Copyright © 2025 Conca Sport and Fitness | Powered By 
Osteoporosis Drugs: What the Research Really Says
When someone is diagnosed with osteoporosis, the first question is often whether medication can help. Drug therapy is typically recommended for those with a history of hip or spine fractures, a T-score below -2.5 on a DXA scan, or—for postmenopausal women and men over 50—low bone mass with a significant 10-year fracture risk (over 3% for hip fractures or 20% for major osteoporotic fractures, based on World Health Organization criteria).
A T-score compares your bone density to that of a healthy 30-year-old woman. By this definition, many older women have been labeled osteoporotic or osteopenic despite having bone density that’s normal for their age. Critics have noted that organizations promoting awareness—like the National Osteoporosis Society (UK) and the National Osteoporosis Foundation (USA)—receive substantial funding from drug companies, raising questions about how treatment thresholds are set.
Bisphosphonates, such as Fosamax, Boniva, and Reclast, are considered the first-line treatment. These drugs can cut the relative risk of vertebral fractures in postmenopausal women by about 50%—from 2.8% down to 1.4%. But in absolute terms, that’s only a 1.4% reduction, meaning 71 people would need treatment to prevent a single fracture.
Hip fractures, which cause the greatest disability, show even less benefit: for patients without a prior major fracture, bisphosphonates haven’t convincingly been shown to prevent them. In those with a previous fracture, the risk may drop by 25% in relative terms—but only about 1% in absolute terms, requiring treatment of 91 people for three years to prevent one hip fracture.
Research also reveals that fracture prevalence varies widely depending on how X-rays are interpreted—estimates range from 3% to 90% in the same elderly population. Only about a third of spinal fractures identified on imaging cause noticeable symptoms. And while hip fractures are associated with a higher risk of death, recent data suggests much of that mortality is due to preexisting health conditions rather than the fracture itself.
A meta-analysis of 38 clinical trials involving over 101,000 osteoporosis patients found that bisphosphonate therapy was not linked to a reduction in overall mortality. Despite this, many patients overestimate their personal fracture risk—one survey found they believed they had a 19% chance of a hip fracture within five years, when the actual risk was closer to 1.4%.
If more people knew how modest the benefits are—and that side effects weren’t even part of this discussion—they might think twice before relying solely on medication. Researchers suggest diet, exercise, and lifestyle changes remain powerful, often undervalued tools in maintaining bone health.