What is the typical treatment for osteoporosis?

From the Guidelines

The typical treatment for osteoporosis includes both medication and lifestyle modifications, with bisphosphonates being the first-line medications, including alendronate (Fosamax) 70mg weekly, risedronate (Actonel) 35mg weekly, ibandronate (Boniva) 150mg monthly, or zoledronic acid (Reclast) 5mg IV yearly, as recommended by the most recent guideline from the American College of Physicians 1.

Medication Options

• Bisphosphonates: alendronate, risedronate, ibandronate, zoledronic acid
• Denosumab (Prolia) 60mg subcutaneously every 6 months
• Teriparatide or abaloparatide, daily injections that stimulate bone formation for severe cases (limited to 2 years due to cancer risk)
• Raloxifene, a selective estrogen receptor modulator for postmenopausal women

Lifestyle Modifications

• Calcium (1000-1200mg daily) and vitamin D (800-1000 IU daily) supplements
• Weight-bearing and resistance exercises
• Avoid smoking and excessive alcohol
• Implement fall prevention strategies

Treatment Selection

• Depends on factors like fracture risk, age, gender, and other medical conditions
• 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
• Current evidence suggests that increasing the duration of bisphosphonate therapy to longer than 3 to 5 years reduces risk for new vertebral fractures but not risk for other fractures, but there is increased risk for long-term harms 1

Key Recommendations

• Clinicians should prescribe generic medications if possible rather than more expensive brand-name medications 1
• Clinicians treating adults with osteoporosis should 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 1

From the FDA Drug Label

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 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 Alendronate decreases bone resorption without directly inhibiting bone formation Teriparatide injection is indicated: For the treatment of postmenopausal women with osteoporosis at high risk for fracture

The typical treatment for osteoporosis includes:

• Alendronate to reduce bone resorption and increase bone mass
• Denosumab to treat osteoporosis in women after menopause who are at high risk for fracture
• Teriparatide to reduce the risk of vertebral and nonvertebral fractures in postmenopausal women with osteoporosis These treatments are used to reduce the risk of fracture and increase bone mass in patients with osteoporosis 2, 3, 4.

From the Research

Treatment Options for Osteoporosis

The typical treatment for osteoporosis involves a combination of lifestyle interventions and pharmacological therapies.

• Lifestyle interventions include exercise, diet, and education, which have been shown to have a positive effect on bone health 5.
• Pharmacological therapies, such as anti-resorptive therapies (e.g., bisphosphonates and denosumab) and bone-forming or dual-action treatments, can increase bone mineral density and reduce the risk of fractures 6.

Pharmacological Therapies

Pharmacological therapies for osteoporosis can be categorized into two main types:

• Anti-resorptive therapies, which include bisphosphonates and denosumab, can increase bone mineral density and reduce the risk of fractures by 20-70% 6.
• Bone-forming or dual-action treatments, which stimulate bone formation and increase bone mineral density, can be more effective than anti-resorptive therapies in preventing fractures in patients with severe osteoporosis 6.

Lifestyle Interventions

Lifestyle interventions, such as exercise and diet, play a crucial role in the management of osteoporosis.

• Exercise, including strength exercises and aerobic exercises, can have a positive effect on fracture risk and bone mineral density 5.
• A diet rich in calcium and vitamin D, as well as supplementation with these nutrients, can help improve bone health 5, 7.
• Avoidance of smoking and excessive alcohol intake, as well as weight-bearing and resistance-training exercise, can also help prevent fractures 7.

Treatment Guidelines

The treatment of osteoporosis should be personalized and based on the individual's risk factors and medical history.

• The Bone Health and Osteoporosis Foundation recommends that osteoporosis detection, diagnosis, and treatment should be routine practice in all adult healthcare settings 7.
• Treatment guidelines, such as those provided by the Clinician's Guide to Prevention and Treatment of Osteoporosis, can help healthcare providers make informed decisions about the management of osteoporosis 7.