From the FDA Drug Label
Osteoporosis is characterized by low bone mass that leads to an increased risk of fracture. The diagnosis can be confirmed by the finding of low bone mass, evidence of fracture on x-ray, a history of osteoporotic fracture, or height loss or kyphosis, indicative of vertebral (spinal) fracture Osteoporosis occurs in both males and females but is most common among women following the menopause, when bone turnover increases and the rate of bone resorption exceeds that of bone formation. Daily oral doses of alendronate (5,20, and 40 mg for six weeks) in postmenopausal women produced biochemical changes indicative of dose-dependent inhibition of bone resorption, including decreases in urinary calcium and urinary markers of bone collagen degradation (such as deoxypyridinoline and crosslinked N-telopeptides of type I collagen)
Osteoporosis is a condition characterized by low bone mass and increased risk of fracture. It is most common in postmenopausal women, where bone turnover increases and bone resorption exceeds bone formation.
- Diagnosis can be confirmed by:
- Low bone mass
- Evidence of fracture on x-ray
- History of osteoporotic fracture
- Height loss or kyphosis
- Alendronate has been shown to produce biochemical changes indicative of dose-dependent inhibition of bone resorption in postmenopausal women, including decreases in urinary calcium and urinary markers of bone collagen degradation 1.
From the Research
Bisphosphonates, such as alendronate or risedronate, are the first-line treatment for osteoporosis, as they have been shown to reduce the risk of vertebral and nonvertebral fractures 2. To manage osteoporosis, a comprehensive approach including medication, lifestyle modifications, and regular monitoring is recommended.
- First-line medications include bisphosphonates such as alendronate (70mg once weekly) or risedronate (35mg once weekly), which have been shown to be safe and effective in increasing bone mass and reducing the risk of fractures 3.
- For those who cannot tolerate bisphosphonates, alternatives include denosumab (60mg subcutaneous injection every 6 months) or teriparatide (20mcg subcutaneous daily for up to 2 years).
- Calcium supplementation (1000-1200mg daily) and vitamin D (800-1000 IU daily) are essential components of treatment, and can be given in a fixed-combination pack with bisphosphonates to improve adherence and effectiveness 4.
- Weight-bearing exercises like walking, jogging, or resistance training for 30 minutes most days of the week help maintain bone density.
- Fall prevention strategies are crucial, including home safety assessments, proper footwear, and balance exercises.
- Bone density should be monitored every 1-2 years to assess treatment effectiveness. Osteoporosis develops when bone resorption exceeds bone formation, leading to decreased bone mass and structural deterioration.
- Medications work by either slowing bone resorption (bisphosphonates, denosumab) or stimulating bone formation (teriparatide), helping to restore the balance of bone remodeling and reduce fracture risk.
- The optimal duration of bisphosphonate therapy is not well established, but it is recommended to consider a "drug holiday" after long-term treatment, as the benefits of treatment may outweigh the risks 5.
- For patients who do not respond adequately to bisphosphonates, transitioning to other therapies such as zoledronic acid, strontium ranelate, denosumab, or teriparatide may be considered 6.