Osteoporosis drugs and side effects


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Three types of drugs

Osteoporosis drugs balance the work of osteoclasts and osteoblasts. There are three types by following functions:

(1) to suppress bone absorption
(2) to enhance bone genesis
(3) to rebalance bone metabolism

Doctors will choose one from a wide range of drugs according to the patient’s “fracture risk,” “age,” “lifestyle,” etc. In addition, the appropriate medicine differs depending on the fracture site, such as “drugs that are highly effective for the spine” and “drugs that are highly effective for the bone at the base of the thigh.”

Proper and consistent use of osteoporosis drugs can increase bone density and reduce the risk of fractures. People with a disease that causes bone loss or without enough exercise or nutrition should continue their medication. In either cases, you will need to consult with the osteoporosis drugs and side effects with your doctor.

Drugs that suppress the bone absorption

Osteoporosis drugs that suppress bone absorption activity suppress the activity of osteoclasts, maintaining a balance with bone formation. There are “Bisphosphonates,” “Denosumab,” and “SERM.”


Bisphosphonates vary by administration types, oral administration, injection at a medical institution, or IV dripping.

Oral medicine has some variations in dosing intervals, such as once a day, once a week, and once a month.

IV drugs have two types, once every four weeks and once a year.

The once-a-year type will be suitable for people who require nursing care, people with dementia, and those who take many medicines for other diseases such as high blood pressure and diabetes.

When taking Bisphosphonates, patients should be fasted before and after the administration and remain upright for 30 to 60 minutes after taking the drug.

Eating before or after taking medicine will hamper absorption significantly and affect the therapeutic effect. In addition, if you lie down immediately after taking the drug, the ingredients of the drug may flow back up, causing esophageal inflammation or ulcers.


Denosumab is a medicine injected subcutaneously at a medical institution once every six months. The effect of increasing bone density is high, and it is for relatively severe cases. It is a new drug with a long dosing interval.


SERMs act like the female hormone estrogen. It is mainly for postmenopausal women in their 50s and 60s who are not at high risk of fractures.

Drugs that enhance the function of building bones

Osteoporosis drugs that enhance the function of bone formation promote the osteoblasts to form bone and maintain a balance with bone absorption. There is a “parathyroid hormone drug.” One type is injected at a medical institution once a week, and the other is self-injected once a day. This drug is for people with multiple fractures and extremely low bone density. You can use it for up to 24 months.
In February 2019, a once-a-month injection called “Romolizumab,” which simultaneously has the characteristics of “suppressing bone absorption and promoting bone genesis, was released.

Drugs to rebalance bone metabolism

Since this type of medicine suppresses bone absorption and promotes bone genesis, it is a drug that adjusts the balance of bone metabolism through both actions. There is an “active vitamin D3 medicine.” It suppresses osteoclasts’ activity and, consequently, bone absorption. It also promotes calcium absorption from the small intestine and promotes bone formation.

About side effects

Here I explain about osteoporosis drugs and side effects. Some Bisphosphonates may cause gastrointestinal symptoms such as nausea and stomach pain, while SERMs may worsen menopausal symptoms. Active vitamin D3 drugs, on the other hand, are characterized by fewer serious side effects.
In addition, as a side effect of Bisphosphonates and Denosumab, which suppress the action of bone absorption, cases of jawbone necrosis during dental treatment, such as tooth extraction, have been reported as rare cases. When you receive dental treatment, tell your dentist that you are using the medicine that suppresses bone absorption, and also make efforts to manage oral hygiene. Although rare, atypical femoral fractures also happen.

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