What is the recommended treatment for osteoporosis?

From the Guidelines

The recommended treatment for osteoporosis typically includes both medication and lifestyle modifications, with bisphosphonates being the first-line medications, including alendronate (Fosamax) 70mg once weekly, risedronate (Actonel) 35mg weekly, or zoledronic acid (Reclast) 5mg IV yearly, as supported by the most recent and highest quality study 1.

Medications

• Bisphosphonates are the first-line medications for osteoporosis treatment, as they slow bone breakdown and increase bone density, with a strong recommendation and high-certainty evidence 1.
• Denosumab (Prolia) 60mg subcutaneously every 6 months is an alternative for postmenopausal women who cannot tolerate bisphosphonates, with a conditional recommendation and moderate-certainty evidence 1.
• Teriparatide or abaloparatide (anabolic agents) may be used for severe cases, typically for 2 years, with a conditional recommendation and low-certainty evidence 1.

Lifestyle Modifications

• Supplementation with calcium (1000-1200mg daily) and vitamin D (800-1000 IU daily) is essential for all patients, as supported by the American College of Physicians guideline 1.
• Weight-bearing exercises like walking, jogging, or resistance training for 30 minutes most days help strengthen bones, with a strong recommendation 1.
• Fall prevention strategies are crucial, including home safety modifications and balance training, with a strong recommendation 1.
• Lifestyle modifications should include smoking cessation, limiting alcohol consumption, and maintaining a healthy weight, with a strong recommendation 1.

Treatment Duration

• Treatment duration varies, but bisphosphonates are typically reassessed after 3-5 years to determine if a drug holiday is appropriate based on fracture risk, with a weak recommendation and low-quality evidence 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 treating 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 the use of 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, with alendronate and risedronate being the most studied agents in terms of efficacy and safety 5.
• Bisphosphonates increase bone mass and reduce the risk of vertebral fractures in patients with established osteoporosis, and are the only agents shown to reduce the risk of hip fractures and other nonvertebral fractures 5.
• Different bisphosphonates, such as zoledronate, risedronate, and alendronate, have varying degrees of effectiveness, with zoledronate potentially resulting in greater increases in bone mineral density (BMD) than risedronate or alendronate 7.

Benefits and Risks of Bisphosphonate Therapy

• Bisphosphonate therapy has been associated with a significant decrease in morbidity and increase in survival, with proven efficacy to reduce fracture risk at the spine, hip, and other nonvertebral skeletal sites 8.
• However, bisphosphonates have also been linked to possible adverse effects, including osteonecrosis of the jaw, atypical femur fractures, atrial fibrillation, and esophageal cancer 8.
• The concept of a "drug holiday" has emerged, where patients who are not at high risk for fracture may be candidates to discontinue bisphosphonate therapy for a period of time to decrease the risk of adverse effects while still benefiting from antifracture efficacy 8.