What causes low bone density?

Your bones are made of living tissue that never stops growing. The layers of tissue in your bones constantly rebuild. Your body breaks down and removes old bone tissue and forms new bone tissue to replace it.

When you are young, new bone replaces old bone quickly. This makes your bones solid and strong. As you get older, your body loses bone tissue faster than it can be replaced. This makes your bones less solid and weaker.

Most people’s bones get weaker as they get older. Whether or not a person has osteopenia or osteoporosis depends on how much of their bone density is lost.

Normal bone density

Low bone density

How common is low bone density?

• About 52 million people in the United States are affected by osteoporosis or low bone density.
• Both men and women can have low bone density.
• Osteoporosis is more common in women, especially women who have gone through menopause. About one in five women in the United States who are over the age of 50 have osteoporosis.

How do I know my risk for breaking a bone?

Your doctor may have used a bone scan or spoken to you about the World Health Organization Fracture Risk Assessment Tool (FRAX^®) calculator to estimate your risk of bone fracture.

Around one in two women over the age of 50 and one in five men will break a bone because of osteoporosis during their lifetime.

Who is most likely to break a bone?

Women, especially those who have gone through menopause or younger women whose ovaries no longer work, have a higher risk for breaking a bone.

Others with a higher risk for breaking a bone include people with:

• Increasing age.
• A history of broken bones from falling.
• Caucasian heritage.
• Rheumatoid arthritis.
• History of smoking.
• Alcohol use.
• Low levels of vitamin D.
• Not enough calcium in their diet.
• A higher risk for falling due to poor balance or other causes.
• Conditions that require medicines like Prednisone^® or other steroids, blood thinners, antiseizure drugs, or breast or prostate cancer drugs.

Why are broken bones dangerous?

Broken bones can cause serious health problems:

• The most common bones that break are the hip, wrist, and spine (backbone).
• Broken bones can cause ongoing pain and make it hard to do daily activities.
• The bones in your spine can crunch together and cause pain. This could cause you to lose an inch or more of height.
• While recovering from a broken bone—especially the hip—you may need constant care and may have to stay in a nursing home.
• If you break your hip, you will probably need surgery to fix it. Surgery increases your risk for other health problems.
• Once you break a bone, you may be more likely to break other bones, which could lead to more health problems.

What medicines are available?

Medicines that help reduce the risk of breaking a bone either help slow the breakdown of old bone or help build new bone more quickly.

• Most research has been done to see how well these medicines work for women with osteoporosis who have already gone through menopause. Not as many studies have been done to see if these medicines work for men or for women who have not gone through menopause.
• Some of these medicines may also be taken by people with osteopenia.
• There is not enough research to exactly know how much the medicines will lower the risk of breaking a bone.
• Even if your bone density does not change while you are taking medicine, that does not mean the medicine is not working to protect you from breaking a bone.

Medicines and the Bones They Protect

For women with osteoporosis who have gone through menopause, researchers found that the following medicines do or do not lower the risk of breaking the bones listed.

How long will the medicine protect my bones?

There is not enough research to say how long most medicines might protect you from breaking a bone, or how long you may need to take a medicine. There is some evidence that taking alendronate (Fosamax^®) for more than 5 years may protect your spine from breaking. Some women may experience protection for bones other than their spine after taking this medicine for 5 years, while other women will not. Only women who still have osteoporosis or bone breaks in their spine after the first 5 years of treatment may gain protection for bones other than their spine by taking medicine for 5 more years.

Bisphosphonates

Bisphosphonates (pronounced biss-FOSS-fuh-nates) are a group of medicines that slow the breakdown of bones.

• For alendronate (Fosamax^®), ibandronate (Boniva^®), and risedronate (Actonel^®), you must take the pill on an empty stomach with a full glass of water. You must also be standing up, and you cannot lie down for at least 30 minutes after taking any of these medicines.
• Unlike other bisphosphonate pills, Atelvia^® must be taken with food and is usually taken right after breakfast.

Researchers found:

• For women with osteoporosis who have gone through menopause:
  • Alendronate (Fosamax^®) lowers the risk of breaking the spine, hip, or other bones. This medicine may also protect your wrist, but there is not enough research to say for certain.
  • Ibandronate (Boniva^®) lowers the risk of breaking the spine.
  • Risedronate (Actonel^® or Atelvia^®) lowers the risk of breaking the spine, hip, or other bones. This medicine may also protect your wrist, but there is not enough research to say for certain.
  • Zoledronic acid (Reclast^®) lowers the risk of breaking the spine, hip, or other bones.
• If you do not follow your doctor’s instructions for taking bisphosphonates, your risk of breaking a bone increases.
• Some medicines are made for you to take once a week (instead of once a day). Others are taken only once a month or once a year.
  • Many people find it easier to take these medicines once a week.
  • There is not enough research to know if people find it easier to take medicines once a month.
  • Side effects might be different for once-a-week and once-amonth medicines.
• There is not enough research to know if any one bisphosphonate works better than any other.

Denosumab (Prolia^®)

• Denosumab is a medicine that slows the breakdown of bones.
• This medicine is for women after menopause, for men, and for women undergoing treatment for some types of cancer.
• It is given as a shot at your doctor’s office every 6 months.

Raloxifene (Evista^®)

• Raloxifene is another medicine that slows the breakdown of bones.
• This medicine is only for women after menopause.
• Raloxifene is not a hormone, but it keeps bones from breaking down like the natural female hormone estrogen.
• Raloxifene is a pill that you usually take every day with or without food. You have to take this pill at about the same time every day.

Teriparatide (Forteo^®)

• Teriparatide is a medicine that acts like a natural hormone. It helps your body form new bone.
• This medicine is for women after menopause and for men.
• It is a shot taken every day that comes in a “pen”—a device you use to inject the medicine into your belly or thigh.

Menopausal Hormone Therapy (MHT)

• MHT is a therapy where women take hormone supplements. Doctors use estrogen or estrogen with progestin for this therapy.
• This treatment is only for women who have gone through menopause.
• MHT can have serious side effects. It can increase your risk of stroke, heart disease, and breast cancer.
• Because of the risk for serious side effects, many health professionals no longer recommend taking estrogen with progestin to prevent osteoporosis.

What are the possible side effects of these medicines?

What are the costs of treatment?

The wholesale prices of prescription osteoporosis medicines are listed below. Wholesale prices are the prices paid by pharmacies. These prices are given here so you can compare the cost of different medicines.

The cost to you for these medicines depends on your health insurance, the dose (amount) needed, and whether the medicine comes in generic form.

Ask your doctor

• What is my risk for breaking a bone?
• What are your reasons for prescribing the specific medicine you chose?
• How do I take this medicine? Do I take it daily, weekly, monthly, or once a year?
• How long will I need to take this medicine?
• What side effects should I expect from this medicine?
• Do I need to take a calcium and vitamin D supplement?
• Which types of exercises are best for me and which types of exercise should I avoid?

Other questions:

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