From the Guidelines
The treatment of osteoporosis involves a combination of pharmacological and non-pharmacological measures to prevent bone loss and reduce fracture risk, with bisphosphonates, such as alendronate and risedronate, being the first-line pharmacological treatments, as recommended by the American College of Physicians 1.
Pharmacological Measures
- Bisphosphonates: alendronate (70mg weekly) and risedronate (35mg weekly) are typically first-line treatments, inhibiting bone resorption and reducing the risk of fractures 1
- Denosumab (60mg subcutaneously every 6 months) is a monoclonal antibody that blocks bone resorption and is effective for patients who cannot tolerate bisphosphonates 1
- Teriparatide (20mcg subcutaneously daily for up to 24 months) is an anabolic agent that stimulates bone formation 1
- Selective estrogen receptor modulators like raloxifene (60mg daily) are useful particularly for postmenopausal women 1
- Hormone replacement therapy can be considered for women with menopausal symptoms 1
Non-Pharmacological Measures
- Weight-bearing and resistance exercises performed 3-4 times weekly to strengthen bones and improve balance 1
- Fall prevention strategies such as home safety assessments and removing tripping hazards are crucial 1
- Smoking cessation and limiting alcohol consumption to moderate levels help prevent further bone loss 1
- Maintaining adequate protein intake (1-1.2g/kg body weight daily) supports bone health 1
- Calcium supplementation (1000-1200mg daily) and vitamin D (800-1000 IU daily) are essential adjuncts to all treatments 1
- Vitamin D and calcium repletion should be ensured in all men above the age of 65 years 1
- Physical exercise and a balanced diet should be recommended to all men with osteoporosis 1
From the FDA Drug Label
14.1 Treatment of Osteoporosis in Postmenopausal Women 14.2 Treatment to Increase Bone Mass in Men with Primary or Hypogonadal Osteoporosis 14.3 Treatment of Men and Women with Glucocorticoid-Induced Osteoporosis
The following are 10 pharmacological and non-pharmacological measures for the treatment of osteoporosis:
- Pharmacological measures:
- Teriparatide (SQ) 2
- Bisphosphonates
- Selective estrogen receptor modulators (SERMs)
- Denosumab
- Non-pharmacological measures:
- Calcium and vitamin D supplementation
- Weight-bearing exercise
- Fall prevention
- Smoking cessation
- Moderation of alcohol consumption
From the Research
Pharmacological Measures
- Bisphosphonates (e.g. alendronate, risedronate) to increase bone mass and reduce the risk of vertebral and nonvertebral fractures 3, 4, 5
- Estrogens to increase bone mass and reduce the risk of fractures 3, 4
- Selective estrogen receptor modulators (e.g. raloxifene) to increase bone mass and reduce the risk of fractures 3, 4
- Denosumab to increase bone mineral density and reduce the risk of fractures 4, 6
- Teriparatide to increase bone mass and reduce the risk of fractures 4, 6
- Abaloparatide to increase bone mass and reduce the risk of fractures 4
- Romosozumab to increase bone mass and reduce the risk of fractures 4
- Calcitonin to increase bone mass and reduce the risk of fractures 3
- Risedronate to increase bone mineral density and decrease the incidence of fractures 5
- Etidronate to increase bone mineral density and decrease the incidence of fractures 3, 5
Non-Pharmacological Measures
- Diet rich in calcium and vitamin D to support bone health 4, 7
- Healthy lifestyle, including weight reduction if obese/overweight, to support bone health 4
- Proper exercise plan, including physical activity, to support bone health 4, 7
- Avoiding alcohol consumption and smoking to support bone health 4
- Increasing physical activity to support bone health 4, 7