What are the treatment options for osteoporosis?

From the Guidelines

Treatment for osteoporosis should prioritize bisphosphonates, such as alendronate, risedronate, or zoledronic acid, as first-line medications to reduce the risk of hip and vertebral fractures in women with known osteoporosis, as recommended by the American College of Physicians 1. The goal of osteoporosis treatment is to prevent fractures, reduce morbidity, and improve quality of life. Key considerations in osteoporosis treatment include:

• Medication: Bisphosphonates, such as alendronate (Fosamax) 70mg once weekly, risedronate (Actonel) 35mg weekly, or zoledronic acid (Reclast) 5mg IV yearly, are the first-line medications, as they have been shown to reduce the risk of vertebral and nonvertebral fractures 1.
• Lifestyle changes: Weight-bearing exercises, such as walking, jogging, or resistance training, should be performed 3-4 times weekly to strengthen bones, and patients should avoid smoking and limit alcohol consumption 1.
• Preventive strategies: Patients should take measures to prevent falls, such as removing tripping hazards at home and using assistive devices if necessary, and adequate calcium and vitamin D intake should be ensured 1.
• Treatment duration: Medication effectiveness should be reassessed after 3-5 years to determine if continued therapy is needed, and clinicians should consider stopping bisphosphonate treatment after 5 years unless the patient has a strong indication for treatment continuation 1. Some key points to consider when treating osteoporosis include:
• The American College of Physicians recommends that clinicians offer pharmacologic treatment with alendronate, risedronate, zoledronic acid, or denosumab to reduce the risk for hip and vertebral fractures in women who have known osteoporosis 1.
• Clinicians should prescribe generic medications if possible rather than more expensive brand-name medications, and encourage adherence to recommended treatments and healthy lifestyle modifications, including exercise, and counseling for evaluation and prevention of falls 1.
• Adequate calcium and vitamin D intake should be part of fracture prevention in all adults with low bone mass or osteoporosis, and 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.

From the FDA Drug Label

Alendronate does not interfere with osteoclast recruitment or attachment, but it does inhibit osteoclast activity. In osteoporosis treatment studies alendronate sodium 10 mg/day decreased the markers of bone formation, osteocalcin and bone specific alkaline phosphatase by approximately 50%, and total serum alkaline phosphatase by approximately 25 to 30% to reach a plateau after 6 to 12 months Osteoporosis in Postmenopausal Women Osteoporosis is characterized by low bone mass that leads to an increased risk of fracture. 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 Long-term treatment of osteoporosis with alendronate sodium 10 mg/day (for up to five years) reduced urinary excretion of markers of bone resorption, deoxypyridinoline and cross-linked N-telopeptides of type I collagen, by approximately 50% and 70%, respectively, to reach levels similar to those seen in healthy premenopausal women Teriparatide injection is indicated: For the treatment of postmenopausal women with osteoporosis at high risk for fracture 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

Treatment for Osteoporosis includes:

• Alendronate: a bisphosphonate that binds to bone hydroxyapatite and specifically inhibits the activity of osteoclasts, the bone-resorbing cells.
• Teriparatide: indicated for the treatment of postmenopausal women with osteoporosis at high risk for fracture.
• Denosumab (Prolia): a prescription medicine used to treat osteoporosis in women after menopause who are at high risk for fracture. The choice of treatment depends on the individual patient's condition and medical history. It is essential to consult a healthcare professional to determine the best course of treatment for osteoporosis 2, 3, 4.

From the Research

Treatment Options for Osteoporosis

• Nonpharmacologic and lifestyle options, such as regular weight-bearing exercise and a balanced diet with adequate calcium and vitamin D intake, can help prevent fractures in postmenopausal women with osteoporosis 5.
• Avoiding smoking, maintaining a healthy body weight, limiting alcohol intake, and reducing fall risks at home are also important for bone health and decreasing fracture risk 5, 6.
• Pharmacological therapies, such as bisphosphonates (e.g., alendronate, risedronate, zoledronate), denosumab, and teriparatide, have been shown to reduce the risk of hip, vertebral, and nonvertebral fractures in postmenopausal women with osteoporosis 7, 8, 9.

Lifestyle Modifications

• Ensuring adequate calcium intake and vitamin D status is crucial for bone health and the prevention of osteoporosis and related fractures 5, 6.
• Regular weight-bearing physical activity throughout life is also important for maintaining bone health 5, 6.
• A balanced diet that includes adequate protein, dairy food, fruits, and vegetables can help support bone health 6.

Pharmacological Therapies

• Denosumab has been shown to be more effective than risedronate in increasing bone mineral density (BMD) and reducing bone turnover in postmenopausal women with osteoporosis 8.
• Alendronate, risedronate, and zoledronate have been shown to reduce the risk of vertebral and nonvertebral fractures in postmenopausal women with osteoporosis 7, 9.
• Teriparatide has been shown to reduce the risk of vertebral and nonvertebral fractures in postmenopausal women with osteoporosis, and may be a cost-effective option for preventing fractures in older women 7, 9.