If you are diagnosed with osteoporosis, or have fractured from a minor fall, ask a doctor for osteoporosis medication and keep taking it—do not treat calcium supplements as a substitute

If osteoporosis is confirmed, or you have already fractured from a light fall, following a doctor's drug plan cuts hip fractures by about half and symptomatic spine fractures by a bit more than half. In older people who start yearly infusion within 90 days after hip-fracture surgery, new fractures over two years fall by about 35%. Calcium alone cannot replace these drugs.

Prescription required; use continues for years. Common options include once-weekly oral drugs and once-yearly infusions. Bone density should be rechecked yearly at first, then every 1 to 2 years once stable. The hard part is continuing when you feel fine.

Fragility fracture means a fracture from minor trauma or everyday activity. The Chinese Medical Association 2017 guideline lists three groups for treatment: prior fragility fracture of spine or hip; bone density T-score −2.5 or lower regardless of prior fracture; or low bone mass plus fragility fracture of wrist, upper arm, or pelvis, or high calculated fracture risk. The guideline states: "There is currently insufficient evidence that calcium supplementation alone can replace other anti-osteoporosis drug therapy." Cochrane's 2025 update on alendronate in postmenopausal women with osteoporosis or prior fracture found hip fractures about 51% lower in the treated group (RR 0.49, 95% CI 0.25 to 0.96) and symptomatic vertebral fractures about 55% lower (RR 0.45, 95% CI 0.28 to 0.73). The HORIZON trial enrolled 2,127 people mean age 74.5 after hip-fracture surgery; yearly zoledronic acid starting within 90 days post-op, median follow-up 1.9 years. New fractures fell from 13.9% to 8.6% (about 35% relative reduction). Death fell from 13.3% to 9.6% (about 28% relative reduction). The guideline notes about 20% of people die from complications within one year after hip fracture. In the 2017–2018 national survey, only 1.4% of women and 0.3% of men with diagnosed osteoporosis or prior fracture were on medication (China).

Controversy: A meta-analysis of 38 trials did not show these drugs lowering overall 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 to prevent fractures, not to cut death rates. Cochrane rated those fracture estimates low to moderate certainty. In women without prior fracture and lower risk, alendronate did not clearly reduce hip fractures (RR 0.76, 95% CI 0.43 to 1.32). Rare harms such as jaw osteonecrosis and atypical femur fracture may not show up in trials of a few years—keep follow-up visits and do not change dose on your own. Injection versus pills depends on the doctor. How to find osteoporosis is item 39 (bone density testing). Primary beneficiaries are you and your parents.

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 ; 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 ; 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 ; 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 ; 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 ; 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