Common questions about osteoporosis medicines

Osteoporosis medicines have many different names, which can be confusing. Some medicines have a family or group name. For example, alendronate, risedronate, ibandronate, zoledronate are part of the ‘bisphosphonate’ family. Teriparatide and abaloparatide are part of the ‘parathyroid hormone’ family.

Many medicines also have brand names. This is the name of the medicine given by the company that makes it. For example, the teriparatide brand name is Forsteo.

An osteoporosis medicine will first be made by one company. After a number of years, other drug companies can produce the same medicine. These are called ‘generic’ versions and will have different brand names. They contain the same drug, but may include different extra ingredients. These extra ingredients may change how it looks or tastes. They do not change how it works.

Sometimes, a medicine becomes available which is a ‘biosimilar’. This is a version of the original drug that is slightly different. The makers of the biosimilar medicine have to prove that it works as well as the original medicine and is as safe. Terrosa and Movymia are examples of teriparatide biosimilars.

Generic and biosimilar drugs are often cheaper than the original branded products. This is the reason they may be prescribed for you. Your new medicine might have a different name and appearance, but it will work just as well to strengthen your bones.

Bone density scans are used to help understand your bone strength and if you would benefit from an osteoporosis medicine.

Scans can often feel like a good way to see progress when you are taking a medicine. But your healthcare professional may not always feel they are necessary. Your scan results won’t change or help with medicine decisions if:

you are over the age of 75 - this is because the scans are not as accurate when you get older 

your medical history makes it clear that you have weaker bones.

Also, scan results don’t show exactly whether a medicine is working. This is because bone density is just one part of your bone strength. Your overall bone strength might be improving even if your bone density hasn’t changed much.

It can feel frustrating that you can’t depend on the scan to give you all the answers. Sometimes you have to trust the research that shows the medicines work.

Find out more about bone density scans.

It can be frustrating having to wait for an appointment with a hospital specialist. Waiting times are often long.

If you are thinking about changing medicines or having problems with side effects, it may be useful to contact your GP surgery. Sometimes, there are other medicine options available from your GP. Or they may be able to contact the specialist by email to get further advice, without you having to attend the hospital.

If your situation is more urgent – for instance, you have broken several bones - there may be ways your GP can get you an urgent hospital appointment.

If you have already seen a specialist at a hospital, you may be able to contact a specialist nurse for advice. Check the letters you have received and the hospital website for a contact number.

If you are taking an osteoporosis tablet and you get bloating, constipation or nausea there are some actions you can take.

First, make sure your tummy problems aren’t caused by a calcium supplement. You could stop the supplement for a week or two and see if your symptoms get better. If it is the supplement causing the problem, you could switch to a different supplement. Or you could increase the amount of calcium in your diet.

If it’s not the supplement causing the problems, then it could be your osteoporosis medicine. Side effects usually get better after a few weeks. If you can, continue to take your tablets for a few weeks. If your symptoms do not improve, you could stop the osteoporosis tablet for a week or two. If the symptoms get better, this suggests they are caused by the medicine.

If you think your medicine is causing the problem, then make an appointment at your GP surgery. They may be able to suggest a different medicine.

If you are still experiencing side effects, it’s important to contact your GP surgery. You will normally get to talk with a doctor, nurse or pharmacist.  

Here are some tips for preparing for a medical appointment: 

GP appointments are usually short, so it’s helpful to work out what you want to say before you go – this could include asking about your osteoporosis medicine options. 

Keep a record of your side effects and when they happen – share these at your appointment. 

Take a notepad and pen to the appointment. 

If you would rather not go on your own, consider asking a family member or friend to go with you.  

Some osteoporosis medicines are linked with a very rare side effect called osteonecrosis of the jaw (ONJ). These medicines are alendronate, ibandronate, risedronate, zoledronate, denosumab and romosozumab.

ONJ is a condition where healing inside the mouth is delayed. This can happen after some dental treatments such as taking a tooth out (a tooth extraction or an implant.

It’s important to tell your dentist if you are on an osteoporosis medicine. Although ONJ is very rare, this means your dentist will be informed. They can then look out for signs of ONJ.

It can be helpful to know that you do not need specialist dental care while you are on these medicines.

You can reduce your risk of ONJ while taking an osteoporosis medicine by:

• keeping your teeth and gums healthy

• seeing a dentist regularly.

Find out more about ONJ.

A drug holiday is a pause in your osteoporosis treatment. It is also called a treatment pause. Bisphosphonates are the only osteoporosis medicines you can ‘pause’. They continue to strengthen bones for a few years after you stop the medicine.

If you have been taking a bisphosphonate medicine, a pause in treatment may be beneficial every three to five years. You can ask a healthcare professional about a treatment pause. Pauses in treatment are a way of reducing the chance of a rare side effect called atypical thigh bone fractures. The chance of these unusual breaks is low. But the chance seems to increase the longer you take your medicine. Having a pause and stopping treatment for 2-3 years acts as a reset. It reduces the chance of the rare side effect.

Some people who have a very high chance of breaking a bone will be advised not to have a treatment ‘pause’. This is because the benefit they will get from their medicine is greater than the chance of side effects.

Steroids are a ‘risk factor’ for osteoporosis. This means they increase your chance of osteoporosis and broken bones.

Usually, if you start steroids, you do not need to change your osteoporosis medicine. You are already helping your bone strength.

In some cases, your doctor may suggest you change to another medicine. Teriparatide, abaloparatide and romosozumab can be helpful if you have a very high chance of breaking a bone. You can only be on these medicines for one to two years, so you will be offered them when you need them most.

If you are unsure speak to a doctor, nurse or pharmacist.

Most other medicines do not stop your osteoporosis medicines from working if taken correctly. Check the instructions that come with your other medicines to make sure. You can also ask your local pharmacist.

If you don’t understand the instructions that come with your medicine, visit your local pharmacy. Pharmacies are a helpful place to ask any questions you have about your osteoporosis medicine. You can also check what services are offered at your local health centre. They may signpost you to a healthcare professional who offers medicine advice.

Osteoporosis medicines are not designed to make you feel better. They will not help with pain from broken bones or other bone-related conditions. But they are constantly working inside your bones to make them stronger. This reduces your chances of breaking a bone in the future.  

We know osteoporosis medicines strengthen bones because they have been proven effective in research. The benefit of osteoporosis medicines is that they reduce your chance of breaking a bone in the future. They do not help with pain caused by broken bones. Though you will not feel your osteoporosis medicine working, it is working in the background improving your bone strength. 

Doctors or nurses can assess your bone strength using a questionnaire called a fracture risk assessment. A bone density scan can also be helpful in some cases. You may have a scan every two to five years. If you have scans too close together, you will not see any change.   

Breaking a bone while taking osteoporosis medicine does not mean it is not working. Osteoporosis medicines reduce your chance of breaking a bone, but they cannot remove the chance completely.  

If you do break a bone while on osteoporosis medicine, you should talk to your doctor or another healthcare professional. They may want to check your bone health again and review if your medicine is working for you. They may suggest changing to a different osteoporosis medicine.