Table 5.
Benefits and Adverse Effects of Osteoporosis Treatment Options
| Agent | Benefita | Adverse effects |
|---|---|---|
| Bisphosphonate3,46,47,b,c,d | Decreases vertebral fracture (41%–70%) | Gastrointestinal tract (nausea, vomiting, abdominal pain, dyspepsia, esophagitis, reflux)e |
| Decreases spine and hip fracture 50% over 3 years (alendronate) | ||
| Decreases nonvertebral fracture 36% over 3 years (risedronate) | ||
| Decreases nonvertebral fracture 25% over 3 years (zoledronic acid) | ||
| Selective estrogen-receptor modulators (raloxifene, tamoxifen)3,40 | Increases BMD, decreases bone turnover, decreases vertebral and nonvertebral fracture (30%–50%) | Increases risk of VTE (deep vein thrombosis, pulmonary embolism, cardiovascular accident), vasomotor symptoms, urogenital symptoms |
| No hip fracture prevention | Increases risk of CV events (raloxifene) | |
| Hormone therapy3,27,40,48 | Decreases BMD loss | Increases risk of VTE |
| Decreases hip, vertebral, and nonvertebral fracture (23%–40%) | Increases risk of CV disease in older postmenopausal women (probably >10 years after menopause) | |
| Parathyroid hormone3,27,f | Decreases vertebral fracture (65%–69%) | Injection site reactions |
| Decreases nonvertebral fracture (35%–40%) | Nausea, dizziness | |
| No hip fracture prevention | Leg cramps | |
| Calcitonin3,49 | Stabilizes BMD loss | Rhinitis, epistaxis (intranasally administered) |
| Increases BMD (modest) in cervical spine | ||
| Decreases vertebral fracture (200 IU/day, intranasal)g | ||
| Decreases fracture-associated pain | ||
| Denosumab50 | Reduces risk of vertebral and nonvertebral fractures and risk of hip fracture | Gastrointestinal tract symptoms (diarrhea, nausea, vomiting), dermatitis, rash, arthralgia, limb and back pain, peripheral edema, nasopharyngitis, headache, hypocalcemia, hypercholesterolemia |
| Increases BMD at the lumbar spine and total hip |
a
Percentages denote relative risk.
b
First-line therapy.
c
Alendronate, risedronate, and zoledronic acid are FDA approved for prevention and treatment of postmenopausal osteoporosis.
d
Alendronate and risedronate are FDA approved for male osteoporosis and glucocorticoid-related osteoporosis.
e
Overall mild but is the reason for discontinuation of therapy for 11%–25% of patients.
f
FDA approved for postmenopausal osteoporosis, men at high fracture risk, men and women at risk due to glucocorticoids.
g
No advantage to higher or lower doses.
CV, cardiovascular; FDA, Food and Drug Administration; VTE, venous thromboembolism.