From the Guidelines
Medications for osteoporosis treatment are approximately 30-50% effective in preventing fractures.
Key Points
- The effectiveness of medications for osteoporosis treatment varies depending on the specific medication and patient population, with denosumab showing a 39% reduction in fragility fractures 1 and teriparatide showing a 66% decrease in nonvertebral and morphometric vertebral fractures 1.
- Bisphosphonates, such as alendronate and risedronate, are first-choice agents for osteoporosis treatment due to their efficacy, tolerability, and low cost 1.
- Denosumab and zoledronic acid are alternative options for patients with oral intolerance or non-compliance, and teriparatide is an option for patients with very severe osteoporosis 1.
- Adherence to osteoporosis medication is a significant issue, with long-term adherence being poor 1, and monitoring of bone turnover markers can help identify patients who are responding to therapy 1.
- The American College of Rheumatology recommends considering the absolute reduction in 5-year risk of vertebral fractures when deciding on osteoporosis treatment, with a conditional recommendation in favor of treatment for reductions of 3% to < 5% 1.
From the Research
Effectiveness of Medications for Osteoporosis Treatment
The effectiveness of medications for osteoporosis treatment can be measured in terms of their ability to increase bone mineral density (BMD) and reduce the risk of fractures.
- The percentage effectiveness of medications for osteoporosis treatment varies depending on the type of medication and the patient population being studied.
- Antiresorptive drugs, such as bisphosphonates and denosumab, have been shown to increase BMD and reduce the risk of vertebral, nonvertebral, and hip fractures in postmenopausal women with osteoporosis 2.
- Specifically, bisphosphonates have been shown to reduce the risk of vertebral fractures by 40-70%, nonvertebral fractures by 25-40%, and hip fractures by 40-53% 2.
- Anabolic therapy with teriparatide has been demonstrated to be superior to the bisphosphonate risedronate in preventing vertebral and clinical fractures in postmenopausal women with vertebral fracture 2.
- 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 2.
- Generic alendronate has been shown to be effective in increasing BMD at the lumbar spine, femoral neck, and total hip after one year of treatment, with over 85% of patients experiencing increased or stable BMD 3.
- Bisphosphonates and denosumab have been associated with a lower fracture incidence in patients on long-term glucocorticoid therapy in real-world settings 4.
Percentage Effectiveness of Specific Medications
- Alendronate: increases BMD at the lumbar spine, femoral neck, and total hip after one year of treatment, with over 85% of patients experiencing increased or stable BMD 3.
- Zoledronic acid: reduces the risk of vertebral fractures by 40-70%, nonvertebral fractures by 25-40%, and hip fractures by 40-53% 2.
- Denosumab: reduces the risk of vertebral fractures by 40-70%, nonvertebral fractures by 25-40%, and hip fractures by 40-53% 2.
- Teriparatide: superior to the bisphosphonate risedronate in preventing vertebral and clinical fractures in postmenopausal women with vertebral fracture 2.
- 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 2.
Factors Affecting Effectiveness
- Patient population: effectiveness of medications may vary depending on the patient population being studied, such as postmenopausal women or patients on long-term glucocorticoid therapy 2, 4.
- Duration of treatment: effectiveness of medications may vary depending on the duration of treatment, with some medications showing sustained effects after treatment is stopped 5, 6.
- Type of medication: effectiveness of medications may vary depending on the type of medication, with some medications showing superior efficacy in preventing fractures 2.