Which osteoporosis medicines are usually tried first?

Bisphosphonates are often the first choice for osteoporosis treatment. These include:

• Alendronate (Fosamax), a weekly pill.
• Risedronate (Actonel, Atelvia), a weekly or monthly pill.
• Ibandronate, a monthly pill or quarterly intravenous (IV) infusion.
• Zoledronic acid (Reclast), an annual IV infusion.

Another common osteoporosis medicine is denosumab (Prolia). Unrelated to bisphosphonates, denosumab might be used in people who can't take a bisphosphonate or did not tolerate one, such as some people with reduced kidney function.

Denosumab is delivered by injections, just under the skin, every six months. If you take denosumab, you might have to do so until your healthcare professional transitions you to another medicine. Unlike bisphosphonates, denosumab is not taken for a certain time and then simply stopped. It is followed by other medicine. Research shows that there could be a high risk of spinal fractures after stopping denosumab, so it's important that you take it consistently.