From the Guidelines
Medications used to treat osteoporotic fractures include bisphosphonates, denosumab, teriparatide, abaloparatide, and romosozumab, with bisphosphonates like alendronate and risedronate being first-line treatments. Bisphosphonates prevent bone resorption, while denosumab inhibits osteoclast formation, and anabolic agents like teriparatide and abaloparatide stimulate bone formation 1. The treatment typically continues for 3-5 years for bisphosphonates, with possible drug holidays afterward based on fracture risk 1.
Key Medications
- Bisphosphonates: alendronate (70mg weekly), risedronate (35mg weekly), ibandronate (150mg monthly), and zoledronic acid (5mg IV yearly)
- Denosumab: 60mg subcutaneous injection every 6 months
- Anabolic agents: teriparatide and abaloparatide (both 20mcg subcutaneous daily for up to 2 years) and romosozumab (210mg subcutaneous monthly for 12 months)
Essential Adjuncts
- Calcium (1000-1200mg daily) and vitamin D (800-1000 IU daily) supplements
Pain Management
- Acetaminophen, NSAIDs, or short-term opioids for acute fractures The American College of Physicians recommends prescribing generic medications if possible, encouraging adherence to recommended treatments and healthy lifestyle modifications, and assessing baseline risk for fracture based on individualized assessment of bone density, history of fractures, and multiple risk factors for fractures 1.
From the FDA Drug Label
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 Increase bone mass in men with osteoporosis who are at high risk for fracture Treat osteoporosis in men and women who will be taking corticosteroid medicines (such as prednisone) for at least 6 months and are at high risk for fracture. Treat bone loss in men who are at high risk for fracture receiving certain treatments for prostate cancer that has not spread to other parts of the body Treat bone loss in women who are at high risk for fracture receiving certain treatments for breast cancer that has not spread to other parts of the body.
The medications used to treat osteoporotic fractures include denosumab (Prolia), which is a prescription medicine used to treat osteoporosis in women after menopause and in men with osteoporosis who are at high risk for fracture.
- Key points about denosumab (Prolia) are:
- It is used to treat osteoporosis and increase bone mass in men with osteoporosis.
- It is used to treat osteoporosis in men and women who will be taking corticosteroid medicines for at least 6 months and are at high risk for fracture.
- It is used to treat bone loss in men who are at high risk for fracture receiving certain treatments for prostate cancer.
- It is used to treat bone loss in women who are at high risk for fracture receiving certain treatments for breast cancer. 2 2
From the Research
Medications for Osteoporotic Fractures
- Bisphosphonates are widely used in the treatment of osteoporosis and have been shown to reduce fractures in women with osteoporosis 3, 4, 5, 6
- Examples of bisphosphonates include:
- Zoledronic acid
- Alendronate
- Risedronate
- Ibandronate
- Clodronate
- Etidronate
- Pamidronate
- These medications work by suppressing bone resorption and increasing bone strength, thereby reducing the risk of fracture 6
- Other medications that have been shown to prevent fractures include:
- Denosumab
- Teriparatide
- Strontium ranelate
- Raloxifene 5
Comparison of Bisphosphonates
- Zoledronic acid has been shown to be effective in preventing vertebral fracture, nonvertebral fracture, and any fracture 4
- Alendronate and zoledronic acid have been shown to be effective in preventing hip fracture 4
- A network meta-analysis found that zoledronic acid ranked first in preventing vertebral fracture, hip fracture, and any fracture, while pamidronate ranked first in preventing nonvertebral fracture and wrist fracture 4
Administration and Safety
- Bisphosphonates can be administered orally or intravenously, with intravenous zoledronic acid providing a convenient alternative to weekly oral bisphosphonates 7
- The safety and efficacy of bisphosphonates have been established, but there is a risk of atypical femoral fractures with long-term use, and reappraisal of ongoing use is recommended after about 5 years 5