, including Evista, are also options. Lifestyle changes such as diet, exercise, and fall prevention are important for all patients. The best choice depends on fracture risk and individual health.

Key Points

• Alternative Bisphosphonates: Intravenous (IV) bisphosphonates like Reclast and injectable Boniva are options for patients with gastrointestinal issues or those needing less frequent dosing than oral Fosamax.

• Prolia Injection: Denosumab (Prolia) is a monoclonal antibody injected every six months, suitable for patients at high fracture risk or unable to tolerate bisphosphonates.

• Bone-Building Anabolic Agents: For severe osteoporosis, drugs like Evenity, Forteo, and Tymlos can stimulate new bone growth, though they are limited to a shorter treatment period.

• Hormone-Related Options: Selective Estrogen Receptor Modulators (SERMs) such as Evista offer a daily tablet alternative for postmenopausal women, while hormone therapy is reserved for specific cases.

• Lifestyle is Key: Beyond medication, a balanced diet rich in calcium and vitamin D, weight-bearing exercise, and fall-prevention strategies are crucial for managing osteoporosis effectively.

• Personalized Treatment: The best course of action is determined by a healthcare provider, who will consider your specific fracture risk, medical history, and preferences.

Other Bisphosphonates

Fosamax (alendronate) belongs to a class of drugs called bisphosphonates, which work by slowing down the rate of bone breakdown. While Fosamax is a common option, other bisphosphonates are available for those who cannot tolerate it or have specific needs.

Bisphosphonate injections and infusions

If oral bisphosphonates cause gastrointestinal side effects like heartburn or stomach upset, or if remembering a daily or weekly pill is difficult, intravenous (IV) bisphosphonates may be recommended.

• Reclast (zoledronic acid): Given as a once-a-year IV infusion, Reclast is highly effective for reducing fracture risk. It bypasses the digestive system entirely, making it suitable for patients with esophageal issues.
• Boniva (ibandronate): Available as an oral tablet and a quarterly IV injection, Boniva helps prevent spinal fractures.

Biologic and Anabolic Treatments

Beyond bisphosphonates, other drug classes work differently to either slow bone resorption or actively stimulate new bone formation.

Denosumab (Prolia)

This is a monoclonal antibody administered via an injection every six months. Prolia works by inhibiting a protein essential for the bone-resorbing cells (osteoclasts). It is often used for patients who cannot tolerate bisphosphonates and those at very high fracture risk. However, stopping Prolia requires transitioning to another bone-stabilizing medication to prevent a rapid increase in fracture risk.

Bone-building (anabolic) agents

These medications are generally reserved for people with severe osteoporosis or a very high risk of fracture because they actively stimulate new bone growth.

• Evenity (romosozumab): This newest bone-building medication is given as a monthly injection for a limited one-year course of treatment. It works by blocking a protein called sclerostin that inhibits bone formation. Because of potential cardiovascular risks, it is not recommended for those with a recent heart attack or stroke. After completing the one-year course, patients typically switch to another osteoporosis medication to maintain the new bone density.
• Forteo (teriparatide) and Tymlos (abaloparatide): These are synthetic forms of a parathyroid hormone that stimulate new bone growth. They are administered via daily self-injections for up to two years. Due to observed increases in bone cancer in animal studies (though not confirmed in humans), they are reserved for high-risk patients and followed by another medication to preserve the new bone mass.

Hormone-Related Therapies

For some postmenopausal women, hormone-related treatments can be an option to address osteoporosis.

• Selective Estrogen Receptor Modulators (SERMs): Raloxifene (Evista) mimics estrogen's beneficial effects on bone density in postmenopausal women, reducing the risk of spinal fractures. It may also lower the risk of certain breast cancers but can increase the risk of blood clots.
• Hormone Therapy (Estrogen): Once a primary treatment, hormone replacement therapy is now typically reserved for younger postmenopausal women who need it for menopausal symptoms and fracture prevention. Current guidelines recommend using the lowest dose for the shortest duration necessary due to risks of blood clots and cancer.

Lifestyle and Supplemental Approaches

Medication is most effective when combined with healthy lifestyle habits. These adjustments can support bone health regardless of the pharmacological treatment plan.

• Diet and Nutrition: Ensuring adequate intake of calcium and vitamin D is crucial for bone health. Calcium-rich foods include dairy products, leafy greens, and fortified juices. Many people, especially older adults, also require vitamin D supplementation to aid in calcium absorption.
• Exercise: Weight-bearing exercises like walking, jogging, and strength training help build and maintain bone density. Balance exercises, such as Tai Chi, are also essential for reducing the risk of falls and fractures.
• Fall Prevention: Taking steps to reduce the risk of falling, such as removing tripping hazards from the home, is vital for those with weakened bones.
• Avoid Smoking and Excessive Alcohol: Smoking accelerates bone loss, and excessive alcohol consumption can increase the risk of falls and impede bone health.

Osteoporosis Medication Comparison

Medication Class	Drug Names	Administration	Mechanism	Typical Use Case	Key Considerations
Bisphosphonates (Non-Oral)	Reclast (zoledronic acid), Boniva (ibandronate) injection	IV infusion (yearly), Injection (quarterly)	Slows bone breakdown	Gastrointestinal intolerance to oral bisphosphonates, difficulty with frequent dosing	Less frequent dosing than oral options
Monoclonal Antibody	Prolia (denosumab)	Subcutaneous injection (every 6 months)	Blocks bone-resorbing cells	Patients intolerant to bisphosphonates or at very high fracture risk	Must be continued indefinitely or transitioned off carefully
Anabolic Agents	Evenity (romosozumab), Forteo (teriparatide), Tymlos (abaloparatide)	Monthly or daily injection	Stimulates new bone formation	Severe osteoporosis, very high fracture risk	Limited treatment duration (1–2 years), require follow-up with another medication
SERMs	Evista (raloxifene)	Oral tablet (daily)	Mimics estrogen in bones	Postmenopausal women with spinal fracture risk; potential breast cancer benefit	May increase risk of blood clots
Hormone Therapy	Estrogen	Various	Prevents bone loss	Younger postmenopausal women needing menopausal symptom relief	Increased risk of blood clots, cancer; used short-term

Conclusion

For those seeking an alternative to Fosamax, a wide range of clinically proven options exists, targeting different aspects of bone health. From other, less-frequent bisphosphonate infusions to potent anabolic agents that rebuild bone, treatment plans can be customized to individual needs, risk profiles, and preferences. The decision should always be made in consultation with a healthcare provider, considering factors like fracture risk, medical history, and tolerance for side effects. A comprehensive approach that combines medication with a healthy diet, regular exercise, and fall-prevention strategies provides the best chance of managing osteoporosis effectively and reducing the risk of debilitating fractures. Ultimately, there is no single best medication, but rather a personalized strategy to safeguard long-term bone health.

Frequently Asked Questions

What are some alternatives to Fosamax (alendronate) for osteoporosis?

Alternatives to Fosamax include other bisphosphonates like Actonel (risedronate) and Reclast (zoledronic acid), the injection Prolia (denosumab), anabolic agents such as Evenity (romosozumab) and Forteo (teriparatide), and hormone-related therapies like Evista (raloxifene).

Is Prolia a better alternative than Fosamax?

Prolia is not necessarily better, but it can be a suitable alternative for certain individuals, such as those who cannot tolerate bisphosphonates or are at very high risk for fractures. Prolia is given every six months, which may be more convenient for some patients.

What is the difference between Prolia and Evenity?

Prolia (denosumab) is an antiresorptive medication that reduces bone breakdown, administered every six months. Evenity (romosozumab) is an anabolic agent that stimulates new bone formation, administered monthly for a limited one-year period. Evenity is typically reserved for severe cases.

What is an anabolic agent for osteoporosis?

Anabolic agents are medications that actively stimulate new bone growth, a different mechanism from most other drugs that primarily slow bone loss. Examples include Forteo (teriparatide), Tymlos (abaloparatide), and Evenity (romosozumab).

Can lifestyle changes reverse osteoporosis without medication?

While diet, exercise, and supplements are critical for supporting bone health and slowing bone loss, they are not typically sufficient on their own to treat established osteoporosis, especially in high-risk patients. Medication is usually necessary to effectively reduce fracture risk.

What are the options for people who can't take oral medication?

For those who have difficulty with oral medications, alternative forms include intravenous (IV) bisphosphonates like Reclast (yearly) and injectable options such as Prolia (every 6 months) or anabolic agents like Forteo and Evenity.

How long do you need to take osteoporosis medication?

The duration of treatment varies. Bisphosphonates are often taken for 3 to 5 years, sometimes followed by a drug holiday. Anabolic agents like Forteo and Evenity are used for 1 to 2 years, after which a different medication is needed to maintain bone density gains. Duration depends on individual risk and medication response.