What is the recommended treatment for osteoporosis?

From the Guidelines

The recommended treatment for osteoporosis is bisphosphonates, including alendronate (Fosamax) 70mg weekly, risedronate (Actonel) 35mg weekly, or zoledronic acid (Reclast) 5mg IV yearly, as the first-line medications to reduce the risk of fractures. These medications work by slowing bone breakdown and allowing bone-building cells to work more effectively 1.

Key Considerations

• For postmenopausal women, selective estrogen receptor modulators like raloxifene (Evista) 60mg daily may be used, while denosumab (Prolia) 60mg subcutaneously every 6 months is another option, particularly for those with kidney problems 1.
• In severe cases or when other treatments fail, teriparatide (Forteo) or abaloparatide (Tymlos) injections may be prescribed for up to 2 years 1.
• All patients should take calcium (1000-1200mg daily) and vitamin D (800-1000 IU daily) supplements, and engage in weight-bearing exercises like walking, dancing, or resistance training for 30 minutes most days to maintain bone density 1.
• Fall prevention strategies, including home safety modifications and balance exercises, are important to reduce fracture risk 1.

Treatment Duration and Monitoring

• Treatment duration varies but typically continues for 3-5 years before reassessment, as some medications can have diminishing benefits or rare side effects with long-term use 1.
• 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.

Lifestyle Modifications

• Physical exercise and a balanced diet should be recommended to all men with osteoporosis 1.
• Serum total testosterone should be assessed, as part of the pre-treatment assessment of men with osteoporosis, and appropriate hormone replacement therapy should be considered in men with low levels of total or free serum testosterone 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 In postmenopausal women with osteoporosis, teriparatide injection reduces the risk of vertebral and nonvertebral fractures. To increase bone mass in men with primary or hypogonadal osteoporosis at high risk for fracture or who have failed or are intolerant to other available osteoporosis therapy For the treatment of men and women with osteoporosis associated with sustained systemic glucocorticoid therapy (daily dosage equivalent to 5 mg or greater of prednisone) at high risk for fracture or who have failed or are intolerant to other available osteoporosis therapy.

The recommended treatments for osteoporosis are:

• Teriparatide injection for postmenopausal women with osteoporosis at high risk for fracture, men with primary or hypogonadal osteoporosis at high risk for fracture, and men and women with osteoporosis associated with sustained systemic glucocorticoid therapy at high risk for fracture 2.
• Alendronate for the treatment and prevention of osteoporosis in postmenopausal women and men, and for the treatment of glucocorticoid-induced osteoporosis 3. Key points to consider when choosing a treatment for osteoporosis include:
• The patient's risk of fracture
• The patient's medical history and current medications
• The potential benefits and risks of each treatment option.

From the Research

Osteoporosis Treatment Overview

• Osteoporosis is a systemic skeletal disorder characterized by bone loss, which leads to impaired bone strength and an increased risk of fractures 4.
• The recommended treatment for osteoporosis includes bisphosphonates, which reduce the risk of fracture by suppressing bone resorption and increasing bone strength 5, 4, 6, 7.

Bisphosphonates for Osteoporosis Treatment

• Bisphosphonates are safe and effective agents for the treatment and prevention of osteoporosis 5.
• Alendronate and risedronate are the best-studied bisphosphonates for osteoporosis in terms of efficacy and safety 5.
• Bisphosphonates increase bone mass and reduce the risk of vertebral fractures in patients with established osteoporosis 5.
• They are also approved by the US FDA for the prevention of bone loss in recently menopausal women, treatment of postmenopausal osteoporosis, and management of glucocorticoid-induced bone loss 5.

Practical Guidance for Bisphosphonate Use

• Bisphosphonates are widely used in the treatment of osteoporosis in postmenopausal women and older men 7.
• Clinical challenges in using bisphosphonates include appropriate patient selection, pretreatment evaluation, potential adverse effects, patient preferences, and adherence 4, 6.
• Strategies for treating patients with bisphosphonates should consider these issues, including monitoring therapy and determining when drug discontinuation should be considered 6.

Combination Therapy and Adherence

• Combining a bisphosphonate with estrogen produces greater gains in bone mass compared to either agent used alone 5.
• A fixed-combination pack of bisphosphonate, calcium, and vitamin D can help patients take their medication correctly and regularly, improving adherence to recommended osteoporosis therapy 8.
• The use of a fixed-combination pack can also enhance correct intake of combination therapy and optimize the effectiveness of treatment 8.