From the Guidelines
Osteoporosis management should prioritize a comprehensive approach including medication, lifestyle modifications, and regular monitoring to reduce morbidity, mortality, and improve quality of life. According to the most recent and highest quality study 1, first-line medications for osteoporosis include bisphosphonates such as alendronate (70mg weekly), risedronate (35mg weekly), or zoledronic acid (5mg IV yearly). For those who cannot tolerate bisphosphonates, alternatives include denosumab (60mg subcutaneously every 6 months) or teriparatide (20mcg subcutaneously daily for up to 2 years).
Key aspects of osteoporosis management include:
- Medication therapy to slow bone loss
- Lifestyle modifications such as weight-bearing exercises (e.g., walking, jogging, or resistance training for 30 minutes most days of the week) to maintain bone density
- Fall prevention strategies, including removing tripping hazards at home, using assistive devices if needed, and improving balance through exercises like tai chi
- Calcium supplementation (1000-1200mg daily) and vitamin D (800-1000 IU daily) as essential adjuncts to medication therapy
- Regular monitoring of bone density every 1-2 years to assess treatment effectiveness, using tools such as DXA (Dual-energy X-ray absorptiometry) which is the current gold standard test for diagnosing osteoporosis 1.
It is also important to consider the risk factors for osteoporotic fracture, which include increasing age, female sex, post-menopause for women, hypogonadism or premature ovarian failure, low body weight, history of parental hip fracture, ethnic background, previous clinical or morphometric vertebral fracture, and long-term use of certain medications 1. The FRAX tool (World Health Organization Fracture Risk Assessment Tool) can be used to predict fracture risk among people with low bone density, taking into account clinical risk factors and BMD testing results 1.
Overall, a comprehensive approach to osteoporosis management, incorporating medication, lifestyle modifications, and regular monitoring, is crucial to reducing the risk of fractures and improving quality of life for individuals with osteoporosis, as supported by the latest evidence 1.
From the Research
Definition and Treatment of Osteoporosis
- Osteoporosis is a systemic skeletal disorder characterized by bone loss, which leads to impaired bone strength and an increased risk of fractures 2
- Bisphosphonates are safe and effective agents for the treatment and prevention of osteoporosis, increasing bone mass and reducing the risk of vertebral and nonvertebral fractures 3
Benefits and Risks of Bisphosphonates
- Bisphosphonates reduce the risk of fracture by suppressing bone resorption and increasing bone strength 2
- The use of bisphosphonates has been limited to up to 10 years with oral bisphosphonates and 6 years with intravenous zoledronic acid due to the risk of rare side-effects 4
- Potential adverse effects of bisphosphonates include osteonecrosis of the jaw, atypical femur fractures, atrial fibrillation, and esophageal cancer 5
Treatment Options and Strategies
- Antiresorptive drugs, such as bisphosphonates and the RANKL inhibitor denosumab, are currently the most widely used osteoporosis medications 4
- Anabolic therapy with teriparatide has been demonstrated to be superior to the bisphosphonate risedronate in preventing vertebral and clinical fractures in postmenopausal women with vertebral fracture 4
- Sequential treatment, starting with a bone-building drug (e.g. teriparatide), followed by an antiresorptive, may provide better long-term fracture prevention for patients with severe osteoporosis and high fracture risk 4