Osteoporosis Meds: Reducing the Risk of Pain and Fractures in Seniors

Table of contents

• Who is most likely to get osteoporosis?
• How is osteoporosis diagnosed?
• Is osteoporosis treatable?
• Can osteoporosis be reversed?

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Bone fractures are a well-known hazard of growing old. They have the potential to cause significant pain and disability. As a result, many seniors can’t return to living independently after experiencing one. 

Osteoporosis, or the loss of bone mineral density, is behind many of these injuries. 

While we can’t completely eliminate osteoporosis for all older adults, there are ways to slow it down and minimize the potential for falls and fractures.

Osteoporosis meds, lifestyle changes, and preventing falls can all help reduce the risk of your loved one experiencing the harmful effects of a fracture.

Who is most likely to get osteoporosis?

Every person experiences gradual bone loss as they age. However, certain people are at higher risk of osteoporosis than others. They might benefit from talking to their providers earlier about osteoporosis meds and other ways to slow bone loss.

Over 50% of postmenopausal white women will have an osteoporosis-related fracture. Many will not be able to return to independent living following treatment. White men are less likely to have fractures but are more likely to pass away afterward. Black males and females develop osteoporosis less often, but those that do have an equal risk of fractures.

Certain lifestyle and medical conditions can put your loved one at higher risk for developing osteoporosis. For example, these include:

• Heavy alcohol use
• Smoking
• Sedentary lifestyle
• Low body weight (BMI under 18.5 kg/m2)
• Having an overactive parathyroid gland
• Having an overactive thyroid gland
• Kidney disease
• Low testosterone levels in men
• Altered absorption in the stomach
• Early menopause
• Low calcium or vitamin D levels

Patients who take certain medications might also be at increased risk of osteoporosis:

• Long-term steroid/glucocorticoids use
• Valproic acid (Depakote)
• Proton pump inhibitors (Prilosec, Protonix, Nexium, etc.)
• Anti-seizure medicines
• Chemotherapy medicines

So, if your parent or loved one falls into one of these categories, encourage them to speak with their healthcare provider about their risk of osteoporosis at their next visit.

How do you diagnose osteoporosis?

If your loved one’s healthcare provider thinks that they are at risk for osteoporosis, they will perform a workup. During this, some blood work and a special imaging test called a DEXA (dual-energy X-ray absorptiometry) scan are done.

The standard laboratory workup for osteoporosis, for example, includes checking:

• Calcium
• Phosphorus
• Albumin
• Liver function tests
• Creatinine
• Vitamin D
• Thyroid-stimulating hormone (TSH)
• Free T4
• Parathyroid hormone (PTH)
• Testosterone levels (for men)

Medical experts recommend an osteoporosis bone density test called a DEXA scan. It is a simple test typically completed in 5-10 minutes. It involves minimal radiation exposure. Moreover, there is no pain or special preparation needed.

An x-ray technician will use a single x-ray beam to measure the bone density in several specific body areas. For instance, this is typically the spine, hip, and forearm. 

The DEXA scan report will also calculate some figures you might have heard of: a t-score and a z-score.

A t-score reflects the difference in bone mineral density between the patient and a healthy young adult. It is reported in standard deviations. Consequently, the lower the score (negative standard deviations), the more likely the patient has osteoporosis.

The z-score tells you how much of a difference there is between the patient being measured and other healthy patients of a similar age. As a result, this is more useful in younger patients and those who might have bone loss caused by other medical conditions.

Is osteoporosis treatable?

While it’s a serious condition that can cause many adverse effects in older adults’ lives, many treatments are available for osteoporosis. 

Healthcare providers recommend lifestyle changes and fall prevention tactics for all patients. Some seniors may also be candidates for osteoporosis meds that help to slow bone loss and prevent fractures.

These range from pills that need to be taken daily or weekly to injections and infusions that are only given a few times per year. Your loved one’s healthcare provider can help decide which osteoporosis treatment will work best.

Osteoporosis treatment tablets

A class of medication called bisphosphonates are the first-line treatment for most people with osteoporosis. These medicines slow down the rate at which the body breaks down bones. Consequently, this leads to less bone loss that can cause fractures.

Some of the most common bisphosphonates that are available in pill form include:

• Alendronate (Fosamax), a weekly pill
• Risedronate (Actonel), a weekly or monthly pill
• Ibandronate (Boniva), a monthly pill 

You should take these osteoporosis meds on an empty stomach with 8 oz of plain water. The person taking them should sit or stand upright for at least 30 minutes afterward and not eat, drink, or take other pills.

Raloxifene (Evista) is another oral medication that treats osteoporosis. You should know that this medication is only for women and is probably best known for its role in breast cancer treatment. However, it also helps treat osteoporosis by binding with estrogen receptors and decreasing bone breakdown. As a result, this reduces the risk of vertebral fractures.

Osteoporosis infusion meds

For seniors who have issues absorbing oral medications, Zoledronic acid (Reclast) is also available as an intravenous infusion. 

Like the bisphosphonates that come in a pill form, Reclast slows the rate at which the body breaks down bones. Studies have shown that it can reduce the rates of bone fractures in both men and women.

A healthcare professional gives zoledronic acid is given through an IV once a year or every two years. Depending on their other medical conditions, this can be provided at an outpatient infusion center or at home by a home health nurse.

Osteoporosis injectable meds

For seniors who can’t tolerate bisphosphonates or have a contraindication, denosumab (Prolia) might be an option. Unlike other medicines, Prolia is a monoclonal antibody (a laboratory-produced molecule that can enhance or restore the immune system). In short, it reduces the amount of bone broken down in the body.

The FDA approved Prolia to treat osteoporosis in: 

• Post menopausal women
• Men at high risk for fractures
• Women with breast cancer on certain treatments
• Men with prostate cancer on certain treatments who have an increased risk for fracture

Denosumab is given by a health professional every six months. It is an injection given into the fatty tissue under the skin.

 In addition, other injectable meds for osteoporosis that a doctor might order include:

• Teriparatide (Forteo)
• Abaloparatide (Tymlos)
• Romosozumab (Evenity)

Other osteoporosis meds

On the other hand, some medications aren’t as common for treating osteoporosis. However, a healthcare provider will order them depending on a senior’s medical condition.

Hormone replacement therapy: Estrogen (for women who have been in menopause for less than 10 years) or testosterone (for men with low natural levels) may be prescribed to increase bone mineral density, decrease bone loss, and reduce the risk of fractures.

Calcitonin (Miacalcin, Fortical): This is one of the oldest osteoporosis meds available. It is a daily nasal spray or injection that prevents bone loss. Research shows that it can reduce the risk of spine fractures, but not other types of fractures.

Can you reverse osteoporosis?

Unfortunately, medications can’t completely reverse osteoporosis. While not curable, seniors can make some health and lifestyle adjustments to reduce the effects.

In addition to osteoporosis meds, seniors can make lifestyle changes to minimize bone loss. These include:

• Cutting back or stopping alcohol use
• Stop smoking
• Perform weight-bearing exercises regularly
• Work on balance and agility to prevent falls
• Ensure they are getting the recommended daily intake of calcium and Vitamin D

The most serious consequences of osteoporosis tend to happen when seniors experience a fall. To sum up, a combination of modifications to the home and strengthening activities (with the help of in-home physical therapy if needed) can help your parents stay safe and independent in their own home for longer.

Contact us today and let us show you how we can help take care of your loved one.