Osteoporosis medications fall into two broad categories: those that slow bone breakdown, and those that stimulate bone building. Understanding the difference between them, and why your doctor might choose one over another, is the foundation of making an informed decision about your treatment.

CALLOUT: No medication reverses osteoporosis completely or stops it forever. The goal is to slow further bone loss, stabilise density, and in many cases modestly improve it enough to meaningfully reduce fracture risk. Measured by that standard, these medications are often remarkably effective.

Antiresorptive medications - slowing bone breakdown

The majority of osteoporosis medications work by slowing the osteoclasts, the cells responsible for breaking down old bone. By reducing bone resorption, they allow the bone-building process to gradually gain ground.

The main antiresorptive medications are:

  • Bisphosphonates are the most commonly prescribed class, taken orally (weekly or monthly) or by infusion (annually). Includes alendronate (Fosamax), risedronate (Actonel), and zoledronic acid (Reclast/Aclasta)
  • Denosumab (Prolia) is a biological medicine given by injection every six months, which works by blocking a protein that activates osteoclasts
  • Raloxifene (Evista) is a SERM (selective oestrogen receptor modulator) that mimics some of oestrogen's protective effects on bone
  • HRT replaces the oestrogen lost at menopause, removing the hormonal driver of bone loss

CALLOUT: Antiresorptive medications do not add new bone. They protect what you have. For many women, that is enough. For women with more severe osteoporosis or a high fracture risk, a bone-building medication may be recommended first.

Anabolic medications - building new bone

Anabolic medications work differently. Rather than slowing breakdown, they actively stimulate the bone-building cells (osteoblasts) to lay down new bone. They are typically reserved for women with severe osteoporosis, very high fracture risk, or those who have not responded adequately to antiresorptive treatment.

  • Teriparatide (Forteo) is a daily self-injection for up to two years, a synthetic version of parathyroid hormone
  • Abaloparatide (Tymlos) is a daily self-injection for up to two years, similar mechanism to teriparatide
  • Romosozumab (Evenity) invovles monthly injections for twelve months, with the unique dual action of both building bone and slowing breakdown simultaneously

QUOTE: "Anabolic medications are not a first resort. They are a powerful tool for women who need more than protection. If your doctor has recommended one, it is because your situation calls for something stronger than slowing the loss."

How your doctor decides which to recommend

Treatment decisions in osteoporosis are not one-size-fits-all. Your doctor will consider:

  • Your T-score and which sites are most affected
  • Your calculated fracture risk (FRAX score)
  • Whether you have already had a fracture
  • Your other medical conditions and medications
  • Your ability to follow the dosing requirements of different medications
  • Your personal preferences about injections vs tablets, daily vs weekly vs monthly dosing

CALLOUT: The medication your doctor recommends should not be arbitrary. It must reflect a considered assessment of your specific situation. If you are unsure why a particular medication was chosen for you, ask. Understanding the reasoning helps you commit to it.

What all these medications have in common

Regardless of which medication you take, a few things are true across the board:

  • All require adequate calcium and vitamin D to work effectively. Supplementation is almost always part of the plan
  • All require consistent adherence. Stopping and starting reduces effectiveness significantly
  • All are monitored over time with repeat DEXA scans to assess response
  • None produce dramatic short-term results. Bone density changes slowly, and meaningful improvements take one to two years to show on a scan

CALLOUT: Lenari's medication explainer covers each of these medications individually - what it does, how you take it, side effects, and questions to ask your doctor. Use it alongside these articles to build a complete picture. [Browse the medication guide →]