Table 1.

Summary of pharmacological agents used in osteoporosis.^{2,3,5,10,12,18,19,21}

Drugs	Route of administration	Dose	% of fracture reduction in comparison to placebo			Limitations	Annual cost (Rs)
			Vertebral	Non-vertebral	Hip
Alendronate	Oral	5 mg daily for 2 years; 10 mg daily or 70 mg once weekly for 5–10 years	50	20	50	Esophagitis, osteonecrosis of jaw, atypical femoral fractures, myalgia	1300
Risedronate	Oral	5 mg daily or 35 mg once weekly or 150 mg once monthly	50	40	40	Esophagitis, flu-like symptoms, hypocalcaemia	2600
Zoledronic acid	I.V.	5 mg as single 15–30 min infusion once yearly	70	25	40	Renal toxicity, flu-like symptoms, severe dizziness, anemia	19,516
Raloxifene	Oral	60 mg daily	30	NR	NR	Worsen vasomotor symptoms, venous thrombosis, peripheral edema, vaginal bleeding, breast pain, fatal strokes	3650
Strontium ranelate	Oral	2 g daily	41	36	36	Risk of myocardial infarct, venous thromboembolism, DRESS syndrome	19,345
Estrogen replacement therapy	Oral or transdermal	Oral 0.3 mg/day esterified estrogen or 5 μg/day ethinyl estradiol; transdermal 50 μg/day estradiol	34	NR	34	Risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, deep vein thrombosis	2400
Teriparatide	S.C.	20 mcg daily for 2 years	65	53	53	Dizziness, muscle cramps, infrequent hypercalcemia, increase risk of osteosarcoma, daily subcutaneous injections	144,000
Denosumab	S.C.	60 mg every 6 months for 3 years	68	20	40	Arthralgia, hypocalcaemia, eczema, cataract	120,000

*NR: Not reported.