From the Guidelines
The recommended management for osteoporosis includes pharmacological treatment with alendronate, risedronate, zoledronic acid, or denosumab to reduce the risk for hip and vertebral fractures, as well as non-pharmacological approaches such as regular weight-bearing and resistance exercises, smoking cessation, limiting alcohol consumption, and fall prevention strategies. According to the most recent and highest quality study 1, first-line medications for men at a high risk of fracture include oral bisphosphonates (alendronate or risedronate), while denosumab or zoledronate are recommended as second-line treatments. Key components of osteoporosis management include:
- Ensuring adequate calcium and vitamin D intake, with supplements recommended if dietary intake is insufficient 1
- Encouraging regular exercise, including balance training, flexibility or stretching exercises, endurance exercise, and resistance and/or progressive strengthening exercises 1
- Smoking cessation and limiting alcohol consumption, as these are risk factors for osteoporosis 1
- Considering anabolic agents such as teriparatide or abaloparatide for severe cases or treatment failures 1
- Monitoring and adjusting treatment based on individual risk factors and response to therapy. It is essential to note that treatment duration and specific medications may vary depending on individual patient factors, and clinicians should make decisions based on a discussion of patient preferences, fracture risk profile, and benefits, harms, and costs of medications 1.
From the FDA Drug Label
Osteoporosis is characterized by low bone mass that leads to an increased risk of fracture The diagnosis can be confirmed by the finding of low bone mass, evidence of fracture on x-ray, a history of osteoporotic fracture, or height loss or kyphosis, indicative of vertebral (spinal) fracture. The recommended management for osteoporosis includes:
- Medications: such as risedronate sodium tablets 2, alendronate sodium 3, and teriparatide injection 4
- Lifestyle modifications:
- Adequate calcium and vitamin D intake
- Regular exercise
- Avoiding smoking and excessive alcohol consumption
- Monitoring: regular assessment of bone density and fracture risk to adjust treatment as needed It is essential to note that the optimal duration of use for these medications has not been determined, and the need for continued therapy should be re-evaluated periodically 2.
From the Research
Definition and Explanation of Osteoporosis
- Osteoporosis is characterized by low bone mass, increased bone fragility, and increased susceptibility to fracture, which is associated with substantial morbidity, mortality, and economic costs 5.
- It is a common condition among older adults that leads to increased susceptibility to fracture, which is associated with substantial morbidity and mortality 5.
Risk Factors for Osteoporosis
- Risk factors for osteoporosis include older age, female sex, prior fractures, prior falls, low body weight, history of hip fracture in a parent, glucocorticoid use, cigarette smoking, excess alcohol consumption, certain comorbidities, and low level of bone mineral density (BMD) 5.
- Age remains a cardinal, independent determinant of fracture risk; hence, the prevalence of osteoporotic fractures is expected to rise as the proportion of older populations increases worldwide 6.
Recommended Management for Osteoporosis
- For patients at high risk of fracture, antiresorptive agents (bisphosphonates or, if contraindicated, denosumab) are recommended to reduce vertebral fractures and hip fractures 5.
- Anabolic medications (teriparatide, abaloparatide, and romosozumab) should be considered in very high-risk individuals, followed by an antiresorptive agent 5.
- Patients are recommended to follow appropriate intake of calcium (1000 to 1200 mg) and vitamin D (600 to 800 IU) guidelines and to pursue a regimen of muscle resistance exercises and balance exercises 5.
- Nonpharmacologic strategies, such as regular physical activity and a balanced diet, should always be implemented, but many patients also need pharmacologic intervention to achieve adequate fracture protection 6.
- Treatment decision should be made on an individual basis, taking into account the relative benefits and risks in different patients, and bone metabolism test helps to assess the patient's condition, which may ultimately lead to therapeutic options and better clinical outcomes 7.
Lifestyle Changes and Prevention
- Osteoporosis prevention and treatment programs should focus on strategies that minimize bone resorption and maximize bone formation, as well as on strategies that reduce falls 8.
- Optimal treatment and prevention of osteoporosis require modification of risk factors, particularly smoking cessation, adequate physical activity, and attention to diet, in addition to pharmacologic intervention 8.
- Avoiding a sedentary lifestyle, alcohol, and smoking is also recommended 9.