The following classes of drugs are used in the treatment of osteoporosis:

• Calcium and vitamin D
  are the cornerstones of prevention and treatment. Calcium is the major component of the mineral bony substance. Vitamin D promotes the absorption of calcium from the diet, supports its incorporation into bone and also improves muscle function.
• Bisphosphonates
  inhibit the cells responsible for the breakdown of bone. This is slowed and bone mass increases. This can significantly reduce the risk of further fractures of the spine and limbs.
• Selective oestrogen receptor modulators (SERM)
  The commonest cause of osteoporosis in women is the lack of the hormone oestrogen after the menopause. In the absence of oestrogen, the breakdown of bone mass increases. Although oestrogens can prevent further breakdown of bone, they also increase the risk of breast cancer and cardiovascular disease and are therefore not recommended for the treatment of osteoporosis. Since selective oestrogen receptor modulators act on oestrogen-binding sites in bone, but not on those in the breast and uterus, they are suitable for treatment.
• Calcitonin
  is a hormone produced by the thyroid gland. It reduces the release of calcium and phosphate from bone tissue and, at the same time, stimulates deposition of the two substances in bone. It acts in a similar manner to hormone replacement therapy with oestrogens and can therefore be used as an alternative if the latter are unsuitable. Calcitonin can also be used in men.
• Analgesics
  Fractures are painful. The vertebral fractures that often occur in osteoporosis restrict movement. Therefore the pain must first be treated with appropriate drugs. Back braces promote medicinal pain control by relieving pressure on the affected vertebral bodies.
• Fluorides
  have long been used in the treatment of osteoporosis. They accumulate in bony tissue where they increase bone density – in the spine more than in other bones. Treatment with fluorides should not be continued for more than three years.