Treatment of Osteoporosis

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There are different approaches to treating osteoporosis depending upon each patient's characteristics (age and comorbidities), bone densitometry results, whether they have a prior history of fractures and which medicines they have taken previously. 

Osteoporosis treatments are based around 4 pillars:

Calcium

Calcium. It is essential to follow a calcium-rich diet or, failing this, take appropriate supplements.

Vitamin D

Vitamin D. An appropriate intake of vitamin D helps the body absorb calcium and ensures correct bone mineralisation.

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A healthy lifestyle. All patients with osteoporosis, osteopenia and/or risk factors for developing osteoporosis should follow a healthy lifestyle. In addition to a calcium-rich diet, individuals should also perform regular physical exercise, quit smoking and drink alcohol in moderation.

Green, blue and white pills

Medicines designed to reduce the risk of suffering fractures. 

Drugs therapy

The drugs used to treat osteoporosis fall into two categories: those used to reduce bone resorption/reabsorption (antiresorptive agents) and those which stimulate bone formation (bone-forming agents). It is important to point out that not all antiresorptive agents are the same. Bisphosphonates (e.g., alendronic acid, risedronic acid, ibandronic acid and zoledronic acid) are the most well-known and commonly used antiresorptive agents.Treatment with denosumab has recently been introduced as an antiresorptive therapy. Other antiresorptive treatments include selective oestrogen receptor modulators (SERMs) and oestrogen therapies. The only bone-forming agent currently available is teriparatide. 

Duration of treatment

Each treatment follows a different regime and its duration should be determined by your doctor. Oral bisphosphonate treatments should generally be reassessed every 5 years and at this point, based on the clinical response, the severity of the osteoporosis and any associated risk factors, your doctor will recommend that you either continue with or take a break from the treatment. 

The total duration of treatment (years) and/or the planned treatment break will depend on several factors, including the type of bisphosphonate being taken or the severity of the osteoporosis. 

On the other hand, bone-forming treatment with teriparatide is recommended for a course of 2 years. 

In the case of treatment with denosumab, it is important not to abandon it without consulting your doctor, because there is a risk that the effect will be lost and that the disease worsens.

The following table lists the different drugs used to treat osteoporosis. 

  Dose Frequency Administration
route
Alendronic acid 70 mg weekly oral
Risedronic acid

35 mg

75 mg

weekly

2 days / month

oral
Ibandronic acid 150 mg monthly oral
Zoledronic acid 5 mg annually intravenous
Denosumab 60 mg six-monthly subcutaneous
SERMs

Raloxifeno
60 mg
Bazedoxifeno
20 mg

daily oral
Teriparatide 20 µg daily subcutaneous

Patients should undergo a clinical check-up 6 or 12 months after starting osteoporosis treatment in order to assess drug tolerance and treatment compliance (i.e., whether you are following treatment guidelines consistently and correctly). The frequency of laboratory tests and bone density scans will depend on each patient's characteristics and the type of drug used.  

Substantiated information by:
Núria GuañabensRheumatologist — Rheumatology DepartmentPilar PerisRheumatologist — Rheumatology DepartmentCelia SauraNurse — Rheumatology Department

Published: 20 February 2018
Updated: 20 February 2018

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