From the Guidelines
The first-line treatment for a 71-year-old female with osteoporosis is typically an oral bisphosphonate, such as alendronate (Fosamax) 70 mg once weekly, as recommended by the American College of Physicians 1. This recommendation is based on high-certainty evidence that bisphosphonates reduce the risk of fractures in postmenopausal women with osteoporosis. The patient should take the medication on an empty stomach with a full glass of water and remain upright for 30-60 minutes afterward to prevent esophageal irritation. Some key points to consider when prescribing bisphosphonates include:
- Calcium supplementation (1000-1200 mg daily) and vitamin D (800-1000 IU daily) should be added to the regimen, but taken separately from the bisphosphonate 1.
- Weight-bearing exercise and fall prevention strategies are also essential components of treatment.
- If bisphosphonates are contraindicated or not tolerated, alternatives include denosumab (Prolia) 60 mg subcutaneously every 6 months 1.
- Treatment duration should be reassessed after 3-5 years to evaluate the need for continuation, drug holiday, or alternative therapy based on fracture risk assessment 1. Bisphosphonates have been shown to have a favorable balance of benefits and harms, and are much cheaper than other pharmacologic treatments, making them a cost-effective option for the treatment of osteoporosis 1.
From the FDA Drug Label
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 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
The first-line treatment for a 71-year-old female with osteoporosis is alendronate sodium 10 mg/day or 70 mg once weekly.
- Key benefits:
- Reduces bone resorption
- Increases bone mass
- Decreases the risk of fractures 2
From the Research
First-Line Treatment for Osteoporosis
The first-line treatment for a 71-year-old female with osteoporosis is typically bisphosphonates, which are a class of medications that help to prevent the loss of bone density and reduce the risk of fractures.
- Bisphosphonates, such as alendronate, are considered the pre-eminent therapy for osteoporosis 3.
- Alendronate is available in a 70 mg formulation to be taken once a week, which has been shown to be therapeutically equivalent to the daily regimen 3, 4.
- The once-weekly dosing regimen of alendronate provides continuous inhibition of bone resorption and is a convenient option for patients 3, 4.
Alternative Treatment Options
While bisphosphonates are the first-line treatment, other options are available for patients who may not respond well to these medications or have certain medical conditions.
- Teriparatide, a recombinant human parathyroid hormone, is an anabolic therapy that can help to improve bone density and reduce the risk of fractures 5, 6.
- However, teriparatide is typically reserved for patients with severe osteoporosis or those who have not responded to other treatments 5.
- Other treatment options, such as raloxifene and denosumab, may also be considered for patients with osteoporosis 7.