From the Guidelines
Fracture risk reduction efficacy varies among medications. The most effective medications for reducing fracture risk are bisphosphonates, such as alendronate and zoledronic acid, which have been shown to reduce the risk of vertebral, non-vertebral, and hip fractures 1.
Comparative Efficacies
- Alendronate and zoledronic acid have been demonstrated to reduce the risk of vertebral, non-vertebral, and hip fractures 1.
- Teriparatide has been shown to reduce the risk of any clinical fractures and radiographic vertebral fractures, but its effect on hip fractures is uncertain 1.
- Romosozumab probably reduces clinical vertebral fractures, radiographic vertebral fractures, and any clinical fractures, but its effect on hip fractures is not reported and it may increase the risk of cardiovascular events 1.
- Raloxifene has been shown to reduce the risk of vertebral fractures, but its effect on non-vertebral and hip fractures is less clear 1.
Key Considerations
- The choice of medication should be based on patient preferences, fracture risk profile, and benefits, harms, and costs of medications 1.
- Regular monitoring for tolerance and adherence is recommended, especially since long-term adherence to drug treatment is poor 1.
- A systematic follow-up, including risk communication and shared decision making, may have a positive influence on adherence 1.
From the FDA Drug Label
The provided drug labels do not contain direct comparative efficacy data for Fosamax (Alendronate), Reclast (Zoledronic acid), Forteo (Teriparatide), Evenity (Romosozumab), and Evista (Raloxifene) in fracture risk reduction.
The FDA drug label does not answer the question.
From the Research
Comparative Efficacies of Osteoporosis Treatments
The comparative efficacies of Fosamax (Alendronate), Reclast (Zoledronic acid), Forteo (Teriparatide), Evenity (Romosozumab), and Evista (Raloxifene) in fracture risk reduction can be summarized as follows:
- Fracture Risk Reduction:
- Teriparatide and romosozumab are more effective than alendronate and risedronate in reducing vertebral fracture risk 2, 3.
- Zoledronic acid is the most effective in preventing vertebral fracture, nonvertebral fracture, and any fracture 4.
- Denosumab reduces the risk of major osteoporotic fractures by 39%, hip fractures by 36%, nonvertebral fractures by 43%, and hospitalized vertebral fractures by 30% compared to alendronate 5.
- Treatment Comparisons:
- Abaloparatide and teriparatide have a statistically lower risk of new vertebral or nonvertebral fractures than placebo, strontium ranelate, risedronate, raloxifene, and alendronate 2.
- Zoledronic acid and romosozumab are significantly more efficacious than placebo, risedronate, and alendronate in preventing clinical fractures 2.
- Denosumab is statistically superior to placebo in preventing new vertebral and nonvertebral fractures, and to placebo, risedronate, and alendronate in preventing clinical fractures 2, 5.
- Bone Mineral Density and Fracture Risk:
- Bone-forming treatments (teriparatide and abaloparatide) increase bone mineral density more than antiresorptives and reduce fracture risk by 85% and 40-50% for vertebral and non-vertebral fractures, respectively, compared to placebo 6.
- Romosozumab leads to more pronounced increases in bone mineral density than other treatment modalities and reduces the risk of vertebral and clinical fractures by 73% and 36% compared to placebo after 12 months 6.