Ballicules.com

Osteoporosis

Use at a glance

• Treat high fracture risk + correct Ca/Vit D

Treatment options

• Bisphosphonate first-line for many patients

Choosing treatment

• Denosumab if bisphosphonate unsuitable

Monitoring / follow-up

• Very high risk → anabolic therapy up front
• teriparatide/abaloparatide/romosozumab
• Follow anabolic with antiresorptive
• Do not abruptly stop denosumab without coverage

Key points

• Adequate calcium + vitamin D (diet or supplements) alongside pharmacotherapy
• Bisphosphonates 1st-line; alendronate/risedronate/zoledronic acid ↓ vertebral, hip, nonvertebral fractures; ibandronate vertebral only
• Denosumab ↓ vertebral, hip, nonvertebral fractures; bisphosphonate alternative at high fracture risk
• PTH analogs teriparatide, abaloparatide ↓ vertebral/nonvertebral fractures; initial option at high risk
• Raloxifene: ↓ vertebral fractures only, ↓ invasive breast cancer; alternative if breast-cancer risk high
• Bazedoxifene/conjugated estrogens: prevents osteoporosis, ↓ vasomotor symptoms; not solely for osteoporosis
• Romosozumab (anti-sclerostin): > alendronate for fractures, > teriparatide for hip BMD; initial high-risk option

Nonpharmacologic therapies

• Dietary calcium
• Dietary vitamin D
• FRAX risk assessment
• BMD monitoring

Pearls

• Treat T-score ≤−2.5, or osteopenia plus fragility fracture or high FRAX
• Estrogen not first-line; consider within 10 years of menopause
• High-dose calcium may raise kidney stone risk
• High-dose vitamin D risks hypercalcemia and hypercalciuria
• Bisphosphonates: esophagitis (oral), flu-like acute-phase reaction (mainly IV)

Self-check

• What should follow anabolic osteoporosis therapy?
  An antiresorptive.
• What comes first in very-high-risk osteoporosis?
  Anabolic therapy.

Drugs used for this (14)

All clinical uses · Open Osteoporosis in the interactive console ↗