Drug therapy for treatment of osteoporosis

When should you consider an anti-osteoporotic drug?

Consider an anti-osteoporotic drug after a minimal trauma fracture in someone with osteoporosis. An anti-osteoporotic drug reduces the risk of further fracture. Those who are at high risk of minimal trauma fracture because they are ≥70 years and have a BMD T-score ≤–3.0 (primary prevention), or people who are taking a glucocorticoid and meet certain criteria, may also be eligible for an anti-osteoporotic drug. 1

People with a minimal trauma fracture are at increased risk of further fractures: the risk of vertebral fracture is about four times higher in women with a previous vertebral fracture than in those without. 2 Despite this, research has shown less than 30% of Australian postmenopausal women with a previous fracture were taking an anti-osteoporotic drug and only 10% of Australian men who were eligible for a PBS-subsidised bisphosphonate were taking (or had taken) one. 3,4

All anti-osteoporotic drugs reduce fracture risk but differ in their specific data and adverse event profiles.There are no comparative fracture prevention trials to guide drug choice: one’s choice should be based on gender, age, medical history and the person’s preference. Bisphosphonates are suitable for men and women; raloxifene,strontium or denosumab are also options for women. 5 There are a range of routes and dose regimens (e.g. alendronate can be given daily, weekly or monthly; zoledronic acid is given as an annual intravenous infusion). Remember that these drugs have been evaluated in people receiving adequate calcium and vitamin D. 5,6 

Provided by the NPS

References

1. Department of Health and Ageing. PBS for Health Professionals. Canberra, 2012. www.pbs.gov.au (accessed 5 March 2012).

2. Klotzbuecher CM, Ross PD, Landsman PB, et al. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 2000;15:721-39. 

3. Eisman J, Clapham S, Kehoe L, et al. Osteoporosis prevalence and levels of treatment in primary care: the Australian BoneCare Study. J Bone Miner Res 2004;19:1969-75. 

4. Bleicher K, Naganathan V, Cumming RG, et al. Prevalence and treatment of osteoporosis  in older Australian men: findings from the CHAMP study. MJA 2010;193:387-91. 

5. Endocrinology Writing Group. Therapeutic Guidelines: Endocrinology, Version 4 Updated March 2012 [eTG complete CD-ROM]. Melbourne: Therapeutic Guidelines Ltd, 2009.

6. Rossi S, ed. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2012.