What are the percentages of bone mineral density increase for different classes of osteoporosis medications, including Bisphosphonates, Selective Estrogen Receptor Modulators (SERMs), and Parathyroid Hormone (PTH) analogs?

From the Guidelines

Osteoporosis medications increase bone mineral density (BMD) at different rates depending on their class, with the most recent and highest quality study 1 indicating that bisphosphonates increase BMD by 2.13-3.00% in the hip and denosumab by 2.07-5.80% in the lumbar spine over 1-2 years.

Classes of Osteoporosis Medications and Their Effects on BMD

The following are the different classes of osteoporosis medications and their effects on BMD:

• Bisphosphonates: increase BMD by 2.13-3.00% in the hip and 2.58% in the lumbar spine over 1 year 1
• Denosumab: increases BMD by 2.07-5.80% in the lumbar spine, 2.07% in the femoral neck, and 2.28% in the total hip over 2 years 1
• Anabolic agents: show the most dramatic improvements, with teriparatide increasing spine BMD by 9-13% and hip BMD by 3-4% over 2 years, and romosozumab producing rapid gains of 13-15% in the spine and 6-7% in the hip over just 12 months 1
• Selective estrogen receptor modulators (SERMs): show more modest increases of 2-3% in spine BMD with minimal hip effects
• Hormone replacement therapy: typically increases BMD by 4-7% in the spine and 2-3% in the hip

Key Findings

The most recent study 1 provides evidence for the efficacy of bisphosphonates and denosumab in increasing BMD in men with osteoporosis. Another study 1 reports that romosozumab followed by alendronate is more effective than alendronate alone in reducing hip fracture risk.

Treatment Considerations

When considering treatment options, it is essential to take into account the potential benefits and risks of each medication, as well as the individual patient's needs and preferences. Adherence to treatment is also crucial, and monitoring bone turnover markers can help identify patients who are not responding to therapy 1.

From the FDA Drug Label

At three years significant increases in BMD, relative both to baseline and placebo, were seen at each measurement site in each study in patients who received alendronate sodium 10 mg/day. The mean increases from baseline in lumbar spine BMD at one year were 5.1% (4.8,5. 4%; 95% CI) in the 70-mg once-weekly group and 5.4% (5.0,5. 8%; 95% CI) in the 10-mg daily group. At two years, the increases in lumbar spine BMD from baseline were significantly greater with the combination (8.3%) than with either estrogen or alendronate sodium alone (both 6. 0%). The addition of alendronate sodium 10 mg once daily to HRT produced, at one year, significantly greater increases in lumbar spine BMD (3.7%) vs. HRT alone (1. 1%). In the placebo-treated patients BMD losses of approximately 1% per year were seen at the spine, hip (femoral neck and trochanter) and total body. In contrast, alendronate sodium 5 mg/day prevented bone loss in the majority of patients and induced significant increases in mean bone mass at each of these sites. The mean increases from baseline in lumbar spine BMD at one year were 2.9% (2.6,3.2%; 95% CI) in the 35-mg once-weekly group and 3.2% (2.9,3.5%; 95% CI) in the 5-mg daily group.

The percentages of bone mineral density increase for alendronate are:

• 5.1% to 5.4% increase in lumbar spine BMD at one year for a 10 mg daily dose or a 70 mg once-weekly dose.
• 8.3% increase in lumbar spine BMD at two years for combination therapy with estrogen.
• 3.7% increase in lumbar spine BMD at one year when added to hormone replacement therapy.
• 2.9% to 3.2% increase in lumbar spine BMD at one year for a 5 mg daily dose or a 35 mg once-weekly dose. 2

From the Research

Bone Mineral Density Increase

The percentages of bone mineral density (BMD) increase for different classes of osteoporosis drugs are not explicitly stated in the provided studies. However, the studies do mention the efficacy of various osteoporosis treatments in increasing BMD and reducing fracture risk.

Efficacy of Osteoporosis Treatments

• Antiresorptive drugs, such as bisphosphonates and denosumab, increase BMD and reduce the risk of vertebral, nonvertebral, and hip fractures in postmenopausal women with osteoporosis 3.
• Anabolic therapy with teriparatide has been shown to be superior to bisphosphonates in preventing vertebral and clinical fractures in postmenopausal women with vertebral fracture 3.
• Treatment with the sclerostin antibody romosozumab increases BMD more profoundly and rapidly than alendronate and is also superior to alendronate in reducing the risk of vertebral and nonvertebral fracture in postmenopausal women with osteoporosis 3.
• Bisphosphonates, such as alendronate, risedronate, and zoledronic acid, have been shown to reduce the relative risk of new vertebral, nonvertebral, and hip fractures in women with postmenopausal osteoporosis 4, 5.
• Teriparatide, a recombinant human formulation of PTH 1-34, has demonstrated good efficacy in postmenopausal women, increasing vertebral and hip BMD and reducing the incidence of fractures at both sites 6.
• Strontium ranelate, a new divalent Strontium salt, acts both as an anti-catabolic and anabolic agent, and has been shown to increase BMD and reduce the incidence of fractures in postmenopausal women with osteoporosis 6.

Comparative Efficacy of Bisphosphonates

• A network meta-analysis comparing the efficacy of different bisphosphonates in preventing fractures for primary osteoporosis found that zoledronic acid seemed the most effective in preventing vertebral fracture, nonvertebral fracture, and any fracture, and alendronate or zoledronic acid seemed the most effective in preventing hip fracture 7.