What are the generic names of injectable medications for osteoporosis treatment?

Injectable Medications for Osteoporosis Treatment

The injectable medications available for osteoporosis treatment include zoledronic acid, ibandronate, denosumab, and teriparatide, with selection based on fracture risk profile and patient-specific factors.

First-Line Injectable Options

• Zoledronic acid (Reclast): An intravenous bisphosphonate administered once yearly (for treatment) or once every two years (for prevention) 1
• Ibandronate (Boniva): An intravenous bisphosphonate administered every three months 1, 2
• Denosumab (Prolia): A RANK ligand inhibitor administered subcutaneously every six months 1

Second-Line Injectable Option

• Teriparatide (Forteo): A recombinant parathyroid hormone administered as a daily subcutaneous injection, typically reserved for patients with severe osteoporosis or who have had fractures 1

Clinical Considerations for Injectable Medications

Bisphosphonates (Zoledronic Acid and Ibandronate)

• Zoledronic acid has demonstrated efficacy in reducing vertebral, non-vertebral, and hip fractures 1
• Ibandronate is administered as an IV bolus injection over 15-30 seconds every 3 months 2
• Common side effects of injectable bisphosphonates include:
  • Influenza-like symptoms (particularly with zoledronic acid) 1
  • Arthritis and arthralgias 1
  • Hypocalcemia 2
  • Risk of osteonecrosis of the jaw and atypical femoral fractures with long-term use 1

Denosumab (RANK Ligand Inhibitor)

• Recommended as a second-line treatment for patients who have contraindications to or experience adverse effects from bisphosphonates 1
• Shows greater BMD increases at all skeletal sites compared to zoledronic acid in patients previously treated with oral bisphosphonates 3
• Higher persistence and compliance rates (68.3%) compared to other osteoporosis treatments 4
• Important consideration: Discontinuation should be followed by alternative treatment to prevent rebound fractures 1

Teriparatide (Recombinant Parathyroid Hormone)

• Typically used only in patients with severe osteoporosis or those who have had fractures 1
• Suggested for females with primary osteoporosis at very high risk of fracture 1
• Should be followed by bisphosphonate therapy after completion 1
• Side effects include upper GI symptoms, headaches, hypercalcemia, and hypercalciuria 1

Practical Considerations for Selection

• Patient adherence: Injectable medications may improve adherence compared to oral formulations 4
• Renal function: Zoledronic acid and ibandronate are contraindicated in patients with severe renal impairment (creatinine clearance <35 mL/min for zoledronic acid, <30 mL/min for ibandronate) 1, 2
• Cost considerations: Generic bisphosphonates (including IV zoledronic acid) are substantially less expensive than denosumab or teriparatide 1
• Administration frequency preferences: Some patients may prefer less frequent dosing (yearly zoledronic acid vs. every 6 months denosumab vs. every 3 months ibandronate vs. daily teriparatide) 1

Important Monitoring and Supplementation

• Prior to administration of injectable bisphosphonates, serum creatinine should be obtained 2
• Routine oral examination is recommended before administration due to risk of osteonecrosis of the jaw 2
• All patients should receive adequate calcium (1000-1200 mg/day) and vitamin D (800 IU/day) supplementation with any osteoporosis treatment 1, 2