A woman in her mid-seventies bends down to lift her grandchild, only to hear a sharp crack in her hip. There is no fall or visible injury—just the heartbreaking sound of a bone breaking under normal weight. For many years, this incident was often viewed as an unavoidable result of aging. However, recent advancements in endocrinology have shifted the focus from merely slowing bone loss to actively rebuilding bone density, utilizing a new class of medications that function fundamentally differently from the osteoporosis treatments available over the past two decades.

This shift is driven by a sobering statistic: one in three women and one in five men over the age of 70 will suffer a fracture due to osteoporosis. Alarmingly, many individuals are still treated with older medications that only halt deterioration instead of restoring health. The medication that's transforming this field is abaloparatide (branded as Tymlos), a parathyroid hormone analog that encourages bone cells to create new tissue instead of just preventing its loss. Alongside it, romosozumab (Evenity) employs a hybrid strategy, quickly strengthening existing bone while simultaneously promoting new bone formation. Together, they embody a significant change in how experts now approach bone health in individuals over 70.

For the last two decades, osteoporosis treatments have predominantly relied on bisphosphonates (like alendronate and risedronate) and denosumab. These drugs work by inhibiting osteoclasts, the cells responsible for bone degradation. While they are effective in reducing fracture risk, they fall short of re-establishing what has already been lost.

This limitation has become all too apparent in clinical practice. A 75-year-old woman with severe osteoporosis who has been using alendronate for a decade might stabilize her bone mineral density but still be at a high risk for fractures due to the compromised state of her underlying bone structure. Endocrinologists have come across a therapeutic ceiling: while these medications prevent further deterioration, they do not offer a true path to recovery.

Abaloparatide modifies this dynamic. It acts by mimicking parathyroid hormone, preferentially stimulating osteoblasts—the cells that build bone—over osteoclasts. Clinical trials have demonstrated that patients using abaloparatide for 18 months exhibit increases in bone density of 10–13% in the spine and 7–8% in the hip, achievements that previous osteoporosis medications simply could not provide. These significant increases result in a noticeably lower fracture risk for patients.

Romosozumab adopts a different mechanism but yields comparable results. It inhibits a protein known as sclerostin, which typically suppresses bone creation. The result is a rapid initial bone hardening—fracture risk decreases within weeks—followed by a sustained period of bone growth. Patients switching from bisphosphonates to romosozumab frequently observe significant improvements in bone density within the first year.

Neither abaloparatide nor romosozumab is suitable as a replacement for older medications in every case. Instead, they represent a new level in the treatment hierarchy, generally utilized when prior therapies have failed or when severe bone loss necessitates a more aggressive approach.

The criteria for transitioning to these newer agents extend beyond simply asking Are you over 70? Endocrinologists apply several concrete factors in making this decision.

Factors for Consideration

• Severity of Bone Loss:Patients with a T-score below -2.5, indicating clinical osteoporosis, are candidates. Those with a T-score between -1 and -2.5 (osteopenia) may also qualify if they have sustained a fracture or show a very high fracture risk based on the FRAX score—a tool that accounts for age, sex, previous fractures, and other risk factors.
• Prior Therapy Status:The recommendation for abaloparatide or romosozumab is most common for patients with earlier treatments that have failed.
• Duration of Prior Therapy:Prolonged use of bisphosphonates—exceeding 10 years—has been linked to rare but serious complications like atypical femur fractures and osteonecrosis of the jaw. Thus, endocrinologists view transitioning to newer agents as beneficial for achieving superior outcomes while minimizing cumulative exposure to previous medications.

Understanding these distinctions is essential to shaping expectations and timelines for treatment.

Traditional bisphosphonates and denosumab are classified as anti-resorptive medications; they impede bone breakdown. Think of a building constantly being demolished—these drugs stop the wrecking crew, halting the building from shrinking. However, they do not initiate any new construction.

On the other hand, abaloparatide and romosozumab are anabolic agents; they encourage active bone formation. Abaloparatide stimulates osteoblasts, promoting new bone building, while romosozumab not only enhances bone formation but also rapidly solidifies existing bone, resulting in both immediate strengthening and long-term growth.

This difference translates to timing. It typically takes months for bisphosphonates to reflect benefits in bone density scans, while abaloparatide shows measurable improvements within 6–12 months. For a frail 76-year-old who has just fractured a hip and requires urgent stabilization, this speed is important. Fracture risk with romosozumab begins to lessen within weeks, whereas a bisphosphonate may take 6–12 months to demonstrate similar effects.

However, there is a catch: abaloparatide is usually prescribed for only 18 months, rather than indefinitely. After this period, most patients switch to a bisphosphonate or denosumab to maintain their improvements. This sequential strategy involves rebuilding for 18 months followed by a stabilization phase lasting several years. Romosozumab is typically administered for 12 months, followed by a transition to maintenance therapy.

These newer medications are not devoid of side effects and may not be universally accessible.

Common side effects of abaloparatide include dizziness—especially shortly after injection—as well as mild nausea or headaches. Injection-site reactions such as redness and bruising are frequent but usually mild. Additionally, this drug has been associated with elevated blood calcium levels, necessitating checks of baseline kidney function and calcium levels prior to initiation.

Romosozumab comes with a black-box warning concerning cardiovascular events, including heart attacks and strokes, based on trial data indicating a slight increase in risk for patients with pre-existing heart conditions. This does not imply that the medication is unsafe for individuals with heart issues, but careful patient selection and informed consent are imperative. Injection-site effects are similar to those experienced with abaloparatide.

Both medications necessitate regular monitoring of calcium levels, kidney functionality, and bone density scans every 12–18 months to ensure effectiveness and early identification of potential problems.

Cost is another major factor. The monthly expense for either abaloparatide or romosozumab ranges from $500 to $800 without insurance. Medicare Part D typically provides coverage for both medications, although with restrictions. Many private insurance plans mandate a trial of bisphosphonates beforehand or require documentation of previous treatment failures. Delays in obtaining prior authorization are also common, making these superior treatments financially unfeasible for some uninsured patients.

Patients should clarify the following before starting treatment with abaloparatide or romosozumab:

Endocrinologists caring for patients post-70 now have effective tools that genuinely restore bone health, rather than merely slowing its loss. While abaloparatide and romosozumab are not appropriate for everyone—they are best suited for individuals with severe osteoporosis or documented treatment failures—they signify a meaningful advancement in what is achievable for appropriate patients. Traditional medications remain the basis of treatment for most; for those experiencing aggressive bone loss, these newer agents offer a valid path toward recovery instead of just maintenance. Consultation with an endocrinologist or bone health specialist can help determine if this new approach is warranted based on the specific situation.

Prices and availability are subject to change. Information is for general guidance only and was last reviewed in August 2026.