Table 6.
Pharmacologic therapies
| First-line therapies with evidence for fracture | Vertebral | Hip | Nonvertebral |
|---|---|---|---|
| prevention in postmenopausal womena | fracture | fracture | fractureb |
| Denosumab (60 mg SC twice yearly) | ✓ | ✓ | ✓ |
| Alendronate (10 mg PO daily or 70 mg PO weekly) | ✓ | ✓ | ✓ |
| Risedronate (5 mg PO daily, 35 mg PO weekly (regular tablet or delayed-release tablet), 75 mg PO monthly duet or 150 mg PO monthly) | ✓ | ✓ | ✓ |
| Zoledronic acid (5 mg IV yearly) | ✓ | ✓ | ✓ |
| Teriparatide (20 mcg SC daily) | ✓ | - | ✓ |
| Raloxifene (60 mg PO daily) | ✓ | - | - |
| Estrogen (hormone therapy)c | ✓ | ✓ | ✓ |
a
Check marks indicate a grade A recommendation for women. For men requiring treatment, alendronate, risedronate, and zoledronic acid can be used as first-line therapies for prevention of fractures (grade D).
b
In clinical trials, nonvertebral fractures are a composite endpoint including hip, femur, pelvis, tibia, humerus, radius, and clavicle.
c
Hormone therapy (estrogen) can be used as first-line therapy in women with menopausal symptoms. Adapted from Osteoporosis Canada (http://www.osteoporosis.ca/multimedia/FractureRiskTool/index.html#/Options).