Osteoporosis is a common problem that affects the bones. Your bones are living tissues that undergo constant resorption and replacement. Growth, remodeling and removal of old bone are normal processes that you undergo throughout life. However, if the formation of new bone does not keep up with resorption of old bone, your bones become brittle and weak, a condition called osteoporosis. Prevention of osteoporosis is highly advisable, but in severe cases, osteoporosis medications are prescribed to prevent fractures.

Approved Osteoporosis Medications

Food and Drug Administration (FDA) approved osteoporosis medications are classified into two categories:

1. Antiresorptives

Antiresorptivesdecrease the rate of bone resorption by bone cells called osteoclasts. These include Bisphosphonates, Calcitonin, Hormone Replacement Therapy and Biologics:

• Bisphosphonates

Bisphosphonates increase bone mineral density by reducing the rate of bone resorption, thus preventing fractures in the wrist, hip,spine or other bones. Bisphosphonates include:

Alendronate	An oral drug for men and women who have osteoporosis caused by overuse of steroids
Ibandronate	An oral or IV medication that is used by women to lower their risk of spinal fracture
Risedronate	An oral medication for men and women who have osteoporosis due to overuse of steroid medications
Zoledronic acid	Anintravenous medication for women who need to increase their bone mass and protect against fractures

Side effects of Bisphosphonates are chest pain, difficulty swallowing, bone, joint, muscle and abdominal pain.

• Calcitonin

Calcitoninis a natural hormone produced by the thyroid. Calcitonin increases bone mass by slowing the rate at which osteoclasts break down bone.

It is indicated for use by women who have experienced menopause for at least five years. It is also best used by patients with severe osteoporosis. It is used via injection or by nasal spray, which allows quick absorption into the blood stream.

Its side effects include nausea, vomiting, flushing of the skin, back pain, nasal irritation, nose bleeding or headaches

• Hormone Replacement Therapy

The therapy is for menopausal women whose estrogen levels are low. Estrogen is a sex hormone that can protect bones. Low estrogen levels during menopause makes women's bones weaken and more vulnerable to fractures. Estrogen and estrogen-progesterone hormone therapy are FDA-approved treatments under various brand names to decrease the risk of developing osteoporosis-related fractures.

However, these hormone treatments may also increase a woman’s risk of stroke, heart attack, blood clots, andbreast cancer. To avoid this, doctors advise taking other osteoporosis medications or the lowest dose of hormone therapy for a short time.

• Biologics (Denosumab)

Biologics is for post-menopausal women with high risk for fractures, which works by blocking the way a RANKL protein which is involved in the process of bone absorption. It is given as an injection every 6 months. It is not recommended for women with low blood calcium levels.

2. Anabolics

Anabolics are osteoporosis medications that promote speedy bone formation. These include teriparatide, a synthetic FDA-approved parathyroid hormone which may be used by men and women as a daily injection. It enhances bone growth and bone density, thereby reducing your risk of bone fractures. Teriparatide has been associated with bone cancer when used in high doses and must be used for not more than two years.

Tips for Taking Osteoporosis Medications

1. Osteoporosis medications in the bisphosphonate category are very similar and the choice of taking any drug is usually based on one’s preference, cost and adherence to dosing schedule.

2. It is advisable to regularly evaluate your need for continuing your medicines annually with your doctor. Discuss whether you need to continue, stop or switch to other osteoporosis medications after 3-5 years of using.

3. Some doctors recommend taking a drug holiday or stopping temporarily after a good response to medications and to monitor bone density.

4. Never stop taking medications without talking to your doctor first. Tell your doctor about your concerns. Stopping abruptly may result in lack of improvementor worsening of your condition.

Natural Alternatives to Osteoporosis Medications

1. Take Supplements

Calcium and vitamin D supplements can help strengthen bones. For people aged 50 years and older, current recommendation for vitamin D intake is at least 800-1,000 international units (from fortified foods or supplements) and at least 1,200 mg of calcium. If you have weakened bones, talk to your doctor about getting 1,500 mg of calcium daily.

2. Do Exercises

Aerobic exercises like walking, jogging and other weight-bearing activities put pressure on bones and promote bone building. In the same way, strength training exercises also help build muscle and improves balance, which can help prevent falls and fractures. Other exercises like tai chi also help improve balance.

3. Prevent Falls

Avoid fractures from falls by limiting your alcohol consumption and avoiding intake of sleeping pills. Get your eyes checked and be sure to have plenty of light to help you see where you're going. Make sure your home is fall-proof by keeping obstacles and extension cords out of your way, placing grab bars and rubber mats in your bathroom and removing loose rugs.