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Scared to start pharmacological therapy for severe osteoporosis
Spine Health | Last Active: Dec 25, 2025 | Replies (23)Comment receiving replies
So-called bone building drugs build brittle bone that is prone to breakage. The best approach is supplementing with a combination of calcium, magnesium, vitamin K and vitamin D as well as engaging in weight-bearing exercise. Also, determine if any of the medications you are on could be causing bone loss. Several medication classes can cause bone loss, most notably glucocorticoids (like prednisone) and hormonal therapies (like aromatase inhibitors for breast cancer or androgen deprivation for prostate cancer). Other culprits include SSRIs, proton pump inhibitors (PPIs), certain antiepileptics, some diabetes drugs (TZDs), and injectable progestins (Depo-Provera), affecting bone density by interfering with calcium/vitamin D, hormone levels, or bone cell activity. Be very careful about stopping SSRIs or antiepileptics abruptly as that could be dangerous.
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@cperlin, hi. the bone building drugs that build more brittle bones are Prolia and Evenity. The bisphosphonates don't build bone except by collecting it; these bones are also more brittle. All these drugs carry a risk of osteonecrosis.
The bone building drugs that remodel bone, Tymlos and Forteo, build bone that does not carry the risk of osteonecrosis and if often given as a treatment for brittle bone caused by the other medications.
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@cperlin Thank you! I was on a SSRI for a while, but I'm no longer taking it. I'm not taking any of the other drugs you mentioned. I just had extensive blood work done and my PTH is low, but vit D, calcium, mag, and thyroid were all normal. So, not sure what's driving the train! I am post menopausal and not been on HRT, but don't think that is the main reason for such rapid bone loss. I really think it might be tied to my gut which is a mess, but none of the Dr.'s can figure out what is going on.