All options below are real published treatments. Evidence-level reflects current clinical guidelines (NAMS / ACOG / Endocrine Society). Cost ranges are starting price estimates от $US public sources.
Systemic estrogen (preventive)
HRTfirst lineFDA-approvedSide effects
breast tenderness, spotting
FDA-approved для osteoporosis prevention в postmenopausal women с VMS. Preserves bone density when started early. Effect reverses on discontinuation.
Providers offering this: midi health, alloy womens health
Bisphosphonates (alendronate, risedronate)
Non-hormonalfirst lineFDA-approvedMonthly cost
$10-$40 generic
Side effects
esophageal irritation, rare jaw osteonecrosis с long-term use
First-line для established osteoporosis. Reduces vertebral fractures ~50%. Strict dosing requirements (empty stomach, 30 min upright).
Contraindications: Esophageal stricture, severe renal impairment
Denosumab (Prolia)
Non-hormonalsecond lineFDA-approvedMonthly cost
$1500 per 6-month dose
Side effects
hypocalcemia, rare jaw osteonecrosis
SubQ injection every 6 months. Useful когда oral bisphosphonates contraindicated. Discontinuation can cause rebound bone loss + fractures — plan transition.
Calcium + vitamin D supplementation
LifestyleadjunctSide effects
constipation, kidney stones if excessive
Calcium 1200mg/day + vitamin D 800-1000 IU. Supplements alone не sufficient when osteoporosis established.
Weight-bearing exercise + strength training
Lifestylefirst lineWalking, jogging, resistance training stimulate bone formation. Required regardless of pharmacotherapy.