Why must a bone saver follow a bone builder?

The extra bone from a builder is lost after it stops, unless a bone saver follows. Doctors plan the saver on the day the builder starts.

Are two osteoporosis medicines together better than one?

Some pairs raise bone density more than one medicine alone, but no trial has shown that they cut fractures more. Teriparatide with alendronate tablets did not add benefit.

Does every person with osteoporosis start with a bone builder?

No. Most people start with a bone saver. Builders are for people at very high fracture risk, and a doctor chooses them.

Patient guide

Bone builders and bone savers: why the order matters

How osteoporosis medicines work in plain words. Bone builders, bone savers, and why doctors plan the order for people at very high fracture risk. Patiala.

Medicines for osteoporosis, which means weak, thin bones, fall into two groups. Bone builders help the body make new bone. Bone savers slow the loss of old bone. Most people start with a bone saver. A smaller group of people at very high risk may start with a bone builder. Your doctor chooses which medicine you take, and in what order.

The page is for men and women. Most of the trial numbers below come from studies in women after menopause, and the page says so next to each one. Trials in men are fewer and smaller, and all were outside India. In men, romosozumab and teriparatide raised bone density, but those trials did not measure fractures. In the romosozumab trial in men, serious heart and blood vessel events affected 4.9 in 100 men, against 2.5 in 100 on a dummy treatment. If you are a man, ask your doctor how these results apply to you.

What are bone builders and bone savers?

Bone builders help the body make new bone for a limited time. They include teriparatide, abaloparatide and romosozumab.

Bone savers slow the removal of old bone. They include:

bisphosphonates, such as alendronate and zoledronic acid
denosumab
raloxifene

Why do doctors sometimes start with a builder?

Some people are at very high risk, for example people with a recent fracture or several fractures. For them, trials in women found fewer fractures when a builder came first. In one trial of women with osteoporosis, some had a year of romosozumab and then alendronate. They had 48% fewer new spine fractures than women who took alendronate alone.

Why must a saver follow a builder?

The extra bone from a builder is lost after it stops, unless a bone saver follows. So doctors plan the saver on the day the builder starts.

Can the wrong order cause problems?

Yes. In studies of women after menopause, hip bone density fell for up to 2 years in women who moved from denosumab to teriparatide. Bone density means how much mineral your bones hold. Doctors usually avoid this switch.

Are two medicines together better than one?

In trials of women after menopause, some pairs raised bone density more than one medicine alone. No trial has shown that they cut fractures more. In a trial of men, adding alendronate tablets to teriparatide gave a smaller rise in bone density than teriparatide alone. A trial in women using a related hormone also found no added benefit.

Do builders have special risks?

In one trial of women with osteoporosis, serious heart and stroke events in the first year affected 2.5 in 100 women on romosozumab. With alendronate, the figure was 1.9 in 100. Doctors check your heart and stroke risk before using romosozumab.

For doctors

The evidence behind this page is in How osteoporosis drugs work and Sequential vs combination osteoporosis therapy.

Talking to a doctor in Patiala

To talk about your bone medicines with Dr Aditya Aggarwal, orthopaedic surgeon, call Aggarwal Clinic on +91 98768 24676.

Aggarwal Clinic, 1-E, The Mall, Patiala.

This page is general information, not medical advice. Please talk to your doctor about what is right for you.

Questions

Common questions

What are bone builders and bone savers?: Bone builders help the body make new bone for a limited time. They include teriparatide, abaloparatide and romosozumab. Bone savers slow the removal of old bone. They include bisphosphonates such as alendronate and zoledronic acid, denosumab and raloxifene.
Why must a bone saver follow a bone builder?: The extra bone from a builder is lost after it stops, unless a bone saver follows. Doctors plan the saver on the day the builder starts.
Are two osteoporosis medicines together better than one?: Some pairs raise bone density more than one medicine alone, but no trial has shown that they cut fractures more. Teriparatide with alendronate tablets did not add benefit.
Does every person with osteoporosis start with a bone builder?: No. Most people start with a bone saver. Builders are for people at very high fracture risk, and a doctor chooses them.

Last reviewed 18 October 2026

General information only; it doesn’t replace a consultation. In an emergency, call 112.