Treatment Options for Osteoporosis

Several treatment options are available to the physician and they include;

  1. Hormone replacement therapy (HRT)
  2. Vitamin D
  3. Calcium
  4. Teraparatide (Forteo)
  5. Raloxifene
  6. Alendronate
  7. Risedronate
  8. Zoledronic Acid (Aclasta)
  9. Denosumab (Prolia)
  10. Strontium Ranelate (Protos)

HRT

Hormone replacement therapy increases bone mass and has been used to treat and prevent post-menopausal osteoporosis. [See Appendix 3]

Vitamin D

With advancing age and frailty, and subsequent lack of exposure to sunlight, patients become Vitamin D deficient. Vitamin D supplementation, in combination with calcium, has been shown to reduce the rate of hip and non-vertebral fractures in nursing home and house-bound patients.

[See ANZBMS position statement on Vitamin D]

Calcium

Calcium has a small positive effect on bone mass with a 1-2% increase over 2-3 years. It is usually used in conjunction with most other specific anti-osteoporotic medication and is more efficient if taken at night. Calcium is essential for general bone health.

PTH (1-24)

Based on parathyroid hormone. A new treatment given by subcutaneous injection that increases bone formation. Now available on a private prescription in Australia.

[Refer to Appendix 2 for additional treatment options]

Raloxifene

Raloxifene is a selective estrogen receptor modulator (SERM) that mimics the effects of estrogen, however it does not stimulate the breast or endometrium. It has been shown to increase bone mass and therefore decrease the risk of vertebral fractures. It is useful if there is an increased risk of breast or uterine cancer.

Alendronate

A bisphosphonate that inhibits osteoclastic action (anti-resorptive agent). Non hormonal and increases bone density and reduces fractures at both the hip and spine.

Risedronate

A bisphosphonate that inhibits osteoclastic action (anti-resorptive agent). Non-hormonal and increases bone mass and reduces fracture rate at both the hip and spine.

Prolia

Denosumab (brand name Prolia) is a medicine used to treat Osteoporosis. Osteoporosis is a common disease, which causes bones to become fragile and brittle so that they break (fracture) more easily even as a result of normal activity (as distinct from a fall). Fractures are painful and restrict a person’s ability to carry out their normal daily tasks. Denosumab reduces the risk of a broken bone or fracture. 

Denosumab is given as an injection under the skin (subcutaneously) and may be injected into the top of the thigh, the abdomen or the back of the arm. The denosumab dose is 60 milligrams given every 6 months.