Osteoporosis is a condition that causes fragile or porous bones and increases the possibility of fractures and breaks. Upwards of 10 million Americans over the age of 50 have osteoporosis. Although it can occur in both men and women, it is most common in women. Treatment starts with lifestyle modifications that include calcium and vitamin D intake, weight bearing exercise, and the avoidance of tobacco and alcohol. If medication is needed, there are several options. Bisphosphonates are a group of drugs that include alendronate (Fosamax), ibandronate (Boniva), and residronate (Actonel). These prescription drugs come in formulations that allow for daily, weekly, or monthly dosing. Some also contain added calcium and vitamin D. Raloxifene (Evista) is taken daily and can improve cholesterol and osteoporosis. Historically, hormone replacement therapy (estrogen) was commonly used in post-menopausal women, but its use has declined due to risk of cancer, heart attack, and stroke. Calcitonin (Miacalcin®) is a nasal spray that is sometimes prescribed. Lastly, daily injections of parathyroid hormone or teriparatide (Forteo®) can be given, but long-term use has not been evaluated.