From the Guidelines
Bisphosphonates, specifically alendronate, risedronate, or zoledronic acid, are the recommended first-line medications for osteoporosis, as they have been shown to reduce the risk of fractures by 40-70%. The most recent and highest quality study, published in 2023 1, supports the use of bisphosphonates as the initial pharmacologic treatment for primary osteoporosis, due to their favorable balance of benefits, harms, patient values, and cost.
Key Considerations
- Bisphosphonates work by inhibiting bone resorption, effectively slowing bone loss and reducing fracture risk.
- Denosumab, a RANK ligand inhibitor, is recommended as a second-line treatment for postmenopausal women with primary osteoporosis who have contraindications to bisphosphonates 1.
- Anabolic agents, such as teriparatide, may be considered for severe cases or when other treatments fail, as they stimulate new bone formation.
- Treatment duration typically involves 3-5 years of bisphosphonates, followed by reassessment.
Additional Recommendations
- Calcium (1000-1200mg daily) and vitamin D (800-1000 IU daily) supplementation should accompany osteoporosis medications, along with weight-bearing exercise and fall prevention strategies for comprehensive management.
- For men with osteoporosis, oral bisphosphonates (alendronate or risedronate) are recommended as first-line treatments, with denosumab or zoledronate as second-line options 1.
- Physical exercise and a balanced diet should be recommended to all patients with osteoporosis, and serum total testosterone should be assessed as part of the pre-treatment evaluation 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
Teriparatide injection is indicated: For the treatment of postmenopausal women with osteoporosis at high risk for fracture In postmenopausal women with osteoporosis, teriparatide injection reduces the risk of vertebral and nonvertebral fractures.
2 DOSAGE AND ADMINISTRATION
The recommended regimen is: one 35 mg delayed-release tablet orally, taken once-a-week
The recommended medications for osteoporosis are Risedronate (PO) and Teriparatide (SQ).
- Risedronate (PO) is recommended for the treatment of postmenopausal osteoporosis, with a dosage of one 35 mg delayed-release tablet orally, taken once-a-week 2.
- Teriparatide (SQ) is indicated for the treatment of postmenopausal women with osteoporosis at high risk for fracture, and also for men with primary or hypogonadal osteoporosis at high risk for fracture or who have failed or are intolerant to other available osteoporosis therapy 3.
From the Research
Recommended Medication for Osteoporosis
The following medications are recommended for the treatment of osteoporosis:
- Alendronate: a nitrogen-containing bisphosphonate that binds to bone surfaces and inhibits bone resorption by osteoclasts 4, 5, 6
- Risedronate: a bisphosphonate that increases bone mass and reduces the risk of vertebral fractures 5
- Zoledronic acid: a bisphosphonate that prevents vertebral, nonvertebral, and hip fractures 7
- Denosumab: an antiresorptive drug that prevents vertebral, nonvertebral, and hip fractures 7
- Teriparatide: an osteoanabolic drug that improves quality of life in severe osteoporosis 7
Dosage and Administration
The recommended dosage and administration of alendronate are:
- Oral alendronate 5 or 10 mg/day 4
- Alendronate 70 mg administered once weekly and 35 mg twice weekly are as effective at increasing bone mineral density as 10 mg/day 4
- Alendronate should be taken with at least 6 oz of water 30 minutes before ingestion of the first food or beverage of the day 6
Efficacy and Safety
The efficacy and safety of bisphosphonates, including alendronate, have been established in several studies:
- Bisphosphonates reduce the risk of fracture by suppressing bone resorption and increasing bone strength 8
- Alendronate is effective and generally well tolerated in the treatment of women or men with primary or corticosteroid-induced osteoporosis 4
- The use of bisphosphonates is associated with a low incidence of adverse events, including upper GI tract adverse events 4, 5