From the Guidelines
Bisphosphonates, such as alendronate (Fosamax) 70mg once weekly or risedronate (Actonel) 35mg once weekly, are the first-line medications for osteoporosis treatment, as they have been shown to reduce the risk of fractures by 40-70% 1. These medications work by inhibiting bone resorption, effectively slowing bone loss. Treatment typically continues for 3-5 years initially, after which a "drug holiday" may be considered based on fracture risk assessment. Some key points to consider when prescribing bisphosphonates include:
- Common side effects include gastrointestinal irritation, so these pills should be taken with a full glass of water while remaining upright for 30-60 minutes after
- For those who cannot tolerate oral bisphosphonates, alternatives include intravenous zoledronic acid (Reclast) given yearly, denosumab (Prolia) injected subcutaneously every 6 months, or anabolic agents like teriparatide (Forteo) for high-risk patients
- Supplementation with calcium (1000-1200mg daily) and vitamin D (800-1000 IU daily) is essential alongside any osteoporosis medication
- Regular weight-bearing exercise and fall prevention strategies are also important components of comprehensive osteoporosis management
- Treatment decisions should be individualized based on fracture risk, age, and comorbidities, and clinicians should consider the patient's preferences, fracture risk profile, and benefits, harms, and costs of medications when making treatment decisions 2. The most recent and highest quality study, published in 2023, recommends the use of bisphosphonates as the initial pharmacologic treatment for primary osteoporosis, due to their favorable balance of benefits, harms, patient values and preferences, and cost 1.
From the FDA Drug Label
Risedronate sodium delayed-release is a prescription medicine used to treat osteoporosis in women after menopause Teriparatide injection is indicated: For the treatment of postmenopausal women with osteoporosis at high risk for fracture Medications for Osteoporosis:
From the Research
Medications for Osteoporosis
The following medications are used to treat osteoporosis:
- Bisphosphonates (BPs) 5, 6, 7, 8, 9
- Denosumab (Dmab) 5, 8
- Teriparatide 5, 7
- Calcitonin 7
- Estrogens 7
- Raloxifene 7
- Zoledronic acid 5, 6
- Alendronate 6, 7, 8, 9
- Ibandronate 7, 8
- Risedronate 6, 7, 8
Treatment Considerations
When considering treatment for osteoporosis, the following factors should be taken into account:
- The patient's risk of fracture 6, 8, 9
- The patient's bone mineral density (BMD) 6, 8, 9
- The patient's history of previous fractures 6, 8, 9
- The potential risks and benefits of each medication 5, 6, 7, 8, 9
- The possibility of a "drug holiday" for patients who have been treated with bisphosphonates for an extended period 6, 8, 9
Specific Medication Information
- Bisphosphonates are the most commonly used medications for osteoporosis and have been shown to reduce the risk of vertebral and non-vertebral fractures 6, 7, 9
- Denosumab has been shown to increase BMD and reduce the risk of vertebral and non-vertebral fractures 5
- Teriparatide has been shown to increase BMD and reduce the risk of vertebral fractures 5, 7