Table 2.
Summary of available drugs for use in fracture prevention in osteoporosis
| Drugs | Dosage | Approved GFR cut-off, mL/min | Predominant mode of action on bone |
|---|---|---|---|
| Bisphosphonates | |||
| Alendronate | 70 mg weekly oral | >35 mL/min | Anti-resorptive |
| Risedronate | 35 mg weekly oral | >30 mL/min | Anti-resorptive |
| Ibandronate | 150 mg monthly oral or 3 mg every 3 months iv | >30 mL/min | Anti-resorptive |
| Zoledronate | 5 mg annually but may require less frequent dosing based on bone turnover markers | >35 mL/min | Anti-resorptive |
| Denosumaba | 60 mg every 6 months subcutaneous | Any GFR | Anti-resorptive |
| Raloxifene | 60 mg daily oral | Not endorsed for use in patients with severely impaired renal function | Anti-resorptive |
| Hormone replacement therapy (HRT) (male and female)/menopausal hormonal therapy (MHT) | Differing doses and preparations; oral, transdermal, continuous or sequential | Any GFR | Anti-resorptive |
| Teriparatide | 20 µg daily subcutaneous daily for up to 2 years | >30 mL/min | Anabolic |
| Romosozumab | 210 mg subcutaneously monthly for 12 months | Not known | Anabolic |
aNo dose adjustment is required in patients with renal impairment. Serum calcium should be monitored in patients with severe renal impairment or receiving dialysis