If osteoporosis is due to another disease or to a medical treatment, treatment may begin with resolving or minimizing the cause, wherever possible. For example, patients taking corticosteroids or other immunosuppressives for conditions such as arthritis, asthma or temporal arteritis can work with their physician to find the lowest effective dose. In some cases the physician may be able to find another treatment or discontinue the drug, but patients should not stop taking the medication on their own.

Physicians often recommend that patients take supplements of calcium and vitamin D and engage in regular weight-bearing exercise such as walking. Patients with advanced osteoporosis may be cautioned to avoid certain high-impact activities.

The Food and Drug Administration (FDA) has approved has approved several medications for osteoporosis:

• Bisphosphonates. These inhibit bone breakdown (resorption), preserve bone mass and increase bone density in the spine and hips and help prevent fractures. Their uses include preventive therapy for people requiring long-term use of corticosteroids, and they may be prescribed to people with cancer or other conditions that can weaken bones.

Some bisphosphonates are available in daily or weekly tablets, and one is available in a monthly tablet or an injection that is given every three months by a healthcare professional. Some research has found that bisphosphonates may be able to be discontinued after several years, but patients are urged to consult their physician and not to do this on their own.

Side effects associated with bisphosphonates include nausea, abdominal pain and irritation of the esophagus. There have been rare cases of jawbone deterioration (osteonecrosis). Esophagitis can be prevented by taking the pill with a full glass of water (8 ounces) and by not lying down for about half an hour after taking the pill on an empty stomach. Bisphosphonates are contraindicated in patients who already have esophageal strictures (narrowing) and in patients who are unable to stand or sit in an upright position for 30 minutes.

• Hormonal drugs. These include:
  
  
• Selective estrogen receptor modulators (SERMs). These medications block estrogen receptors in breast cells. These medications block estrogen receptors in breast cells. Used to fight breast cancer, they also strengthen bones in women after menopause. Side effects may include hot flashes, upset stomach or risk of blood clots.
  
  
• Calcitonin (Fortical, Miacalcin). Produced by the thyroid gland, this hormone reduces bone resorption and may slow bone loss in postmenopausal women. Calcitonin may also prevent spinal fractures but does not appear to lessen the risk of hip fracture. Administered via nasal spray, it irritates nasal passages and causes nausea in some patients. It is very expensive and is not usually recommended as the first line of treatment.
  
  
• Teriparatide (Forteo). This injectable synthetic version of parathyroid hormone helps to regulate calcium and phosphate metabolism in bones. It may be prescribed to women or men at high risk for fractures. Side effects may include nausea, dizziness and leg cramps.
  
  
• Testosterone therapy. This may benefit men who have or are at high risk for osteoporosis because of low levels of testosterone.
  

Hormone replacement therapy (HRT) had long been the primary treatment for osteoporosis in women. By taking estrogen or combined estrogen and progesterone replacements, women have been able to slow down or halt the loss of bone mass associated with menopause. However, recent studies link long-term HRT to serious risks including breast cancer and blood clots. As a result, many experts no longer recommend HRT as a primary means of controlling osteoporosis.

Patients with osteoporosis may benefit from physical therapy to enhance balance, strength and mobility. Electrical therapy such as transcutaneous electrical nerve stimulation (TENS) can relieve severe pain and muscle spasms caused by an osteoporotic spinal fracture. Pain management techniques such as acupuncture or acupressure may also reduce back pain. Occupational therapy and instruction in posture and ergonomics can help maximize independence in daily activities.

Operations to repair osteoporotic fractures include arthroplasty such as joint replacement and spinal surgeries such as vertebroplasty and kyphoplasty.

Patients are advised to consult their physician before trying any alternative or complementary therapies. The FDA has warned dozens of companies promoting unproven “alternate” hormone therapies for osteoporosis and other conditions.

Scientists are conducting a great deal of research on osteoporosis. Researchers are developing additional medications, and investigating whether antidepressants that block a brain chemical called serotonin can prevent or treat the disease by increasing bone mass.