What are the treatment options for osteoporosis?

From the Guidelines

Treatment for osteoporosis should prioritize bisphosphonates, such as alendronate or risedronate, as first-line medications, along with calcium and vitamin D supplementation, to reduce the risk of fractures and improve bone density, as recommended by the most recent guidelines 1. The goal of osteoporosis treatment is to prevent fractures, reduce morbidity, and improve quality of life.

Key Considerations

• Bisphosphonates, including alendronate (Fosamax) 70mg once weekly, risedronate (Actonel) 35mg weekly, or zoledronic acid (Reclast) 5mg IV yearly, are the primary medications for treating osteoporosis, as they slow bone breakdown and allow bone-building cells to work more effectively 1.
• Denosumab (Prolia) 60mg subcutaneous injection every 6 months is an alternative option for patients who cannot tolerate bisphosphonates 1.
• Calcium supplementation (1000-1200mg daily) and vitamin D (800-1000 IU daily) are essential components of treatment, as they help maintain bone health and prevent fractures 1.
• Weight-bearing exercises, such as walking, jogging, or resistance training, for 30 minutes most days, can help strengthen bones and improve overall health 1.
• Fall prevention strategies, including home safety modifications and balance training, are crucial to prevent fractures and reduce morbidity 1.

Treatment Duration and Monitoring

• Bisphosphonates are typically reassessed after 3-5 years to evaluate the need for continuation or a drug holiday based on fracture risk, as prolonged use may increase the risk of long-term harms 1.
• Current evidence suggests that increasing the duration of bisphosphonate therapy to longer than 3 to 5 years reduces the risk for new vertebral fractures but not other fractures, while increasing the risk for long-term harms 1.

Special Considerations

• For men with osteoporosis, oral bisphosphonates (alendronate or risedronate) are recommended as first-line treatments, with denosumab or zoledronate as second-line options 1.
• Vitamin D and calcium repletion should be ensured in all men above the age of 65 years, and physical exercise and a balanced diet should be recommended to all men with osteoporosis 1.

From the FDA Drug Label

Prolia is a prescription medicine used to: Treat osteoporosis (thinning and weakening of bone) in women after menopause ("change of life") who: are at high risk for fracture (broken bone) cannot use another osteoporosis medicine or other osteoporosis medicines did not work well Increase bone mass in men with osteoporosis who are at high risk for fracture Treat osteoporosis in men and women who will be taking corticosteroid medicines (such as prednisone) for at least 6 months and are at high risk for fracture Treat bone loss in men who are at high risk for fracture receiving certain treatments for prostate cancer that has not spread to other parts of the body Treat bone loss in women who are at high risk for fracture receiving certain treatments for breast cancer that has not spread to other parts of the body

Treatment for Osteoporosis:

• Denosumab (Prolia) is used to treat osteoporosis in women after menopause who are at high risk for fracture, cannot use another osteoporosis medicine, or other osteoporosis medicines did not work well 2.
• Alendronate is used to treat osteoporosis in postmenopausal women and men, and to prevent osteoporosis in postmenopausal women 3.
• Teriparatide injection is indicated for the treatment of postmenopausal women with osteoporosis at high risk for fracture, and to increase bone mass in men with primary or hypogonadal osteoporosis at high risk for fracture 4.
• The key points for treatment are:
  • High risk for fracture
  • Failed or intolerant to other available osteoporosis therapy
  • Associated with sustained systemic glucocorticoid therapy
  • Receiving certain treatments for prostate or breast cancer
• It is essential to consult a doctor to determine the best course of treatment for osteoporosis, as the choice of medication depends on individual factors, such as medical history and risk of fracture.

From the Research

Treatment Options for Osteoporosis

• The treatment of osteoporosis is influenced by the patient's fracture risk, the effectiveness of fracture risk reduction, and medication safety 5.
• Patients at high risk of fracture should consider treatment with antiresorptive therapy, including bisphosphonates and denosumab 5.
• Anabolic agents such as teriparatide, abaloparatide, and romosozumab should be considered for patients at very high risk or with previous vertebral fractures 5.
• A variety of nonhormonal pharmacological options are available for prevention and treatment of osteoporosis, including bisphosphonates, calcitonin, raloxifene, teriparatide, and denosumab 6.

Lifestyle Changes for Osteoporosis Management

• Healthy lifestyle changes can reduce the risk of osteoporosis and/or fragility fractures, including adequate dietary intakes of calcium, vitamin D, and protein, regular weight-bearing exercise, reduction in alcohol intake, and smoking cessation 7.
• Ensuring adequate calcium intake and vitamin D status and having regular weight-bearing physical activity throughout life are important for bone health and the prevention of osteoporosis and related fractures 8.
• A bone-healthy lifestyle, including weight-bearing and resistance exercise, limiting alcohol and caffeine intake, smoking cessation, and fall prevention strategies, is used to manage postmenopausal osteoporosis 9.

Nutrition and Supplementation

• European guidance recommends a daily intake of at least 1000 mg/day for calcium, 800 IU/day for vitamin D, and 1 g/kg body weight of protein for all women aged over 50 years 7.
• Supplements containing calcium and vitamin D are needed by many postmenopausal women because of an inadequate intake and other factors 9.
• Adequate protein intake and higher intake of fruits and vegetables are beneficial to bone health 8.