By Angelica Bottaro 

 Medically reviewed by Stella Bard, MD

The breakdown and regrowth of bone is a constant process. In children and teens, bones grow faster than they break down. For young adults, the rate at which bone growth occurs is the same as bone loss.

As you age, the rate of bone growth slows, so it can't keep up with how quickly bone tissue breaks down. This leads to weak bone mass and, eventually, osteoporosis. There is no cure for the condition, but proper treatment can help improve symptoms.

This article discusses how treatments can maintain or reverse the bone loss found in osteoporosis.

Wutthichai Luemuang / EyeEm / Getty Images

Is Osteoporosis Reversible or Curable?

Osteoporosis is a progressive loss of bone mass, and there is no cure. It also cannot be completely reversed. However, there is a wide variety of treatments available designed to rebuild bone and slow down any further bone loss.1

Stages of Osteoporosis

The four stages of osteoporosis, each correlating with a specific level of bone loss, are:2

• Stage 1: During stage 1, the rate of bone loss is the same as bone growth. There are no symptoms.

• Stage 2: There are still no symptoms in stage 2, but the bone breaks down faster than it can be replaced.

• Stage 3: Stage 3 is considered an official osteoporosis diagnosis. At this point, the bone loss is severe enough that having a minor fall or hitting your leg against a table could result in a fracture or break. People at this stage rarely notice symptoms until they experience a fracture.

• Stage 4: Stage 4 is the most severe stage of osteoporosis, and the symptoms of bone loss begin to occur, such as pain and a change in posture due to weak spinal bones.

Medical Treatment

Many medications are available for people with osteoporosis. Some of the drugs slow down progressive bone loss, while others speed up bone growth. Some can even do both.

Bisphosphonates

Bisphosphonates help people with osteoporosis by slowing down the breakdown of bone tissue, known as bone resorption rate.3 It works by giving osteoclasts (cells tasked with breaking down bones) something else to absorb instead of the bone tissue.

This action helps form new bone because when the old bone is broken down at a slower rate, the production of new bone can catch up to prevent loss.

Hormone-Related Medications

Certain medications can act as hormones within the body to help reduce the amount of bone loss associated with hormonal deficiencies. Since estrogen is known to play a crucial role in bone remodeling (buildup and breakdown of bones), certain medications are used to mimic its abilities to reduce bone loss. One specific medication used to mimic estrogen is Evista (raloxifene).

Another hormone-related medication, Forteo (teriparatide), is often used to encourage the production of new bone tissue as opposed to slowing down the progression of osteoporosis. It acts as a parathyroid hormone, which helps return calcium to normal levels.4

Hormone Therapy

Hormone-replacement therapy may also be used for osteoporosis, especially in postmenopausal people. A loss of estrogen during menopause contributes to an increase in bone loss. Estrogen therapy can help to reduce further bone loss by restoring adequate levels of the hormone.5

How Does Estrogen Deficiency Contribute to Bone Loss?

Estrogen aids bone health by reducing the level of osteoclasts. With lower estrogen, the number of osteoclasts increases, leading to a higher level of bone destruction and, thus, bone loss.  

Antibody Drugs

The bone remodeling cycle relies on various bodily processes, one of those being signaling pathways. These pathways create a direct line of communication between molecules that help control certain functions in the body.

The two signaling pathways involved in the bone remodeling cycle that have been targeted in research are:6

• Wnt/B-catenin

• RANK/RANKL/OPG

These pathways help to regulate the action of osteoclasts and osteoblasts. Osteoclasts break down bones and osteoblast cells build new bone tissue.

Specific antibody medications that can target these pathways include:6

• Xgeva or Prolia (denosumab)

• Evenity (romosozumab)

How Do Antibody Drugs Work for Osteoporosis?

These medications can bind to specific molecules within the affected pathways. By doing so, they can change communication along the pathways and encourage reduced bone resorption and increased bone formation.6  

How to Strengthen Your Bones

Aside from medications, certain lifestyle changes can help reduce the progression of osteoporosis by limiting bone loss and strengthening bones.

Exercise

While it may be challenging to exercise with osteoporosis, it’s a necessary lifestyle habit that can help strengthen the bones. When a person adopts a more active lifestyle, their bones become more vigorous. The best exercises to do with osteoporosis include weight-bearing and resistance exercises.7

What Exercises Should I Be Doing to Improve Osteoporosis Bone Loss?

There are several activities you can engage in that fall under both weight-bearing and resistance categories, including:7

• Walking

• Climbing stairs

• Jogging

• Tai chi

• Lifting weights

• Dancing 

Always speak with your medical provider before starting any new exercise regimen.

Diet

Ensuring that you eat a healthy diet rich in vitamins and minerals is essential for all aspects of health, but it can also aid in reducing osteoporosis symptoms and bone loss. There are three specific minerals you want to pay attention to: vitamin D, calcium, and phosphate.

Calcium and phosphate aid in the formation of new, healthy bone, and vitamin D acts as a catalyst for these minerals. Without adequate vitamin D levels, the body will not absorb calcium or phosphate properly. People with osteoporosis should also focus on getting sufficient levels of other nutrients, including:8

• Protein

• Potassium

• Magnesium

• Vitamin K

• Vitamin C

Each nutrient plays its role in bone health, so getting enough is vital for people who want to reduce bone loss or increase bone strength.

Vitamin D and Calcium Supplementation

Supplementation is often recommended for people with osteoporosis who don’t get enough vitamin D or calcium in their diet. Because of how vital the nutrients are for bone health, some medical providers suggest supplementation to top up levels and improve bone health.

Quit Smoking

Smoking is a risk factor for osteoporosis, so people with osteoporosis should avoid it. Smoking can cause bone loss indirectly by:9

• Encouraging a lower body weight, which can decrease the body’s ability to form new bones

• Inhibiting the absorption of nutrients, such as vitamin D and calcium

• Causing an imbalance in adrenal and sex hormones that play a role in bone remodeling

• Increasing levels of free radicals, molecules that can cause inflammation when out of control, leading to oxidative stress and lowering antioxidant levels within the body

Smoking can also directly affect bone health. It decreases new bone formation by compromising the bone remodeling cycle and the number of osteoblasts in bone tissue. Quitting smoking can improve bone health significantly.9

Avoid Drinking Alcohol

Heavy alcohol consumption can have a negative impact on your health. Drinking alcohol regularly can decrease bone mass by:1011

• Throwing hormone levels off balance

• Inhibiting the absorption of vitamin D and calcium

• Increasing levels of the stress hormone cortisol, which slows down bone formation and increases bone breakdown

Lifestyle Changes and Osteoporosis

You don’t have to wait until you develop osteoporosis to make these lifestyle changes, as they will benefit you at any time. However, if you have already been diagnosed, adopting a healthier lifestyle can significantly improve your bone health, reduce your risk of fractures, and increase the efficacy of your medication.

Finding the Right Treatment Plan

At a certain point, everyone with osteoporosis will need to develop a treatment plan with their medical care team. The critical aspects to discuss during planning are your expectations, what you’re willing to do outside of medication intake, and the side effects of all possible medications.

Since each person is unique, their treatment plan must be personalized.

Summary

Osteoporosis is incurable; once you develop it, you will have to manage it for life. However, many medications and lifestyle options help people with severe bone loss reduce their risk of fractures and further bone loss. Some options can even help rebuild new healthy bone tissue to restore some bone strength lost throughout the disease. You can speak to your medical care provider to learn about the best treatment options for you.

Sources

National Institute on Aging. Osteoporosis.

National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. Bone mass measurement: What the numbers mean.

Maraka S, Kennel KA. Bisphosphonates for the prevention and treatment of osteoporosis. BMJ. 2015 Sep 2;351:h3783. doi:10.1136/bmj.h3783

Endocrine Society. Osteoporosis treatment.

Gambacciani M, Levancini M. Hormone replacement therapy and the prevention of postmenopausal osteoporosis. Prz Menopauzalny. 2014 Sep;13(4):213-20. doi:10.5114/pm.2014.44996

Chang B, Quan Q, Li Y, Qiu H, Peng J, Gu Y. Treatment of osteoporosis, with a focus on 2 monoclonal antibodies. Med Sci Monit. 2018 Dec 3;24:8758-8766. doi:10.12659/MSM.912309

Benedetti MG, Furlini G, Zati A, Letizia Mauro G. The effectiveness of physical exercise on bone density in osteoporotic patients. Biomed Res Int. 2018 Dec 23;2018:4840531. doi:10.1155/2018/4840531

Muñoz-Garach A, García-Fontana B, Muñoz-Torres M. Nutrients and dietary patterns related to osteoporosis. Nutrients. 2020 Jul 3;12(7):1986. doi:10.3390/nu12071986

Al-Bashaireh AM, Haddad LG, Weaver M, Chengguo X, Kelly DL, Yoon S. The effect of tobacco smoking on bone mass: An overview of pathophysiologic mechanisms. J Osteoporos. 2018 Dec 2;2018:1206235. doi:10.1155/2018/1206235

Cheraghi Z, Doosti-Irani A, Almasi-Hashiani A, Baigi V, Mansournia N, Etminan M, Mansournia MA. The effect of alcohol on osteoporosis: A systematic review and meta-analysis. Drug Alcohol Depend. 2019 Apr 1;197:197-202. doi:10.1016/j.drugalcdep.2019.01.025

The Recovery Village. Can alcohol cause osteoporosis?

• • Abrahamsen B, Osmond C, Cooper C. Life expectancy in patients treated for osteoporosis: observational cohort study using national danish prescription data. J Bone Miner Res. 2015;30(9):1553-1559. doi:10.1002/jbmr.2478

By Angelica Bottaro
Angelica Bottaro is a professional freelance writer with over 5 years of experience. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space.