What are the treatment options for osteoporosis?

From the Guidelines

The primary treatment for osteoporosis should include medications such as bisphosphonates (e.g., alendronate 70mg once weekly, risedronate 35mg once weekly, or zoledronic acid 5mg IV annually) as first-line treatments, along with lifestyle changes and dietary modifications to slow bone loss, increase bone density, and reduce fracture risk. The treatment options for osteoporosis can be broken down into several categories:

• Medications:
  • Bisphosphonates are first-line treatments, working by slowing bone breakdown 1.
  • Denosumab (60mg subcutaneous injection every 6 months) is an alternative for those who can't tolerate bisphosphonates, inhibiting bone resorption 1.
  • For severe cases or in postmenopausal women at high risk, anabolic agents like teriparatide (20mcg subcutaneous daily for up to 2 years) may be used to stimulate bone formation 1.
• Lifestyle changes:
  • Regular weight-bearing and resistance exercises (30 minutes, 3-4 times per week) to strengthen bones and improve balance 1.
  • Quit smoking and limit alcohol consumption to reduce bone loss 1.
• Dietary modifications:
  • Increase calcium intake (1000-1200mg daily) through diet or supplements 1.
  • Ensure adequate vitamin D (800-1000 IU daily) through sunlight exposure or supplements 1.
• Fall prevention:
  • Remove tripping hazards at home.
  • Use assistive devices if necessary. These treatments work together to slow bone loss, increase bone density, and reduce fracture risk. The combination of medication to directly affect bone metabolism, along with lifestyle and dietary changes to support overall bone health, provides a comprehensive approach to managing osteoporosis. Regular follow-up with bone density scans (typically every 1-2 years) is important to monitor treatment effectiveness and adjust the plan as needed 1. It is also important to consider the patient's individual risk factors, such as history of fractures, and to involve them in the decision-making process when choosing a treatment plan 1. In addition, clinicians should assess baseline risk for fracture based on individualized assessment of bone density, history of fractures, response to prior treatments for osteoporosis, and multiple risk factors for fractures 1. Overall, the goal of treatment is to reduce the risk of fractures and improve the patient's quality of life, while also considering the potential benefits and harms of each treatment option 1.

From the FDA Drug Label

For the treatment of postmenopausal women with osteoporosis at high risk for fracture Alendronate sodium 10 mg/day (for up to five years) reduced urinary excretion of markers of bone resorption Prolia is a prescription medicine used to: Treat osteoporosis (thinning and weakening of bone) in women after menopause

The treatment options for osteoporosis include:

• Alendronate (2): a bisphosphonate that reduces bone resorption
• Teriparatide (3): indicated for the treatment of postmenopausal women with osteoporosis at high risk for fracture
• Denosumab (Prolia) (4): a prescription medicine used to treat osteoporosis in women after menopause and increase bone mass in men with osteoporosis. Key points to consider when choosing a treatment option include the patient's risk of fracture, medical history, and ability to tolerate the medication.

From the Research

Treatment Options for Osteoporosis

The treatment options for osteoporosis include:

• Lifestyle changes, such as weight reduction, increasing physical activity, and avoiding alcohol consumption and smoking 5
• Calcium and vitamin D3 supplementation until the vitamin D deficit is resolved 5
• Antiresorptive agents, including estrogens, selective estrogen receptor modulators, bisphosphonates, and denosumab 5
• Anabolic agents, including teriparatide, abaloparatide, and romosozumab 5
• Combination therapy with antiresorptive and anabolic agents to increase bone mineral density (BMD) 5

Lifestyle Interventions

Lifestyle interventions that can improve bone health in women at high risk of osteoporosis include:

• Exercise, such as strength exercises and aerobic exercises 6
• Diet, including soy protein supplementation and vitamin K supplementation 6
• Calcium supplementation to improve femur and lumbar bone mineral density 6
• Vitamin D supplementation to improve lumbar bone mineral density 6
• Self-management programs for better bone health to improve balance and quality of life 6

Pharmaceutical Treatment

Pharmaceutical treatment options for osteoporosis include:

• Bisphosphonates 7
• Calcium and vitamin D3 7
• Denosumab 7
• Teriparatide 7
• Raloxifene 7
• Strontium ranelate 7

Non-Pharmaceutical Treatment

Non-pharmaceutical treatment options for osteoporosis include:

• Exercise 7
• Kinesitherapy 7
• Treatment at a health resort 7
• Physical therapy 7
• Diet 7

Prevention Strategies

Prevention strategies for osteoporosis include:

• Lifestyle modification 8
• Fall prevention 8
• Adequate intake of calcium and vitamin D 8
• Education and prevention of the disease 7