If osteoporosis is found, or you have broken a bone from a light fall, ask a doctor to prescribe an anti-osteoporosis drug and keep using it; calcium supplements are not a substitute

Cost

It needs a prescription and is used for several years. Common ones are a pill taken once a week or an infusion given once a year. When you start, recheck bone density every year; once stable, every 1 to 2 years. The hard part is keeping on when you feel nothing.

What you get

A fragility fracture is a bone break that happens from minor trauma or ordinary daily activity. The Chinese Medical Association's (中华医学会) 2017 guideline names three groups to treat. First, people who have had a fragility fracture of the spine or hip. Second, people with a bone density T-score of -2.5 or below, whether or not they have ever broken a bone. Third, people with low bone mass who have also had a fragility fracture of the wrist, upper arm or pelvis, or whose calculated fracture risk is high. The guideline also states that “there is currently no sufficient evidence that calcium supplements alone can replace other anti-osteoporosis drug treatment.” Cochrane updated its review of alendronate in 2025. In postmenopausal women who already had osteoporosis or fractures, the drug group had about 51% fewer hip fractures (RR 0.49; 95% CI 0.25 to 0.96, the plausible range). Symptomatic spine fractures were about 55% fewer (RR 0.45, 95% CI 0.28 to 0.73). The HORIZON trial enrolled 2127 people who had had hip fracture surgery, with an average age of 74.5. A once-a-year zoledronic acid infusion was started within 90 days after surgery, with a median follow-up of 1.9 years. New fractures fell from 13.9% to 8.6%, about 35% fewer. Deaths fell from 13.3% to 9.6%, about 28% fewer. The guideline notes that about 20% of people die of various complications within a year after a hip fracture. In the 2017 to 2018 national survey, only 1.4% of women and only 0.3% of men diagnosed with osteoporosis or a fracture were taking medication (China).

Notes

Disputed: a meta-analysis pooling 38 trials did not find that these drugs lower total mortality (RR 0.98, 95% CI 0.91 to 1.05). Zoledronic acid alone was also not significant (RR 0.88, 95% CI 0.68 to 1.13). The authors concluded these drugs should be used only to have fewer fractures. The certainty of those Cochrane numbers was also rated low to moderate. For women who have not yet broken a bone and have lower fracture risk, alendronate showed no clear effect on hip fractures (RR 0.76, 95% CI 0.43 to 1.32). Rare side effects such as osteonecrosis of the jaw and atypical femur fractures can't be fully seen in trials lasting a few years, so go to your checkups on time and don't add or stop medicine on your own. Some people suit an injection and some a pill; the doctor decides which. For how osteoporosis is found, see §1.39 (bone density test). Menopausal hormone therapy can also reduce fractures, but it is generally considered only when other drugs don't suit. For using hormones for hot flashes and night sweats, see §2.43 (get assessed for hormone therapy for hot flashes around menopause). The beneficiary is mainly you, and also your parents.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. 中华医学会骨质疏松和骨矿盐疾病分会 (2017). 原发性骨质疏松症诊疗指南(2017). 中华骨质疏松和骨矿盐疾病杂志, 10(5), 413-443（表 10 抗骨质疏松症药物治疗适应证；钙剂一节；疗效监测一节）. https://html.rhhz.net/GUSS/html/cc825127-29a3-47c1-9a95-7a212fdcce55.htm
2. Wells GA, Hsieh SC, Peterson J, et al. (2025). Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001155.pub3
3. Lyles KW, Colón-Emeric CS, Magaziner JS, et al. (2007). Zoledronic acid and clinical fractures and mortality after hip fracture. New England Journal of Medicine. https://doi.org/10.1056/NEJMoa074941
4. Cummings SR, Lui LY, Eastell R, Allen IE (2019). Association Between Drug Treatments for Patients With Osteoporosis and Overall Mortality Rates: A Meta-analysis. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2019.2779
5. Kahwati LC, Kistler CE, Booth G, et al. (2025). Screening for Osteoporosis to Prevent Fractures: A Systematic Evidence Review for the US Preventive Services Task Force. JAMA. https://doi.org/10.1001/jama.2024.21653
6. Wang L, Yu W, Yin X, et al. (2021). Prevalence of Osteoporosis and Fracture in China: The China Osteoporosis Prevalence Study. JAMA Network Open. https://doi.org/10.1001/jamanetworkopen.2021.21106

Translated from the Chinese original. Original book, section 1, tip 40. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer