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Treatment of Osteoporosis

Key treatment options:

Even though there is no cure for osteoporosis, there are many treatments available that have been approved to improve bone health to treat or help prevent fractures for the disease.1-3

Bisphosphonates - Alendronate, etidronate, ibandronate, risedronate.

Hormone-based treatments - Hormone replacement therapy (HRT), parathyroid hormone (PTH) and teriparatide (recombinant PTH), calcitriol.

Other treatments - Denosumab, raloxifene, strontium ranelate. 

Calcium and vitamin D

These bone sparing treatments have been shown to reduce the risk of vertebral fractures when taken with calcium and vitamin D supplements.4

Oral bisphosphonates are relatively inexpensive and are recommended as first-line treatment by NICE Guidelines.5-7

Raloxifine and teriparatide are recommended as an alternative treatment option for the secondary prevention of osteoporotic fragility fractures in postmenopausal women.6

Denosumab, a RANK Ligand inhibitor which reduces osteoclast activity, is recommended as an option for patients unsuitable for oral bisphosphonates (primary and secondary prevention) or at an increased risk of fractures (primary prevention).8

Hormone replacement treatment (HRT) is no longer a first-line treatment for osteoporosis.3 The main aim of the above drug treatments is to decrease the risk of breaking bones, and drugs are licensed on the basis that they do this.

To ensure optimal efficacy, antiresorptives require patients to be calcium and vitamin D replete, therefore NICE guidance states:

“Calcium and/or vitamin D supplementation should be provided unless clinicians are confident that women who receive treatment for osteoporosis have an adequate calcium intake and are vitamin D replete.”5,6

Average:

  • References

    1. Osteoporosis in the UK at...Breaking Point. September 2010.

    2. Osteoporosis treatments, Royal Osteoporosis Society. Available at: https://theros.org.uk/information-and-support/osteoporosis/treatment/ Last accessed: June 2023.

    3. Osteoporosis treatment, NHS. Available at: https://www.nhs.uk/conditions/osteoporosis/treatment/ Last accessed: June 2023.

    4. Clinical guideline for the prevention and treatment of osteoporosis. National Osteoporosis Guideline Group, 2017 (updated July 2018).

    5. NICE Technology appraisal guidance 160, October 2008. (Last updated February 2018).

    6. NICE Technology appraisal guidance 161, October 2008. (Last updated February 2018).

    7. Osteoporosis - prevention of fragility fractures. Available at: https://cks.nice.org.uk/osteoporosis-prevention-of-fragility-fractures#!scenario:1/ Last accessed: June 2023.

    8. NICE Technology appraisal guidance 204, October 2010.

    KKI/UK/STX/0024 November 2023