From the Guidelines
The best treatment for osteoporosis to increase bone density is oral bisphosphonates, such as alendronate or risedronate, as first-line therapy, with denosumab or zoledronate as second-line treatments for individuals at high risk of fracture 1.
Key Treatment Options
- Oral bisphosphonates: alendronate or risedronate are recommended as first-line treatments for individuals at high risk of fracture 1
- Denosumab or zoledronate: are recommended as second-line treatments for individuals at high risk of fracture 1
- Abaloparatide: may be considered as an initial bone-forming therapy for individuals who would benefit from it, although further studies are needed to confirm its efficacy 1
Important Considerations
- Vitamin D and calcium repletion: should be ensured in all individuals above the age of 65 years 1
- Physical exercise and a balanced diet: should be recommended to all individuals with osteoporosis 1
- Adherence monitoring: can be done by measuring bone turnover markers at baseline and at 3 months to identify a decrease above the least significant change 1
Treatment Approach
- A sequential therapy starting with a bone-forming agent followed by an anti-resorptive agent should be considered for individuals at very high risk of fracture 1
- The decision to treat should be based on a discussion of patient preferences, fracture risk profile, and benefits, harms, and costs of medications 1
From the Research
Treatment Options for Osteoporosis
The best treatment for osteoporosis to increase bone density includes:
- Antiresorptive drugs, such as bisphosphonates and the RANKL inhibitor denosumab, which increase bone mineral density (BMD) and reduce the risk of fractures 2
- Anabolic therapy with teriparatide, which has been shown to be superior to bisphosphonates in preventing vertebral and clinical fractures in postmenopausal women with vertebral fracture 2, 3
- Sclerostin antibody romosozumab, which increases BMD more profoundly and rapidly than alendronate and reduces the risk of vertebral and nonvertebral fracture in postmenopausal women with osteoporosis 2, 3
Sequential Treatment Approach
For patients with severe osteoporosis and high fracture risk, a sequential treatment approach is recommended, starting with a bone-building drug (e.g. teriparatide) followed by an antiresorptive agent, to provide better long-term fracture prevention 2, 4, 3
Comparison of Treatment Options
- Bisphosphonates, such as alendronate and risedronate, are safe and effective agents for treatment and prevention of osteoporosis, but may have limitations due to rare side effects 2, 5
- Anabolic agents, such as teriparatide and romosozumab, have been shown to be superior to bisphosphonates for high-risk patients, with greater benefit when initial treatment is with an anabolic agent followed by an antiresorptive drug 4, 3