Which pharmacologic agents are used in the prevention of osteoporosis?

Updated: Jan 20, 2021
  • Author: Rachel Elizabeth Whitaker Elam, MD, MSc; Chief Editor: Herbert S Diamond, MD  more...
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Patients who have disorders or take medications that can cause or accelerate bone loss should ensure adequate intakes of calcium and vitamin D  and, in some cases, pharmacologic treatment. [239]  Pharmacologic prevention methods include calcium supplementation and administration of raloxifene or bisphosphonates (alendronate or risedronate). Bisphosphonates should be considered as first-line agents for the prevention of osteoporosis. [240]

In 2017, the American College of Rheumatology published revised recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Recommendations include optimizing calcium and vitamin D supplementation and lifestyle modifications for all adults on long-term glucocorticoid treatment (≥2.5 mg/day prednisone for ≥3 months). Furthermore, categorization of patients by fracture risk (using the FRAX score adjusted for glucocorticoid use) is recommended. First-line pharmacotherapy for patients at moderate-to-high fracture risk is an oral bisphosphonate, which is preferred for safety, cost, and because of lack of evidence of superior antifracture benefits from alternative medications. Other pharmacologic treatments recommended, if oral bisphosphonates are not appropriate, include (in order of preference): IV bisphosphonates, teriparatide, denosumab, and raloxifene. [12]

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