From the Guidelines
Osteoporosis treatment should prioritize pharmacologic therapy with bisphosphonates, such as alendronate or zoledronic acid, to reduce the risk of hip and vertebral fractures in women with known osteoporosis, as recommended by the American College of Physicians 1. The treatment of osteoporosis focuses on preventing fractures through medication, lifestyle changes, and fall prevention.
First-line Medications
First-line medications include:
- Bisphosphonates such as alendronate (70mg weekly) or zoledronic acid (5mg IV yearly), which work by slowing bone breakdown
- For those who cannot tolerate bisphosphonates, alternatives include denosumab (60mg subcutaneous injection every 6 months), which inhibits bone resorption
Lifestyle Modifications
Lifestyle modifications are essential and include:
- Calcium supplementation (1000-1200mg daily) and vitamin D (800-1000 IU daily)
- Regular weight-bearing exercise (30 minutes, 3-4 times weekly) and resistance training to help maintain bone density
- Smoking cessation, limiting alcohol consumption, and reducing fall risks at home by removing tripping hazards, installing grab bars, and improving lighting
Treatment Duration and Monitoring
Treatment duration varies, but bisphosphonates typically require reassessment after 3-5 years, while denosumab needs continuous administration to prevent rapid bone loss. Bone density testing every 1-2 years helps monitor treatment effectiveness and guide therapy adjustments, as recommended by the American College of Physicians 1.
Special Considerations
For adults beginning or continuing glucocorticoid treatment, initial assessment of fracture risks and pharmacologic treatment with bisphosphonates, denosumab, or parathyroid hormone analogs should be considered, as recommended by the American College of Rheumatology 1. However, the most recent and highest quality study on osteoporosis treatment is from the American College of Physicians 1, which prioritizes bisphosphonates as the first-line treatment. Therefore, bisphosphonates, such as alendronate or zoledronic acid, should be the primary treatment option for osteoporosis, with a treatment duration of 3-5 years, and regular monitoring of bone density to guide therapy adjustments 1.
From the FDA Drug Label
Alendronate does not interfere with osteoclast recruitment or attachment, but it does inhibit osteoclast activity. Alendronate is a bisphosphonate that binds to bone hydroxyapatite and specifically inhibits the activity of osteoclasts, the bone-resorbing cells. Prolia is a prescription medicine used to: Treat osteoporosis (thinning and weakening of bone) in women after menopause ("change of life") who: are at high risk for fracture (broken bone) cannot use another osteoporosis medicine or other osteoporosis medicines did not work well Teriparatide injection is indicated: For the treatment of postmenopausal women with osteoporosis at high risk for fracture (defined herein as having a history of osteoporotic fracture or multiple risk factors for fracture) or who have failed or are intolerant to other available osteoporosis therapy
The treatment for osteoporosis includes:
- Alendronate (2) which inhibits osteoclast activity and is used to treat osteoporosis in postmenopausal women and men.
- Denosumab (Prolia) (3) which is used to treat osteoporosis in women after menopause who are at high risk for fracture.
- Teriparatide (4) which is used to treat postmenopausal women with osteoporosis at high risk for fracture.
Key points to consider when treating osteoporosis:
- The choice of treatment depends on the individual patient's risk factors and medical history.
- Treatment should be tailored to the specific needs of the patient.
- Patients should be monitored regularly for response to treatment and potential side effects.
From the Research
Treatment Options for Osteoporosis
- Bisphosphonates are a common treatment for osteoporosis, reducing the risk of fracture by suppressing bone resorption and increasing bone strength 5
- Other treatment options include raloxifene, teriparatide, and denosumab, which can be used for certain subsets of patients or for those who are unable to take or whose condition does not respond to bisphosphonates 6
- Treatment with effective antifracture medication can prevent fractures and improve outcomes in patients with osteoporosis 7
Non-Pharmacological Interventions
- Fall prevention, smoking cessation, and moderation of alcohol intake are important non-pharmacological interventions for preventing fractures in patients with osteoporosis 6
- Adequate intake of calcium and vitamin D, weight-bearing and resistance-training exercise, and fall prevention are also included in the fracture prevention armamentarium 7
Switching Therapies
- 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 8
- Switching to denosumab or bisphosphonates after completion of teriparatide treatment can help maintain or increase bone mineral density in postmenopausal women with severe osteoporosis 9