Important: This page provides general information only. It is not a substitute for professional medical advice, diagnosis, or treatment. If you have concerns about your bone health, please speak to your GP.
Treatment Options
Osteoporosis is a treatable condition. While bone density cannot be fully restored to its original level, effective treatments can significantly slow or halt bone loss, reduce fracture risk, and in some cases modestly increase bone density.
Important: This page provides a general overview for educational purposes only. It does not include dosage information or recommendations. All treatment decisions must be made in consultation with your GP or specialist, taking into account your individual circumstances, medical history, and test results.
The Foundation: Calcium, Vitamin D, and Exercise
Regardless of which medication (if any) your GP recommends, the following are considered essential for everyone with osteoporosis:
- Adequate calcium — ideally through diet; supplements may be added if dietary intake is insufficient
- Adequate Vitamin D — supplementation is almost always recommended in Ireland due to limited sunlight; GPs typically prescribe this alongside medication
- Regular weight-bearing and resistance exercise — see our Exercise page
- Falls prevention — addressing fall risk is as important as treating bone density; see our Falls Prevention page
These measures form the foundation of osteoporosis management for everyone — with or without additional medication.
Medication Classes
Your GP or specialist will decide whether medication is appropriate based on your bone density results, fracture history, fracture risk score, age, and other health factors. The most commonly used medication classes are:
Bisphosphonates
Examples: Alendronate (Fosamax), risedronate, ibandronate, zoledronic acid
How it works:
Bisphosphonates are the most widely prescribed first-line treatment for osteoporosis worldwide. They work by slowing down the breakdown of bone (reducing osteoclast activity), which allows bone-building to keep pace with bone breakdown, increasing bone density over time.
What you should know:
They are available as weekly oral tablets, monthly oral tablets, or annual infusions (zoledronic acid). The oral forms should be taken on an empty stomach with a full glass of water, and you should stay upright for at least 30 minutes afterwards. Rare side effects (jaw problems, atypical fractures) should be discussed with your GP — the benefits significantly outweigh the risks for most people. Treatment breaks (drug holidays) may be considered after 5 years on oral bisphosphonates.
Denosumab
Examples: Prolia (brand name)
How it works:
Denosumab is a monoclonal antibody — a biological medicine — that blocks RANK ligand, a protein essential to osteoclast (bone breakdown cell) function. By blocking this protein, it significantly reduces bone breakdown and increases bone density.
What you should know:
Given as a subcutaneous injection every 6 months, usually at a GP surgery or hospital clinic. It is effective for both post-menopausal osteoporosis and for bone loss in men on androgen deprivation therapy. It is important not to miss or delay injections, as stopping denosumab without a transition plan can lead to a rapid increase in fracture risk.
Hormone Replacement Therapy (HRT)
Examples: Various forms of oestrogen (with or without progestogen for women with a uterus)
How it works:
Oestrogen plays a key role in maintaining bone density in women. HRT replaces the oestrogen lost at menopause and has been shown to reduce fracture risk. It is often used for women who need treatment for menopausal symptoms (hot flushes, night sweats, etc.) and who also have osteoporosis or are at high risk.
What you should know:
HRT is not a one-size-fits-all treatment. Your GP will discuss the benefits and risks of HRT in relation to your individual medical history. Modern HRT (particularly transdermal forms) is considered much safer than older formulations in most women. Bone protective effect is maintained while HRT is being taken.
Anabolic Agents (Bone Builders)
Examples: Teriparatide (Forsteo), abaloparatide, romosozumab (Evenity)
How it works:
Unlike bisphosphonates and denosumab, which primarily slow bone breakdown, anabolic agents actively stimulate bone formation. They work by activating parathyroid hormone receptors (teriparatide) or blocking sclerostin, a protein that inhibits bone formation (romosozumab).
What you should know:
Anabolic agents are generally reserved for people with severe osteoporosis, very high fracture risk, or those who have not responded to other treatments. They are given as daily or monthly injections and are typically used for a defined period (e.g. 18–24 months for teriparatide), after which a bone-protective agent is prescribed to maintain the gains.
Selective Oestrogen Receptor Modulators (SERMs)
Examples: Raloxifene (Evista)
How it works:
SERMs mimic oestrogen's beneficial effects on bone without the same effects on breast or uterine tissue. Raloxifene reduces the risk of vertebral fractures and is sometimes used in post-menopausal women who cannot take or are reluctant to take bisphosphonates.
What you should know:
Less effective than bisphosphonates for hip fracture prevention. Associated with increased risk of deep vein thrombosis (blood clots) — not suitable for those with a history of DVT.
How Long Is Treatment?
Osteoporosis treatment is typically long-term — often years rather than months. However, treatment is not necessarily lifelong. Your GP will monitor your bone density periodically (usually every 1–2 years) and reassess whether treatment should continue, be changed, or include a treatment break.
Do not stop any osteoporosis medication without discussing it with your GP first. Stopping some treatments abruptly (particularly denosumab) can have significant effects on bone density.
For a guide on how to talk to your GP about these options, including questions to ask about any recommended medication, visit our Talking to Your Doctor page.
Talk to Your GP
All treatment decisions must be made with your GP or specialist. This page provides general information only. If you have been diagnosed with osteoporosis, ask your GP what treatment options are right for you.
You can say: “I'd like to discuss my bone health and whether I should have a DXA scan.”
Questions to Ask Your DoctorLast reviewed: February 2026 — FragilityFracture.ie Editorial Team