TREATMENT FOR OSTEOPOROSIS

Bisphosphonates are the most widely used osteoporosis medications. They work by reducing bone resorption and preserving or increasing BMD. They are prescribed to both women and men. Common bisphosphonates include:

• Alendronate
• Risedronate
• Ibandronate
• Zoledronate

Good to know

• Bisphosphonates are available in oral (solid tablet or effervescent tablet in solution) and intravenous formulations.
• Administration may be daily, weekly, monthly, or annually, depending on the medication.
• Bisphosphonates are often prescribed as the primary treatment for postmenopausal women in the absence of contraindications.
• Oral bisphosphonates should be taken after an overnight fast, with water only, 30 to 60 minutes prior to any food or other drinks to ensure better absorption and reduce the gastrointestinal side effects commonly known with these medications. Patients are also advised to remain upright (sitting or preferably standing/walking) for at least 30 minutes after taking the medication to prevent oesophageal irritation and to help the tablet move into the stomach quickly. Effervescent, buffered soluble forms of bisphosphonates may be better tolerated by patients experiencing or at risk of gastro-oesophageal irritation. For those with difficulty in fasting, a gastro-resistant form may be helpful.

Menopausal Hormone Therapy (MHT), also known as Hormone Replacement Therapy (HRT), may consist of oestrogen alone or in combination with progestin. MHT is approved for the treatment of common menopausal symptoms including hot flashes and vaginal discomfort, and it is also effective in the prevention of bone loss and to lower the risk of fracture in young postmenopausal women. MHT is commonly available as a tablet or transdermal patch, as well as in other forms and in different doses.

Because MHT has effects beyond the skeletal system, it's important to have a thorough discussion with your doctor to weigh the benefits and potential risks.

SERMs mimic oestrogen’s bone-preserving effects and include the following medications:

• Raloxifene
• Bazedoxifene
• The combination of bazedoxifene with conjugated equine oestrogen

These drugs help reduce the risk of spine fractures in postmenopausal women, with other beneficial effects including a reduction in breast cancer risk.

Denosumab is a biological agent (monoclonal antibody) administered via sub-cutaneous injections every six months to patients (women and men) at high risk of fracture. A very effective treatment, denosumab should not be stopped without discussion with your doctor as bone loss can recommence rapidly once discontinued. Once you have completed your course of therapy, or a treatment change is needed, your physician will recommend that you switch to another therapy in order to prevent the loss of bone gained.

Recently, biosimilar agents of denosumab were approved in the US, Canada and Europe. Other denosumab biosimilars are also under development in various countries. A biosimilar is a biological medicine that is highly similar to an already-approved biological medicine.

Denosumab may be prescribed for both women and men.

These medications are typically used for patients who have failed other osteoporosis treatments or are at a very high risk of fracture.

• Teriparatide administration increases overall BMD, particularly in the spine. It is injected subcutaneously (i.e. under the skin), usually as a daily injection, but once-weekly or twice-weekly teriparatide regimens at higher doses are also available in some countries, such as Japan. Teriparatide may be prescribed for both women and men. Treatment can be given for up to 2 years.
• Abaloparatide is another medication that is injected subcutaneously each day to stimulate bone formation, usually for an 18 month course. Once you have completed your course of therapy, your physician will recommend that you switch to another therapy in order to prevent the loss of bone gained. Abaloparatide is prescribed for women and, in some countries (e.g. USA) for men.

Romosozumab is a biological agent (monocloncal antibody) administered subcutaneously once every month, usually for a 12 month course. It stimulates bone formation while reducing resorption offering a dual-effect for those needing both types of treatment. Once you have completed your course of therapy, your physician will recommend that you switch to another therapy in order to prevent the loss of bone gained. Romosozumab is prescribed for postmenopausal women and, in some countries (e.g Japan) for men.