Regardless of whether you are taking a prescription medication for osteoporosis, it makes sense to optimize your nutrition (food and supplements as needed) and exercise program.

If you have been diagnosed with osteoporosis or your T score is low for your age (as assessed by the Z score), you should understand the underlying causes for your low bone density. If you are menopausal, this may be your only cause - but many of us have additional factors that have played a role in our low bone density.

Michael Lavacot has produced two excellent videos discussing medications and their mode of action (see Resources/videos/Michael Lavacot):

• Osteoporosis Treatments and Medications, Part 1
• Osteoporosis Treatments and Medications, Part 2

Before you start any of these medications, be sure to discuss with your doctor

• contraindications
• any dental problems - should get a thorough exam from a dentist asking if they foresee any problems in the next 2 or so years
• side effects - and best ways to avoid them
• how long they plan to keep you on the drug
• whether you need a follow-up drug after taking the recommended one
• costs - what your insurance covers and whether the manufacturer provides any patient support

Prescription medications fall into 3 classes

• Anti-resorptive drugs. These slow down the breakdown of bone (a necessary process for remodeling and repair). These are typically the first line of treatment, but not always the best option (even if the insurance company says so). These drugs include
  • various bisphosponates
    • alendronate (fosamax)
    • zolendronate (reclast)
    • ?? (actonel)
  • antibodies to RANKL
    • Denosumab (prolia) - requires a follow-up drug.
• Anabolic drugs. These drugs focus on building bone but may have mild anti-resorptive properties. They are typically "reserved" for people with T scores less than -3.0 (at any location) or who have had a fragility fracture. However, they work better if you have not recently taken an anti-resorptive medication. Depending on the medication, they are used for 1 to 2 years and require a follow-up drug in order not to lose all of the bone density gains (called the rebound affect)
  • Parathyroid analogs
    • Forteo - self administered as a daily injection (although an oral version is in clinical trials)
    • Tymlos - self administered as a daily injection
  • Antibodies to sclerostin
    • Romosozumab (Evenity)
• Hormone/Menopause replacement therapy

New drugs - in preclinical (animal) or clinical (human) trials

• AGA2118
• SK124

Romosozumab (Evenity)