Table 3.

Therapies for osteoporosis

Name of drug	Points to consider	Dosing regimen
Alendronate oral (Fosamax) & Risedronate oral (Actonel)	Post-menopausal women: Prevents vertebral, non-vertebral, and hip fractures. Glucocorticoid induced osteoporosis (GIO) : Some evidence of decreased vertebral fracture risk	Alendronate 5 & 10 mg daily 35 & 70 mg weekly Risedronate 5 mg daily 35 mg weekly 150 mg monthly
Ibandronate oral & IV (Boniva)	Prevents spinal fractures No proven benefit in hip and non-vertebral fractures	Ibandronate 2.5 mg po daily 150 mg po monthly,3 mg IV/3 months
Zolendronic acid IV (Reclast)	Post-menopausal women: prevents vertebral, non-vertebral, and hip fractures GIO: maintains BMD Cost effectiveness may limit use Consider for high-risk patients who are unable to tolerate oral therapy or have poor adherence Caution: When used in high doses, increases the risk of osteonecrosis of jaw.	Zolendronic acid 5 mg IV yearly Approved for the prevention of osteoporosis in postmenopausal women given as a single intravenous dose every 2 years
Raloxifene oral (Evista)	Post-menopausal women: reduces the incidence of vertebral fractures May be considered in post-menopausal women who are unable to tolerate/take bisphosphonates and have no history of thromboembolic disease Caution: May increase the risk of venous thromboembolic disease and stroke
Denosumab SC (Prolia)	Postmenopausal women: prevents vertebral, non-vertebral, and hip fractures Cost and lack of long term safety data may limit use	Denosumab 60 mg SC q6 monthly
Teriparatide SC (Forteo)	Post-menopausal women: prevents vertebral and non-vertebral fractures in postmenopausal women with severe OP Some evidence of benefit in the treatment of GIO Cost and need for daily subcutaneous injection may limit use Consider for patients at increased risk of fracture or lack of response to other therapies Maximum lifetime exposure is 24 months Bisphosphonates must be discontinued prior to treatment Gains in BMD decline once treatment with teriparatide is discontinued; consider anti-resorptive therapy after completing treatment course
Calcitonin	Post-menopausal women: Reduces incidence of vertebral fractures however evidence for benefit is limited Consider as an alternative when other more effective drugs cannot be used Effective in decreasing acute pain associated with vertebral osteoporotic fractures Calcitonin injection is currently not approved for the treatment of OP; it is sometimes prescribed for patients who have pain due to acute vertebral fractures The intranasal spray formulation is used for OP. Caution: Concerns about increase in cancer risk with use of intranasal spray.
HRT	Post-menopausal women: Shown to prevent vertebral, hip and non-vertebral fractures Is not recommended for the sole indication of OP prevention and for long term use for this indication; consider benefits versus risks May be appropriate for OP prevention when it is already being used for the management of menopausal symptoms	High dose: 2 mg Estradiol 100 mcg transdermal estradiol Medium dose:0.625 mg conjugated estrogens 1 mg oral estradiol 50 mcg transdermal estradiol Low dose: 0.3 mg conjugated estrogens 0.5 mg oral estradiol 25 mcg transdermal estradiol