What are the medications for osteoporosis?

From the Guidelines

Bisphosphonates, such as alendronate (Fosamax) 70mg weekly, risedronate (Actonel) 35mg weekly, or zoledronic acid (Reclast) given as an annual IV infusion, are the recommended first-line treatments for osteoporosis. These medications work by slowing bone breakdown and are typically the initial choice for managing osteoporosis 1.

Treatment Options

Other treatment options include:

• Denosumab (Prolia), given as a subcutaneous injection every 6 months, which prevents bone breakdown and is useful for patients who can't tolerate bisphosphonates 1.
• Anabolic agents like teriparatide (Forteo) or abaloparatide (Tymlos) given as daily injections for up to 2 years, which can stimulate new bone formation 1.
• Romosozumab (Evenity), administered monthly for 12 months, another anabolic option 1.
• Selective estrogen receptor modulators like raloxifene (Evista) 60mg daily, which may be used for postmenopausal women 1.

Treatment Duration and Supplements

Treatment duration varies, with bisphosphonates often prescribed for 3-5 years before reassessment 1. Calcium (1000-1200mg daily) and vitamin D (800-1000 IU daily) supplements are typically recommended alongside these medications to support bone health 1.

Factors Influencing Treatment Choice

The choice of treatment depends on factors like fracture risk, age, gender, and other medical conditions 1. Ensuring adequate calcium and vitamin D intake, as well as encouraging a healthy lifestyle with exercise and fall prevention counseling, are also crucial components of osteoporosis management 1.

Recent Guidelines

Recent guidelines suggest that bisphosphonates have the most favorable balance of benefits, harms, patient values, and costs among the examined drugs, making them a preferred initial treatment for osteoporosis 1. For men, oral bisphosphonates (alendronate or risedronate) are recommended as first-line treatments for those at a high risk of fracture, with denosumab or zoledronate considered as second-line options 1.

From the FDA Drug Label

Risedronate sodium delayed-release is a prescription medicine used to treat osteoporosis in women after menopause Teriparatide injection is indicated: For the treatment of postmenopausal women with osteoporosis at high risk for fracture The medications used to treat osteoporosis are:

• Risedronate sodium delayed-release
• Teriparatide injection These medications are used to treat osteoporosis in different patient populations, including postmenopausal women and men with primary or hypogonadal osteoporosis 2 3.

From the Research

Medication for Osteoporosis

• Bisphosphonates are a class of medications that are safe and effective for the treatment and prevention of osteoporosis 4.
• They increase bone mass and reduce the risk of vertebral fractures, and are the only agents shown to reduce the risk of hip fractures and other nonvertebral fractures 4, 5.
• Alendronate and risedronate are the most well-studied bisphosphonates and are approved by the US FDA for prevention of bone loss in recently menopausal women, treatment of postmenopausal osteoporosis, and management of glucocorticoid-induced bone loss 4, 5.
• Other bisphosphonates, such as etidronate, pamidronate, and zoledronate, are also available and can be used off-label for patients who cannot tolerate approved agents 4, 5.
• Bisphosphonates can be administered orally or intravenously, and once-weekly oral administration may offer improved convenience and compliance compared to daily administration 6.
• The use of bisphosphonates in combination with other medications, such as estrogen or raloxifene, may produce greater gains in bone mass, but the benefit on fracture risk is not clear and may be associated with increased cost and side effects 4, 5.

Types of Bisphosphonates

• Alendronate and risedronate are the most well-studied bisphosphonates and have been shown to be effective in reducing fractures in women with osteoporosis 7.
• Zoledronate may be more effective than risedronate or alendronate in increasing bone mineral density, and its use may be supported by the need for less frequent administration 7.
• Etidronate, pamidronate, and zoledronate are also available and can be used off-label for patients who cannot tolerate approved agents 4, 5.

Administration and Efficacy

• Bisphosphonates have been shown to reduce the risk of fracture quickly, with the risk of radiographic vertebral deformities reduced after 1 year of treatment with risedronate, and the risk of clinical vertebral fractures reduced after 1 year of treatment with alendronate and 6 months' treatment with risedronate 5.
• The antifracture effect of risedronate has been shown to continue through 5 years of treatment 5.
• Once-weekly oral administration of bisphosphonates may offer improved convenience and compliance compared to daily administration, and may also provide improved efficacy and tolerability 6.